I don’t want to either end the old year on a sour note or start the new year on one, so today’s a good chance for a little rant about everyone’s favorite topic…health insurance! And it can all go away tomorrow with my Happy New Year post.
Until then, I need to vent. I bit the bullet a couple months ago and abandoned my primo (so they tell me) individual HMO plan that I’ve had for the 10 years I’ve been self-employed and switched to a newly offered high-deductible plan. So instead of paying a lot every month, plus co-pays for doctor visits, for the privilege of not having to deal with coverage issues, I now pay much less a month (2½ times less!) but have to meet a $1200 annual deductible, then cost-share for another $1000. Even with all that, it still saves me $800 a year over my old plan, and makes me eligible to start a tax-advantageous Health Savings Account (HSA), so I went for it.
But of course, the glitches are already starting. Though my Member Handbook clearly states in 2 places that annual “routine” mammograms are fully covered, it seems my annual mammogram a couple weeks ago was coded as “diagnostic,” thus incurring a hefty charge. Given that my OB-GYN calls it diagnostic simply so the place will also do an ultrasound (due to higher risk/family history), I have little faith that I can get this corrected, even though it is in fact my annual “routine” mammogram.
Hey, I’m even willing to pay extra for the ultrasound, as I understand it’s not routine for most women, though it is for me. But I balk at having to pay for the same smash-your-boob-in-the-machine mammogram every other woman in my plan gets covered for free.
The really rant-y part: I’m sure NONE of these types of administrative/system issues that hurt well-meaning, premium-paying citizens like me are addressed in the mega-cost, mega-debt-inducing, tax-raising, rammed-down-our-throats-on-Christmas-Eve, so-called health care “reform” plan that is expected to raise the premiums of — or eliminate completely — the kind of high-deductible HSA-eligible plan I enrolled in specifically to save money and “have a better hand in my health” as my insurer likes to urge 10 times a day in commercials…
That felt good anyway. Deep cleansing ujjayi breath. Inhale for 5, pause, exhale for 5, pause.Repeat today’s mantra: I will not get frustrated. I will not get frustrated. I will not…
Better go keep working on that last part.
The trouble with always trying to preserve the health of the body
is that it is so difficult to do without destroying the health of the mind.
~ G. K. Chesterton
Writing by Ear 
Facie said,
Wednesday, December 30, 2009 at 5:01 pm
I feel your pain. I am going on Brian’s crappy plan next month. It will save me hundreds of dollars over COBRA, but, as you may recall from my complaining about Jordan’s ER visit early this year, too many things are not covered.
I hope you can get some type of resolution for your mammogram; you should not have to pay for that. Just keeping badgering whomever you need to.
God help us all!
mel said,
Wednesday, December 30, 2009 at 8:34 pm
Both of yinz: I had the fun of being TURNED DOWN for coverage a few weeks ago. After I’d been planning on one of those high-deductible plans after COBRA ran out… Turns out my prediabetes, although completely unmedicated and managed by diet, plus my stupid heart murmur which is really a slightly prolapsed mitrol valve (very common in women) caused enough of a red flag to deny me initially. I had to go to my doc, get copies of records, have doc write a letter telling these people I’m not a risk, and then they relented and allowed me on my family’s plan. How friggin’ MAGNANIMOUS of them, eh? Facie, you are right: God help us all. I am so ready to go to D.C. and start slugging Dems that I am starting to fear myself. NEVER have I felt so unrepresented in my life. I’d vote every last one of them out if I could. Soon, I WILL.
WritingbyEar said,
Wednesday, December 30, 2009 at 11:32 pm
Geez Mel, I feel your pain on that, too. I think I mentioned that Mike was recently screwed on insurance as well when the insurance company canceled out of the blue the Small Group plan his employer was in. Mike was denied enrollment in any cheaper plan because of — get this — allergies. Allergies that require only a shot every couple weeks. His allergist’s intervention and letter-writing did nothing. So he was forced into a very expensive plan (basically a plan for people who can’t get any other insurance). For allergies! It’s just ridiculous.(Yet, I bet if he was a smoker or obese, he could have gotten into a better plan.)