Susan Portland, OR
I just got off the phone with my health insurance company. I had just received an Explanation of Benefits showing my deductible was not met, and a bill from a doctor showing that I owed the whole thing.
Now this seemed curious. I have breast cancer and have already been through multiple imaging procedures, surgery, installation of a portacath and the first round of chemo. My deductible was met a long time ago.
The explanation? I have two deductibles on my plan, one for “in plan” and one for “out of plan.” I’d seen my dermatologist for an issue unrelated to the cancer, a doctor I’ve been seeing for over 15 years as insurance arrangements have come and gone in my life. Apparently she’s “out of plan.
There are lots of, shall we say, nuances to health insurance coverage that you won’t know until you try to use it. In my late twenties, that is, roughly 28-33 years ago, I maintained a private health insurance policy. I originally got it during a period when I didn’t have employer provided health insurance, and it seemed like a good idea to just keep it going; it was a good deal.
I don’t remember how much it started out at, but I remember it costing about $16/month just before the insurance mergers began and premiums started to skyrocket. It was through Blue Shield, which tended to pay 100% of doctor fees and 80% of hospital fees. Employer provided health insurance was generally through Blue Cross, which tended to pay 80% of doctor fees and 100% of hospital fees.
And they didn’t coordinate benefits, so when I had some shoulder surgery in 1980, not only was it all paid, but I also got some nice refunds. Really. Ah, surgery in the old days. They “let” me come in the morning of the surgery instead of spending the preceding night in the hospital because my doctor trusted me not to eat too close to the surgery.
I met the anesthesiologist well before the time when he hooked me up, and he checked on me back in my room after I was fully awake. (My dad was an anesthesiologist. They used to “make rounds” of both pre- and post-surgical patients in the hospital.) They kept me in the hospital for two nights.
Fast forward to May, 2009. My insurance premium is $369/month, and no I don’t make anything like 2300% of what I did then. The day of the surgery I arrived about noon for some additional imaging procedures before being admitted to the short stay unit. I think the actual operation was in the late afternoon, removing a substantial chunk of breast and a bunch of lymph nodes and inserting a drain.
I had a tough time coming out of the anesthetic in recovery and didn’t get back to a room until about 9 PM. Also had a rough night, including a nasty reaction to a pain med, but in the morning I was sent on my way after a quick lesson in caring for the drain. And I don’t know how I am going to pay the rest of the bills. The first one marked “past due” arrived yesterday, and it’s for well over $2,000, and that’s just the start.
And it’s not as if my other bills are going to be suspended just because I’m sick. My point is, it’s hard to get at the whole story on the numbers here. Not only am I paying 23 times as much for health insurance premiums as I did 29 years ago, I’m also paying (or trying to pay) an enormous amount more in co-pays, deductibles and other non-covered fees.
And most years I pay for all of my medical care out of pocket because my deductibles are not met. The health insurance industry has managed to contort any concept of rational health care funding beyond recognition. We don’t really have an “insurance” system, in which you pay regular premiums but when you get sick you get taken care of.
We don’t really have a “savings” system in which you pay into an account that you can use to pay your bills. It’s not that it’s a hybrid, but that it’s neither. We pay regular premiums, maybe for years on end that we don’t see a dime back.
And we are still subject to bankrupting bills when we get sick. Meanwhile, doctors and nurses work in assembly line environments in which they are expected to minimize their time with each patient. They enter their professions with far more debt and are far less well compensated than they were even a few years ago.
Where is all the money going? More tests and expensive equipment? Sure, but that’s not enough. A lot of the money we pay for health care goes missing between the premium payers and the providers.
Somewhere along the line, health insurance exited the health system and became part of the financial system. It is now not so much a means of paying for health care as an excuse to disappear money into the black hole of an extraction economy.
Just as Enron figured out that selling nothing for something was the ticket to incredible profits, just as the banking industry figured out that Ponzi was its patron saint, health insurers figured out that the route to incredible profits was to charge a captive market whatever they could get away with and then minimize payouts. As soon as their mission was narrowed to producing profits, all practices that furthered that were justified. As far as they are concerned, when we talk about “fairness” we are speaking in irrelevancies.
Their reason for being is to spread obligation and loss far and wide in order to concentrate wealth for a few. And they do it well. Because a captive market is the key to their success, they will fight like hell for the status quo. They should be told to be happy they’re not being prosecuted under RICO. And then we should move on.
The survival of the insurance industry should be the new irrelevancy. No matter what happens to health reform in this country, I may still lose everything due to this illness, if only due to timing.
But it's past time to put a stop to that.
Now this seemed curious. I have breast cancer and have already been through multiple imaging procedures, surgery, installation of a portacath and the first round of chemo. My deductible was met a long time ago.
The explanation? I have two deductibles on my plan, one for “in plan” and one for “out of plan.” I’d seen my dermatologist for an issue unrelated to the cancer, a doctor I’ve been seeing for over 15 years as insurance arrangements have come and gone in my life. Apparently she’s “out of plan.
There are lots of, shall we say, nuances to health insurance coverage that you won’t know until you try to use it. In my late twenties, that is, roughly 28-33 years ago, I maintained a private health insurance policy. I originally got it during a period when I didn’t have employer provided health insurance, and it seemed like a good idea to just keep it going; it was a good deal.
I don’t remember how much it started out at, but I remember it costing about $16/month just before the insurance mergers began and premiums started to skyrocket. It was through Blue Shield, which tended to pay 100% of doctor fees and 80% of hospital fees. Employer provided health insurance was generally through Blue Cross, which tended to pay 80% of doctor fees and 100% of hospital fees.
And they didn’t coordinate benefits, so when I had some shoulder surgery in 1980, not only was it all paid, but I also got some nice refunds. Really. Ah, surgery in the old days. They “let” me come in the morning of the surgery instead of spending the preceding night in the hospital because my doctor trusted me not to eat too close to the surgery.
I met the anesthesiologist well before the time when he hooked me up, and he checked on me back in my room after I was fully awake. (My dad was an anesthesiologist. They used to “make rounds” of both pre- and post-surgical patients in the hospital.) They kept me in the hospital for two nights.
Fast forward to May, 2009. My insurance premium is $369/month, and no I don’t make anything like 2300% of what I did then. The day of the surgery I arrived about noon for some additional imaging procedures before being admitted to the short stay unit. I think the actual operation was in the late afternoon, removing a substantial chunk of breast and a bunch of lymph nodes and inserting a drain.
I had a tough time coming out of the anesthetic in recovery and didn’t get back to a room until about 9 PM. Also had a rough night, including a nasty reaction to a pain med, but in the morning I was sent on my way after a quick lesson in caring for the drain. And I don’t know how I am going to pay the rest of the bills. The first one marked “past due” arrived yesterday, and it’s for well over $2,000, and that’s just the start.
And it’s not as if my other bills are going to be suspended just because I’m sick. My point is, it’s hard to get at the whole story on the numbers here. Not only am I paying 23 times as much for health insurance premiums as I did 29 years ago, I’m also paying (or trying to pay) an enormous amount more in co-pays, deductibles and other non-covered fees.
And most years I pay for all of my medical care out of pocket because my deductibles are not met. The health insurance industry has managed to contort any concept of rational health care funding beyond recognition. We don’t really have an “insurance” system, in which you pay regular premiums but when you get sick you get taken care of.
We don’t really have a “savings” system in which you pay into an account that you can use to pay your bills. It’s not that it’s a hybrid, but that it’s neither. We pay regular premiums, maybe for years on end that we don’t see a dime back.
And we are still subject to bankrupting bills when we get sick. Meanwhile, doctors and nurses work in assembly line environments in which they are expected to minimize their time with each patient. They enter their professions with far more debt and are far less well compensated than they were even a few years ago.
Where is all the money going? More tests and expensive equipment? Sure, but that’s not enough. A lot of the money we pay for health care goes missing between the premium payers and the providers.
Somewhere along the line, health insurance exited the health system and became part of the financial system. It is now not so much a means of paying for health care as an excuse to disappear money into the black hole of an extraction economy.
Just as Enron figured out that selling nothing for something was the ticket to incredible profits, just as the banking industry figured out that Ponzi was its patron saint, health insurers figured out that the route to incredible profits was to charge a captive market whatever they could get away with and then minimize payouts. As soon as their mission was narrowed to producing profits, all practices that furthered that were justified. As far as they are concerned, when we talk about “fairness” we are speaking in irrelevancies.
Their reason for being is to spread obligation and loss far and wide in order to concentrate wealth for a few. And they do it well. Because a captive market is the key to their success, they will fight like hell for the status quo. They should be told to be happy they’re not being prosecuted under RICO. And then we should move on.
The survival of the insurance industry should be the new irrelevancy. No matter what happens to health reform in this country, I may still lose everything due to this illness, if only due to timing.
But it's past time to put a stop to that.
Source: http://stories.barackobama.com/healthcare/stories/187439
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