Wednesday, September 2, 2009

Health Care

Yes, I drank the Obama Koolaid. There are a lot of reasons for that, but it would be a waste of type space to go into them because I have the unique honor of having friends who have strong political feelings on both sides of the aisle, and if you're reading this, chances are you're among them, and what I say won't persuade you either way. But, yes, I admit that I would probably support health care reform regardless of my personal situation as a result of simply believing in the Obama camp's visions. However, I do have a personal situation which deeply impacted how I felt about the topic. So, let me tell you about it and see if I can inch you a step closer to that ice chest holding the Health Care Reform flavored Koolaid. It's really refreshing, I can promise you that.

When Kelsey was five, I drug her out of school to listen to Hillary Clinton speak about health care reform. Little Kelsey was bored to tears of course, and I knew she wouldn't follow what was being said, but I wanted her to be able to say she'd seen the First Lady. I always had a feeling the female Clinton would be a political force for a long time, and it would some day be a neat experience to think back on. Now, 18 years later, the debate continues on. It has taken Kelsey's entire lifetime time to get where we are, and we're still not there. But, back then when I listened to Mrs. Clinton speak, I did so with a polite detachment. I really had no personal stake in the matter. We were enrolled in an HMO through Greg's work, my two children were healthy, Greg and I were healthy. No worries.

Well, life has a funny way of changing. Over several of the last nine years, my entire income funneled back out to pay for the care teams we had assembled for our daughters and/or their residential treatment, and we basically lived on Greg's income. The ultimate Catch-22 was that I needed to be home to care for my daughters, but I needed to work to afford to do it. When I was a partner in the business, that was possible when it just became too much to juggle. My majority partner found a way to utilize me so I could work from home, and I "retired" for the first time when we still owned the company. It was charity, pretty pure and simple, and I think everyone knew it. But, then we sold the company and charity is not something modern corporations can engage in, and I came back to work in the office for a time. In a story yet to be told, that was not a good move, and I had to leave once more. I have been in and out of that place so often that I joke I am the proverbial bad penny. Part of the conundrum is that eating disorders are very complex to treat, which equates to expensive and insurance companies do not like that. Most individual doctors, therapists and nutritionists who work in the eating disorder community do not take insurance. If you want to file a claim, you have to do it yourself. The reason for this is simple: they want to fight the disease, not the insurance company, and getting any of the treatment covered is a fight. We were lucky to have found a prominent specialist in Austin who treated Kelsey for a long time. When I first contacted him and set up the initial appointment, his office sent me an extensive packet that included a detailed instruction sheet on what to expect from one's insurance company and tips on how to fight it. The message was clear: your insurance company is not going to want to pay for it, you are going to have to fight for every dime. But, at first we were fairly lucky. Compared to a lot of families, that is to say. We had United Health Care at the time, and I have to say they were pretty decent overall to work with. We had some hassles; I formally protested some decisions, which never ended up doing me any good, they turned down some claims because of ridiculous red tape issues over diagnostic codes and they were slower than molasses to pay out claims, but from what I can gather, they paid out a significant amount for Kelsey's treatment. I was bemused by their willingness, almost eagerness, to pay for Marissa's various drug treatments, but how they were much more cautious when it came to Kelsey, but overall I was pretty grateful for what we had. I kept hearing how I should be really glad I didn't have Blue Cross Blue Shield because that company refused to pay for treatment for eating disorders.

But, of course, our luck did not hold. United kept raising premiums, and the company went shopping for a better deal. I remember a meeting we attended with representatives of a new company that was looking to cover us. Greg and I were both there, as was another manager who has cystic fibrosis. I can't remember what the company was or exactly what their schtick was other than it was some sort of new fangled cafeteria plan that held the belief that patients should understand the true cost of health care so they don't abuse it. I remember that they didn't cover emergency room visits up front like most of the others do for that reason. Of course, I immediately was turned off by that premise. After all, I knew better than most people in the room what true medical costs were, I had been up fronting them for a few years by then. I more or less assumed most of us don't purposefully abuse our coverage because we don't see the whole ice berg. I know it happens, but I found the assumption that the average worker does it to be insulting. Anyway, my friend with CF and I began asking a lot of pointed questions. We were heavy users of insurance, it was the predominant employee benefit for us, and we weren't particularly stupid. What I do remember is how uncomfortable the two presenters began to look as the presentation wore on. I don't think they really thought they would be insuring people who were actually sick. I can't speak for my friend, but the feeling was mutual. We were all given a questionnaire to complete, and I went back home to my two ailing, troubled kids, definitely worried about what was going to happen. What happened was that we got an announcement a few days later that the company had declined to do business with us. I called the HR Director, terrified that it was because of my friend and I, and wondering, if that was true, how long either of us could expect to work there. She assured me there was no indication that was the case, but I've never been convinced of that.

I dodged a bullet for a time, but there was more than one round in the chamber. The next move was to engage with none other than Blue Cross, Blue Shield. Wow. I'd been told at least four separate times by four completely different people to be grateful we didn't have it, and now we do. In fairness, by that point, Kelsey had been to residential treatment three times and we were pretty cash poor. By then, it was Marissa who was the cause of most of the claims. But, I have never gotten a handle on those people. It's like a crap shoot what they will pay for and what they won't, but it's a better bet that they simply won't pay, and how one goes about filing a protest or a self claim is less clear than it was with United. I asked Greg recently if he could cancel his coverage and ask for the premiums the company pays toward his insurance be in turn paid to him. He said they wouldn't do that. So, in essence, if I had enough of this crap and wanted to go with another insurance company, I would basically give away about $4,000 a year in compensation. And when Kelsey was alive, I would have had to disclose her condition. No company would have accepted us probably. Or at least not at a rate we could afford. Our choices are to do what at least two families I know of do, which is to do without. In both cases, the husbands are self-employed. They live on prayer and good luck, but I can tell you luck is a fickle mistress. So, if we decide not to trust in luck, I could try and find a job with another company so we could get a different package. Long term, that probably is what I'll do. But, that sucks - for lack of a better term. What if I like my job and don't want to leave it? Should I have to just because I need different insurance? Let me just help you with that answer: no, I should not.

The part of all this I haven't discussed is how time intensive all this fighting with companies and trying to keep track of all these expenses is. And, trust me, if you're in a situation where you need to take on big insurance, that probably means your time would be better spent taking care of a loved one. It's a total racket. Whether it always has been, I can't say. But, it has been since for the last nine years anyway.

I want competition in insurance. I want to be able to pick my carrier. I want that public option. I believe sincerely that, no matter what bill ends up passing, eating disorders will not be addressed because it's an extremely complicated disease to treat, and it will not be a panacea for those individuals still struggling with that particular issue, but I still saw how completely wrong the current situation is for everyone else. It needs to be corrected. Even if those of us who are committed to better coverage for eating disorders have to fight on.

The final insult came a few days ago when Blue Cross rejected the claim for the Emergency Services team who responded to the final 911 call when Kelsey died. Why? I have no idea. They didn't send me anything. I got the decision from the Travis County EMS. I drove past a billboard for Blue Cross today that read "The Color of Support". I would find that funny if I weren't so sad.

2 comments:

  1. I just got into a huge Facebook debate with some idiot who is a friend of a friend. Basically, his argument against healthcare goes like this: Nobody gave him nothin', if they haven't planned right that is their problem, he gives to charity and he shouldn't be forced (by taxes) to give to charity, he owns two businesses and he pays enough taxes already. Smart, huh? After I thoroughly trashed his inane and hateful arguments (such as they were) with a little thing called facts, did that change his mind? Nope he responded by telling me, yet again, how nobody ever gave him anything, he was a marine and was shot twice (I do not know why that made a difference, but apparently he felt it was pertinent). It's like arguing with a KKK member who thinks people of color are not people. What's the point? They aren't interested in facts, just fear...and hate. I really don't think it has anything to do with taxes or fear of socialism. They got theirs, and they really don't see why they should help anyone else. Sometimes I despair for the human race.

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  2. The interesting backlash to us finally seeing past the color barrier to elect this particular President is that it has brought hard liners out of the woodwork - they feel they have to defend "their" America. It's all emotion, no rational thought involved. Doesn't that man realize his taxes support uninsured patients now? Who does he think pays the bill for all those poor people who don't have regular healthcare and end up going to the Brackenridge ER? Am I overlooking something here? It's so easy to see. I think I share your despair.

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