Health Care, or If You Ain’t Dead in 7 Days, You Don’t Need No Doctor

NOTE ADDED 9/30/2010 Since I first published this entry a year ago, my employer has had to choose a new plan (at the insurance company’s request.) It now costs $600 per dependent and $1200 for a spouse, meaning it would cost us $3000 a month to insure the family.)

 This is not a blog for or against public health care.  Frankly, I don’t understand enough about health care to make a decision about what kind of system we should have, and definitely not enough to go out picketing and screaming at people and accusing them of being socialists, grandma-killers, or cold-hearted greedy bastards. I vote for people who I hope will take the time to listen to the experts and really understand what they are voting on, so I don’t have to.

(Actually I do know enough to not scream about socialism, since I had to do quite a study of socialist political systems pursuing my International Studies degree and I can tell you resoundingly that we are not close to socialism right now, but that’s another full-length book entirely….)

This is about my health care, and my family’s lack therof.

Here’s my shameful confession: I have health insurance. My children and my husband do not.

Why not? Because my employer pays 100 percent for my insurance, but none for family members. To insure my family through my employer would cost me $260 a month PER KID (2) and $550 a month for my husband.

$1070 A MONTH. And my income is too high for my children to receive Medicaid or SCHIP (State Children’s Health Insurance Program).  Sometimes I wonder why I bother to strive to make a decent income, when I end up with less money to spend than I would have if I made less than $30,000 a year.

Kid #3 is on the way; she will be carried on my insurance for the first year. Of course, my last child was on my insurance, but the pediatrician’s office who saw him in the hospital screwed up the billing and we didn’t catch it until after the deadline for filing had passed and my insurance refused to pay it. So now I owe them $650 dollars, after paying $260 a month for insurance to cover the costs that ended up not being covered anyway.

(Sometimes I wonder if health providers have trouble collecting money from patients, not because patients don’t want to pay, but because their billing methods suck so bad that us patients can’t figure out what the f— is going on. My dentist charges me at the office, then sends me a bill, then sends me a refund, then bills me for the refund back. My old ob-gyn installed a new accounting system and keeps billing me for things I paid three years ago, and another organization never knows if I’ve paid or not. And, really, once the pediatrician’s billing office got a message from me that they had misspelled my child’s name, please correct it and refile….why didn’t they think “Refile? We have her down as self-pay. Call the hospital and doublecheck to see if she filed insurance. Or at least CALL HER AND ASK!”)

I was once very impressed because my part-time job at Target offered insurance partly covered by the company. I was impressed right up until I took my son in for a well-child checkup and shots, gave them my insurance information, went back and saw the doctor, came to check out and got hit by a $238 bill. Turned out my insurance didn’t cover the appointment because IT WAS NOT REQUIRED BY LAW IN NORTH CAROLINA, and no one bothered to tell me until I checked out, at which point I did not have the option to reschedule. So I had to write them a check, then rush to the bank and put a stop on the check I had written for my electric bill. Why, oh why, was I paying for the damn insurance?

And no, before you ask – the book explaining the benefits did not mention the exception, apparently because it was state-specific but the book was for customers nation-wide.

(Same pediatrician’s office as in above paragraph, by the way. Wonder why I switched to Eastern North Carolina Medical Group, the Nashville office? Now you know. I’ve never had a billing problem at Eastern NC, even though I pay out of pocket, and they even KNOW MY CHILDREN’S NAMES when I see them in the grocery store.)

Speaking of money thrown away, give me a second to talk about private health insurance. We used to carry a BlueCross BlueShield policy, but I was paying about $300 a month and still had to meet a yearly deductible of a couple of thousand dollars, not to mention the co-pays and coinsurance. Do the math – we never used the health care enough to meet the deductible so that insurance actually started paying! I was paying $300 a month to be allowed to pay $1000 for care, and almost praying that something bad enough would happen to make it worth it.

While on this insurance, flu went through our household. We hadn’t met the deductible yet (by the way, I didn’t realize when I bought the insurance that I had to actually pay $2500 before the insurance company paid anything at all. Company provided health insurance didn’t work that way.) so we paid for the doctor’s visits. Then the medicine came to $115 EACH!!!! We couldn’t afford it all, so we bought the doses for the kids and my husband just suffered.

Of course, my oldest son did break his arm last year. That was just before the private policy started, because my husband lost his job and the new insurance hadn’t started yet. Because my son broke his arm at daycare, though, the school’s insurance covered it and I paid the rest out of pocket. I still came out cheaper than I would have paying for useless insurance every month.

Last time I applied for private insurance, my youngest son was turned down. Because he’d had more than 3 ear infections in the previous 12 months. He was 18 months old. In daycare. WTC?

And I know that I will never get privately insured again, if my employer stops paying. For the first time I have gestational diabetes, which puts me at higher risk for Type II diabetes when I reach my 40s. My soon-to-be-born daughter will be at a higher risk as well. Do you think an insurance company is going to touch us with a 10 foot pole? Or keep us if we do get diagnosed?

After hearing the testimony of insurance company executives about how they must be allowed to drop high-risk individuals if they get diagnosed with a costly disease (like breast cancer, for example), I seriously doubt it.

So here’s what we do. Kids are not negotiable – they go to the doctor ASAP. We pay out of pocket, but my doctor is amazing and the prices are very reasonable. Medication is generic, or we use samples when available.

Adults – well, adults deal. Unless one of us is obviously dying (or pregnant, which feels like it sometimes), doctors are off-limits. If you ain’t dead in 7 days, you don’t need no doctor.

And here’s the math. Last year, according to the receipts I gathered for my taxes, I paid just over $5,000 in medical expenses. That included the expenses left over after the school insurance ran out on the kid’s broken arm.

Okay, if I’d had insurance through work, I would have paid $1070 x 12 for premiums. $12,840. Before the $15 copay per visit and the $2o to $40 prescription co-pay. So I actually saved over $7,000 by NOT having health insurance.

If I’d had the private health insurance, I would have paid $300 x 12 PLUS $2500. $6100 BEFORE THE INSURANCE STARTED PICKING UP THE TAB. After the insurance I still would have paid $25 co-pay per visit and $10 to $50 per prescription. So I saved AT LEAST $1100 by NOT having health insurance.

The way I see it, saving that money instead of paying a premium every month keeps my assets fluid, so I can afford to pay for care when I need it.

It’s funny that I was always taught that gambling is immoral, but am considered irresponsible for not having health insurance. As far as I can tell, health insurance as it currently stands is nothing but roulette. I’m betting that I will get sick enough to justify the cost, and the insurance company is gambling that I won’t get sick and they can keep my money. Of course, they have the house advantage, because they can kick me out of the casino if I start winning (getting sick, in other words – sick, ain’t it?).

So that’s our strategy. As long as we don’t get REALLY sick, we’re winning on this hand. And if employers continue to cut costs by cutting insurance (which I honestly understand – I’d be better off with the money in my paycheck than in the insurer’s), more and more families will follow the same one.

Luckily, I’m only 31 and my husband is 28. When we get old, I guess we’ll just find a Dr. Kervorkian. I don’t want the strain on my wallet, or on my descendents.

Turns out it isn’t death panels that we should be watching out for….

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~ by gypsyjonga on September 1, 2009.

2 Responses to “Health Care, or If You Ain’t Dead in 7 Days, You Don’t Need No Doctor”

  1. Hey, great blog…but I don’t understand how to add your site in my rss reader. Can you Help me, please 🙂

  2. I don’t know If I said it already but …Hey good stuff…keep up the good work! 🙂 I read a lot of blogs on a daily basis and for the most part, people lack substance but, I just wanted to make a quick comment to say I’m glad I found your blog. Thanks,)

    A definite great read..Jim Bean

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