Denied Again
December 12th, 2005Today we were notified by a different, out-of-state provider that they wouldn’t cover us. They cited the same things the local company did; my already treated “condition”, Heather’s post-partum depression and Leta’s plagiocephaly (her head is normal shaped now). Plagiocephaly is something that is red flagged until a child reaches the age of thirteen. Part of me feels that we are living in a combination Brave New World slash Gattaca world where we shouldn’t have conceived without consulting a geneticist first.
Thanks to everybody who commented and made recommendations. Our monthly premium will be nearly four figures on the state plan. This is with a $1,000 deductible with an out of pocket maximum of $3,000. I think we’ll probably end up doing the next scale up, which reduces the fees by almost a third and will be the $2,500 deductible and the $$6,000 out of pocket maximum. The good thing about the state plan is that it’s month-to-month, so if other options open up, we can bail.
I’m going to look into the Chamber of Commerce, small business associations, catastrophic only and other options that you’ve all mentioned and sent in. Thanks so much for all the suggestions. As we’ll be forming a business, I have a feeling that while we’ll be able to get insurance, the fees will be higher than the state plan. We’ll also probably do a health savings account or some kind of savings plan for health care. I had hoped that some of the money we made could go into a college fund for Leta, but that may have to wait awhile. I don’t say this for sympathy, I say it because I think we’re not alone. I think a lot of people are taking the money they’d use to do other things with and pay for health coverage.
If you live in a country besides the U.S. and have universal coverage, what is the cost? Does it work for you? Do the taxes kill you? Do you think the medical care you get is adequate? Excellent?
Here’s the freedom and peace of mind I think every person deserves: if one is sick or has a health-related problem, one finds the nearest or most favorite physician and makes an appointment or walks in and gets help. Every person alive deserves this. That we don’t live this way is hypocritical and inexcusable. We have the technology.
If you want the scary big picture, look at the charts (PowerPoint, but Keynote will open them) on this page (source: US National Center for Health Statistics). According to the charts, in 2003, $1.3 TRILLION dollars was spent on personal healthcare in the United States. That is 15% of GDP. Where does the money go? The biggest slices go to hospitals, physicians and “other”. I’d love to know what that other is. Prescription drugs and nursing homes get the rest.
How do we make a change? How many of us will it take? Where do we go and who do we talk to that will listen? Is it time to start petitions and marching? Protests? What do we want? What sacrifices will have to be made? How will universal care take away someone else’s freedom/liberty (fries)? o
December 12th, 2005 at 10:30 pm
Hey, I am from Canada. We pay about $100 a month for Alberta Health Care. (It varies by province) We just go to the doctor, and don’t even see the bill, ever. I have had nothing but amazing care, for myself and my family. Rural areas have a hard time finding a good family doctor, so that is a problem. All in all, I am very happy with the Canadian Health Care system. I hope it all works out for you and your family, that really sucks having to pay so much.
December 12th, 2005 at 10:35 pm
Itís really quite unbelievable that universal health care is not accessible for all citizens. I understand the political ideology of a free market, but it still seems ridiculous. In Australia, health insurance is universal and taxpayers contribute 1.5% of their annual taxable income. The service covers all costs of everyday doctor, dentist visits, IVF treatments, optic health, x-rays, etc. But in some instances it only pays for a percentage of services, and you pay the remainder. In addition to government services, private healthcare exists which can costs a maximum of approx. $100-$160 a month (per individual), and provides similar services to the government, except quicker. For me personally, the universal coverage is excellent, but annual reports in our country always indicate people who require surgery or healthcare in hospitals are incredibly disadvantaged, because of waiting lists. One instance exists where a boyís skull was removed and because they couldn’t operate on him until a few weeks later, he had to live in a motorcycle helmet to protect his brain. So universal healthcare is good for me, bad for him, but its healthcare for everyone. Come Down Under, weíll take care of ya.
December 12th, 2005 at 11:00 pm
New Zealand has pretty much state funded healthcare. We still pay about $50 for a doctors visit, dental is only subsidised for children, but most big things are free - maternity services etc. People do still die on waiting lists for major operations like heart. For this reason we decided to get my husband health insurance as he isn’t the healthiest speciman. He got turned down flat, but looking at his history I can see why.
December 12th, 2005 at 11:06 pm
All the time I lived in the U.S. I never had adequate, or usually any, health care coverage. I just hoped and felt eternally precarious. Now I live in Slovenia, where health care is universal. I am self-employed and my resident visa requires that I have coverage. I’m insured through an international agency on a policy valid anywhere outside of the U.S. and Canada. I don’t trust it and have never made a claim — I have it for the catastrophe scenario, and to satisfy the visa people. The beauty of Europe is that if you don’t have the national coverage and have to pay for a doctor visit, you can actually afford to do so. I had an emergency appendectomy, spent three nights in the hospital, and it came to about $500 (less than my deductible). Try that in the U.S. I never bother to file a claim because I figure the bloodsuckers will just find some pretext to deny it and then cancel my policy for having a ‘condition’. It’s cheaper and easier here to just visit the doctors and pay them the reasonable fees, with no insurance interference whatsoever. Okay, you wait a little longer and put up with some red tape, but it WORKS — people can actually do it. Your tales of woe confirm what I always suspect, fear, and loathe about insurance. How to fix the problem at home? A damn good question…
December 13th, 2005 at 12:05 am
I don’t understand the whole insurance thing at all. I’m 21 and in my last year of college, so I’m still able to be under either my mother or father’s plan. However, next semester, I don’t need a lot of credits to graduate. I was immediately threatened with losing my insurance AND some school benefits. I had to pick up a bunch of random 1 credit courses in order to keep a bunch of stuff. As a part time student, I would have ended up paying more out of pocket than as a full time student. Crazy. We just got the insurance thing hammered out, thankfully. But seriously…it is things like this that make me want to get the hell out of this country. They will milk me of all my money, then peace out. I wish you the best of luck in this process. I can only imagine the hell it is for you.
December 13th, 2005 at 12:16 am
I agree with HANK, the Australian system is pretty excellent. The only health insurance I pay is for extras (major dental, physio, optical frames/lenses etc) and it comes to about $14 a fortnight. My last visit to the dentist was only $40 and GP visits are under $30 and once you/your family spend a certain amount a year they’re free. Even my most recent spate of 10 optometrist visit only cost me a total of $100. Emergency room visits are free (but often abused by cheapscates or people who find it hard to get into a GP). Unfortunately there are less and less GP in full-time practice which is making it harder here to get an appointment unless you’re already on a clinics books. Sure waiting lists are long for some operations but doing the maths the number of months you’d have to wait vs the cost of hospital insurance for the same period your better of waiting. The amount of tax we pay http://tinyurl.com/yu4co in comparison to what we get is reasonable (other than health we get decent unemployment benefits, reasonable schools etc.)…. and then there’s subsidised prescription medication. The US system just doesn’t make sense to me.
Anyways best of luck to you all
December 13th, 2005 at 1:40 am
Here in the UK the universal health care - free at the point of need - is paid for out of the pot of money raised through taxes and ‘national insurance’, and no, the taxes don’t kill anyone.
Some people pay for health insurance and private health care.
The national health service is not perfect, but is getting better and has served me well. I have difficulty believing the state of things over there.
December 13th, 2005 at 1:59 am
At least you saw it coming when you quit your day job. Now, you just have to keep searching, and searching, and searching. You WILL find something reasonable eventually! Until then, wrap your house in saran wrap and bubble paper, and hope for the best………
December 13th, 2005 at 2:00 am
OR move to Canada.
December 13th, 2005 at 2:13 am
Or, so it seems, any other Commonwealth country.
December 13th, 2005 at 2:28 am
Hi! I’m from France. “State” (”State” is to be understood here as “Federal” would be in the US) health insurance works like this : any body who works contributes in two ways. 1. A portion of one’s income tax goes towards health insurance; its hard to say how much exactly, but some of the money filters through to the health system or “Social Security” as its called. 2. Either your employer or yourself - if you’re self employed - pays a direct contribution to the state as a percentage of the worker’s income. This is where the bulk of the health insurance’s cash comes from. An employer may pay up to 33% of an employee’s salary directly to the state as a contribution to health, retirement and family allowance plans. The same goes for someone who is self employed (give some take some, it would be too long to go into all the details here), except for there is a catch : you start paying even before you’ve earn’t a cent! As in the US, its easier NOT being self employed. One thing though, I believe anyone can subscribe to the state health insurance system, providing they pay for it. I have no idea how much that would cost, but have a feeling it would be a handsome amount. Last but not least, in France there is a thing called “Universal Health Coverage” whic basically entitles any human being, French or not, tax payer or not, to health care in the country.
December 13th, 2005 at 2:36 am
I’m in Germany, but from California so the change of system has been confusing for me. When I was covering myself I paid 125 euros a month on a foriegn student plan. That covered everything though: vision, dental, and physical therapy when I hurt my neck.
Now I’m working and a larger chunk comes out of my paycheck towards health care. I pay 225 - 250 euros/month and I’m better covered than I ever was in the US and when/if hospitalized I have my choice of physician and a private room. Part of what I pay covers those who can’t pay. It took getting used to but makes perfect sense.
I checked into what would happen if I ever moved back to the US and I’ll keep my German coverage, it will still cover me better abroad than a US provider.
Health care is a basic human right, goverments are obligated to provide coverage for their citizens. What’s happening to you is flat out wrong.
December 13th, 2005 at 2:43 am
Here in the UK things are way, way worse than people like to admit, but not a day goes by without the newspapers slamming our NHS. We pay for it with our taxes, and additional ‘National Insurance’ (6% on top of our taxes too). This is ‘free’ healthcare, yet we have the biggest problem of MRSA in Europe (probably the world) cos our hospitals aren’t as clean as they should be, there are constant reports of people lying in beds shoved in corridors in hospitals (cos there isn’t enough room), and we don’t have the option to opt out of this. If I could, I would stop paying my NHS costs and pay for private healthcare, but I can’t opt out of it so I’d be paying twice. We already have to pay for
Don’t get me wrong, the NHS served me well when I was a child with chronic asthma, and I’ve definitely spent more time in hospital than most people. But our health service is in desperate need of rehabilitation, and the whole country knows it.
December 13th, 2005 at 2:54 am
Hey, I’ve been reading your blog for ages, but never commented so far. I live in Germany (and happen to be a medical student) and we have universal healthcare here. It’s said to be expensive and insufficient, but for me it has worked fine, especially compared to the situation in the US. I was shocked to read all those comments of inadequatly insured people, I had no idea the situation is in fact THAT bad (especially if you hear your professors praising US medicine every single day - well, the US might have the best research and ultramodern treatments, but as it looks it’s not accessible to most of the people). I was also shocked to read that maternity and pregnancy costs don’t seem to be covered by a lot of insurances, does that mean you have to actually pay to deliver your child in a hospital?!
Over here most people (up to 90 %) have compulsory health insurance with fees around 12 - 16 % of your income. Your employer will pay the other half. People who earn more than a certain yearly amount might as well leave compulsory health insurance and get private insurance, which offers more (single rooms in hospitals, head physician treatment etc.). Your healthcare insurance will pay for almost every treatment you need (including physio, surgery, dental work if you have made yearly preventive checkups, rehabilitation, …). Only recently deductibles have been introduced: 10 Euro (= $ 12) per GP visit per quarter of the year, 10 Euro per specialist visit if you haven’t seen your GP first, 10 Euro per day in hospital (for a maximum of 28 days), plus deductibles for up to 10 Euro for medication. However, the maximum amount you have to spend on deductibles is fixed to 2 % of your yearly income (1 % if you suffer from a chronic condition such as diabetes). I expect the dedubtible rate to rise a bit in the near future, as this was only the “introductory rate” to make people feel comfortable with it. But it’s still nothing compared to the US. For children it’s again completely different, they get almost everything for free and are normally covered by family insurance.
You have free choice of your doctor, free choice of hospital, … There are no real waiting lists like in the UK. You might have to wait for 1 or 2 months (this depends on the hospital) to get elective surgery, such as for example hip joint replacements. But if you need to have heart sugery NOW, you will get heart surgery NOW. People complain a lot about the healthcare system, and surely there are still a lot of inefficiencies which have to be reformed. But on the whole I’m content with what we have here.
I really hope that you can find a solution to your insurance problems!
December 13th, 2005 at 4:09 am
Again, all my love and support and best wishes to you both ant to your lovely little frog.
I’m writing from Spain. I’m a freelance as you, and I pay 28% of my declared income to a National Health Fund called the National Security (Seguridad Social). Because I’m under 30, and a female (female unemployment is much higher than male, so we have benefits like this) I qualify for a 25% reduction in my fee. Still, it’s 175 euro (about 200 dollars?) /month. That covers both the health insurance and a retirement benefit. Were I not a freelance, it would also cover unemployment benefits.
As long as the health insurance is concerned, the National Health Fund covers almost everything. Primary care, childbirth, pediatricians, minor and major surgery.. Also mental health, but only the really serious cases and mainly as outpatients. Dental health, speech therapy, etc. are not included.
Medications are free for the elderly (independently of their income, why? because they’re a big share of the population, i.e. of potential voters) but everybody benefits from a discount on the price of meds. This is a huge expense for the National Health Fund and thus for the State (in the same sense as French “State”), so thy’re turning now to generics.
If you’re unemployed or a foreinger (which means you don’t pay Social Security Fees) you are also entitled to healthcare. It is a fundamental right and the Spanish society recognizes it as such. If you have have your insurance complany pay for it.
The system is socially fair, but overwhelmed and badly managed- it takes couple of hours to be seen by a family doctor, and a couple of months to be seen by an specialist and to have a blood test taken, even longer to undergo surgery. Unless it’s an emergencyt, of course. When I go to the gyno, I make an appointment for the next year.
Politics always say the’re committed to manage better the health system and are always very demagogic on this point (I mean, they make big unrealistic promises and take no steps to fulfill them) because they know that we Spaniards are VERY sensitive on this issue. Any political party proposing to cut the services of the National Health Fund or to privatise the health system entirely is bound to disaster.
Of course, the universal healthcare system is not covered only by the benefits payed by the employees. So what? That’s what taxes are for!
You’re welcome to Spain. Any time.
December 13th, 2005 at 5:01 am
I wouldn’t want to live anywhere but Australia. I am a full time occupational therapy student (Go Leta!) and I make regular use of services for which I don’t have to pay a cent for - other than my tax contribution.
In the past week I have seen a doctor of my choice (free) and within a day of making an apointment (yay), had blood tests (ew! but free!), and saw a cognitive behavioral therapist. The latter I do pay for but I get a 50% student discount and I go because I need it. One hour of therapy costs $50 AUD which I feel is very reasonable. As a low income earner I pay less than $5 AUD for my antidepressants.
Our public health system has been under considerable scrutiny recently. I have worked in paediatric occuaptional therapy settings and the waiting lists there were astronomical for public OT services. I’m talking in excess of six-months. Many parents end up resorting to paying for private therapy as six months if far too long for any child to have to wait. Not when their social, emotional and physical development is at stake.
One question. When will the producers of cigarettes, alcohol and industrial pollutants start to foot the bill for their contribution to widespread ill health? The Phillip Morris Lung Cancer Institute?
I hope it all works out!
December 13th, 2005 at 5:23 am
Another Canadian here. Toronto. The Canadian system is not without its problems. Here in Toronto the big one is generally waiting time if you need an MRI or something like that. Emergency services are fine though. And we never see a bill from the hospital other than for phone and tv rentals. Just over a year ago I was on vacation in the US and suffered a kidney stone attack. I ended up spending 5 hours in an albeit excellent facility in Phoenix. Those 5 hours consisted of 2 scans (done at the same time), 2 doeses of a painkiller with IV fluids, a doctor looking at me twice and a bed in the emergency room. Total cost: $4500 US. Thankfully my wife’s health plan through work is excellent and covered the entire thing. The same treatment at home (an earlier attack) may have cost the same, but the only thing I paid for was parking across the street.
Many people say that the taxes in Canada are much higher (maybe a bit), but the additional services we get, especially if you require health coverage is worth it.
Toronto would love the blurbdoocery.
December 13th, 2005 at 5:36 am
Your health care system still amazes me… no matter what, I just can’t seem to be able to get over it
I live in Scandinavia, taxes are insane, but I’m basically used to it (even I do keep complaining about them all the time :P). I know it’s very unlike that I ever will become a millionare, not with these taxes, but I hope to survive after all. And since I’m in the middle of getting my free double master’s degree (thanks to our school system), I probably should just shut the fuck up and stop complaining.
We also have a decent public health care system, which works pretty nicely most of the time. I believe it cost about 8 USD or so to see the doctor or then you can decide to pay 20 USD in a year. 20 bugs give you a freedom to visit the doctor every day all year round for free.
This system only gets pretty ugly if you will get an injury which would require a minor surgery… the lines are huge and not so accute cases have to wait for a very long time.
That is the main reason why I also have a private accident health insurance (which costs me about 40 USD in a year), which is only covering the “accidents”. I trust the “normal” doctors in normal flu cases, but when I will kill my leg, I definitely want to walk to the best orthopaedist right away for free. Thanks to my horrible knee genes, my insurance company has already paid me two knee scoopings in the last five years and as far as I know, they don’t seem to have any problems with it or me.
I guess overall this system (public helth care system and high taxes) we use is pretty nice for poor and middle class people, rich are the ones who hate it
I guess after all basically the rich people are the ones paying everything and keeping this system alive.
December 13th, 2005 at 6:11 am
I’m living in Switzerland: The health insurance system becomes quite an expensive problem here. There an obligatory basic health insurance, whose rates rise actually every year. YOu can try to save some monthly money by either changing health insurance provider every year by comparing the rates for the basic, or rise your “out-of-the-pocket”-part. The basic coverage is sufficient, but if you want extras, you have to conclude extra insurances and, of course, pay for it, as for dental treatments, natural and homeopathic medicine, international coverage, etc.
For middle and low incomes the health insurance is a big problem, for families too, so the social services pay part of their health insurance.
The government wants hospitals and medecins to work more efficient and to take more care of the budget, but this, experience made, doesn’t work all the times. For example, i’ve been to the urgencies of my local hospital once, they examined me during four hours. Then, i got one invoice, and another, and another, totally five invoices from the same hospital, but different services ! Quite disgusting! Five enveloppes, five, stamps, maybe five different accounting departments in the same building ? And they want us to pay more every year for such a service, an hospital who is lucky to be state owned, because on the private market it wouldn’t survive practising like this…
December 13th, 2005 at 6:13 am
I’m Canadian, and although I’m currently in northern Ontario, I’ve spent the majority of my life in southern Ontario, near Guelph.
I feel like a bit of a git, because I don’t really know how to answer this question. All I know is that at my last job, the taxes that came off my pay cheque were around 20%. I assume some of this goes to health care. I know that as ones pay cheque increases, so do the taxes. My stepmom pays 35-40% I think.
While regular visits to the doc (gyno, sicko, etc) are all covered, vision and dentist visits are not. Also, as someone else mentioned, MRIs take a while. I waited 8 months in 1999 for one, and that was the short wait. BUT, because I got a referral from my campus doctor (I was doing my undergrad at the time), it didn’t cost me any out of pocket cash.
It was suggested recently that every time we go to the doctor, they hand us a sheet of paper letting us know how much the cost would have been without coverage. I truly think they should do that so we know how good we’ve got it.
I firmly believe that if I need to go to the doctor, I can go; regardless of if I have sufficient money in my pocket. I’m a little concerned about the two tier health care being proposed for Alberta, but I don’t live there so I don’t get a say. I don’t like the idea that people with money get better care than those that don’t. I guess I’m a bit of an idealist, but that’s where I stand right now.
December 13th, 2005 at 6:15 am
Oh yeah….
And prescriptions are not covered. For that, you do need some kind of insurance. I was fortunate enough to buy into my school’s plan for $124 for the year (presciptions, massage therapy, physio, orthotics…)
December 13th, 2005 at 6:24 am
This makes me think of a friend in college in California who’d had a heart transplant when he was 16 and was heavily dependant on his meds to keep his body from rejecting the organ. He’d joke that his parents’ health insurance company had a contract out on him to end the huge bills they were covering.
when he wasn’t joking he would wonder what would happen to him when he turned 24 and no one would cover him.
They saved his life at 16 and wanted to wash their hands of him eight years later.
December 13th, 2005 at 6:36 am
An unbelieveable amount of the money that goes to “hospitals, physicians, and other” is going toward their respective malpractice insurance. For example: Many hopsitals do not employ anesthesiologists, but contract a private group…because something around half of what an anesthesiologist charges is going straight to their malpractice insurance. Hosptials cannot afford the increase in coverage.
Having worked in a VA hospital (the closest thing to government healthcare in the US) I realized that it is impossible for a gov’t hospital to break even, let alone turn a profit. Our health care system is ridiculous; health care with a physician of your choice in a reasonable time frame at a feasible price should be a right…but the number of things that will need to change are enourmous.
December 13th, 2005 at 6:53 am
I live in Canada so I don’t pay for health insurance. I can’t imagine having to pay for hospital and doctor’s visits. Some people say that our health care system isn’t as good since we get it for free but I have never had anything but excellent care from doctors and hospitals anytime I’ve had to go to them.
I’m covered by student health insurance until I finish university. Its about 200 dollars a year but it covers everything and I only end up paying 10% of my prescription prices.
I hope you guys have better luck with your health care dilemma. Health care is a right, not a privilege.
December 13th, 2005 at 6:55 am
For some non-anecdotal information regarding health care in Canada, quality of services etc, I refer you to the Canadian Institute for Health Information, a private, not-for-profit organization whose mission is to collect and analyze information regarding health care in Canada:
http://www.cihi.ca
Within the site, there is a link to “Reports” and a ton of information, much more than can be summmarized in a quick post. To start, I recommend “Health Care in Canada 2005″ http://tinyurl.com/85xc5.
I don’t have a link, but there was a Supreme Court of Canada ruling this year that found the wait times and unequal access to health care in Canada constituted a violation of basic human rights. The case was regarding whether the Canadian system, which does not allow any private health care providers (a two tier system) violates constitutional rights of Canadian citizens. The ruling is believed to be the first chip in the foundation of the single tier, equal access Canadian system by making it possible for people to pay directly for health services from private doctors, clinics and hospitals.
Incidentally, a two-tier system has been in existence in Quebec for years, much to the chagrin of the rest of Canada. My experience having serious health problems while living in Montreal in 1997 was mixed. Going through the government paid health services was very HMO-like, no choice and long waits. I had blood drawn and didn’t get any results back for 4 weeks, that’s how long the back-log was at the government run lab. When I finally did get to see a specialist, it was only because we had an on-site doctor at my company who called his gastroenterologist friend when I fainted at work one day and was able to get me an appointment in three weeks (the standard wait to see a GI was 6 months at that time). But I got my diagnosis and didn’t have to declare bankruptcy along the way.
Good luck with your research.