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
It is absolutely time for protests and petitiions. Unfortunately, in the US, there are too many people who have been lulled into to complacency and are content with the shitty HMO bones their big corporate employers throw at them.
The health care situation in tbe US is deplorable. I wish there were an easy answer, for you and so many others. People are dying because of insurance lobbies and lack of governmental support.
All my fellow Canadians are right – the system here isn’t perfect but we never see a bill, aside from the occassional ambulance trip ($45 or so) and phone usage.
When I had my oldest, our work benefits covered what the province didn’t and I had a swanky private room. When the Troll Baby was born however, we were 1 month away from benefits at hubby’s new job and so I had to share a room with 3 other moms and their babies. I still recieved excellent care, ate pretty well, and the nurses took the baby for 5 hours so I could really sleep after labouring.
I sure hope you get coverage that is cheaper – that is a ton of money to have to shell out every month. Not to be ignorant (but I don’t know) – is it not better to sock that money away every month in case of emergency rather than give it to a company, never to be seen again unless something comes up?
This is all so depressing. My husband and I are moving to Utah in the Spring (from LA) and i am officially worried about our healthcare now.
We have a history of problems getting coverage. I once took Accutane, and now according to Blue Cross, I am a risk for plastic surgery. My husband had mild arthritis (not rhuematoid) in his knee that he sought treatment for (ie. big Advil pills) while he was training for the Olympic trials. Now we are both marked as risks.
We were denied coverage by a couple of plans, and now in order to have coverage, we pay a 50% increase in premium on a plan that is essentially useless to us.
I would love it if you could let us know what you find out, since we are basically in the same boat – we own a small studio, and are going to have to buy our own coverage.
Jon,
I moved to Canada in 1993 when I got married. If I hadn’t, I would be dead now (and if not dead, certainly BROKE!). There is no way that I would have been able to afford to pay for the medical care that I needed in 1998 in the United States.
Here in Canada we have universal health coverage. The best explanation of our coverage that I could find online is located at http://www.canadian-healthcare.org/
Sure, sometimes we have long waits for certain things. I had a long wait for an MRI once, and it was scary, but I don’t have to worry about going bankrupt to stay alive! Our taxes are a bit on the high side, but my standard of living doesn’t seem to b much lower here than it did when I was living in the States, AND when I travel outside of North America I can proudly say that I am a Canadian now!
George W. Bush *IS* the Anti-Christ you know!
I live in the UK, but got interested in US healthcare system after my mum spent some time in intensive care in the States 3 months ago.
Having experienced the NHS all my life, money aside you do get a better standard of care in the States. Patients (and their relatives, since my mum was unconscious for several days), are treated like customers. Each injection, procedure, that happened to mum, right from the ER, was explained to me in great detail. Why it was happening, what it was etc. In the UK, you don’t get this communication.
In the States, doctors tend to paint the picture what is on their minds, in the case of mum it was suspected meningitis. In the UK, the doctors would tell you, ‘we don’t know, we are running some tests’. This was a culture shock for me. I suspect as being a more direct participant in paying for your care, through private means, you
All the above said, money has to come into the equation. I live in a country were not a second thought is given as to: will I be able to access treatment? In the States I was acutely aware: what would happen if no insurance? As soon as mum was admitted, the insurance question came up, and whilst I was able to answer ‘yes she is covered’, I wondered what would have happened if not. Would she have been thrown out in an unconscious state?
When mum was discharged, I nearly had a heart attack when charged the equiv of 400 quid for medication at the pharmacy. (Later claimed from the insurance co, but thoughts ran away with me if I didn’t have the money upfront). The maximum we pay in the UK for any item is £6.40, and we complain that is expensive.
In the US you get more tests too. Cost is at the heart of the NHS, and you don’t get tested for everything under the sun. You generally are under one consultant for a hospital admission, in the States you are seen by several.
The downside of UK stuff is waiting lists. I’ve now been waiting 9 months for a hospital outpatient appointment, and no chance of one coming soon. Operation waiting lists, sometimes go on for a couple of years.
I’ve also used hospitals in France and Italy (emergencies). Casualty / ER departments appeared devoid of people, thus suggesting a more efficient system. Indeed the media plays on this, when it comes to shipping NHS patients elsewhere in Europe, to get their operation.
The NHS for all its faults, I wouldn’t be without universal free health care.
I totally hear you. As a family of 4, I pay over $1,200 a month for private insurance. How ridiculous is that? My husband and I are both self employed (separately). We have no pre-existing conditions. There are 2 legitimate health insurers in our state that issue private policies. We make too much to have our kids covered by the state policy for low income children, but not enough to actually pay for our premiums. We are unable to get ahead at all for our kids college funds, for retirement, for needed repairs/improvements to our house, all because I am afraid of something happening to one of us.
It’s criminal, really.
(An aside, I find it fascinating how many people that read you are from such a wide variety of countries. It is so cool!)
I just saw on TV last night that Peter Jennings was working on a documentary when he died and they are going to be airing it. It is about the health insurance crisis in the United States. You can find a link to it here: http://abcnews.go.com/WNT/story?id=1323033. I intend to watch it. I thought you would find it interesting as well.
I can completely relate to the health care frustration. My son was born with Spina Bifida and has to rely on catheters to empty his bladder. We are small business owners and have had our share of insurance woes and making sure that he and our other children are covered.
I think forming a business and establishing health care coverage that way is the way to go, but it’s also frustrating since you won’t be able to save and set a little money aside that easily.
For the first 13 months of our marriage my husband and I were without health insurance here in Utah. Blue Cross turned us down for my husband’s asthma/allergies and my use of anti-anxiety medication. We ended up getting catastrophic insurance until I started a 30 hr/week job at the U of U (30 hours is considered full time at the U and all FT positions are benefited). We are students but the student health insurance is like $400 a month for both of us which is something we cannot afford. It IS scary to live in this country without insurance, during that year without it I was constantly petrified that one of us would come down with something that the catastrophic insurance would cover. Thank goodness the disk in my lower spine chose to freak out *after* I started my University job.
I have a Canadian friend who said that I would’ve waited months to get an MRI in Canada, which is ridiculous since I could neither work nor walk before my surgery (which was scheduled a mere week here in the US after my initial injury). This same Canadian friend was extremely sick for months while living in Canada and they couldn’t figure out what was wrong with him because he needed an endoscopy (which he was on a waiting list for, of course). He ended up going to the US for treatment of an esophogeal ulcer (sp?). Still, he claims he would take Canada’s health care system over ours because it’s more affordable in most cases.
When I lived in Idaho, my neighbor was a Canadian-born orthpedic surgeon who told me that the waiting lists and doctor shortages in Canada can be attributed to the fact that doctors in the US earn what he called a “decent wage” for the work they do (I see the doctors in the US being *overpaid*, especially the specialists, but this doc claimed that MD’s in the US pay more for schooling, sometimes up to 300,000 if you’re a heart surgeon or something). He moved to the US for the money, basically, which is sad because it sounds like they need him up there.
Jon, we can start here. We can start now. We have two years. I believe enough is enough. You should not have to make a choice between whether or not Leta has medical coverage or goes to college. It used to be in this nation that parents strived to give their children opportunites that they themselves didn’t have. Going backwards cannot be an acceptable direction.
Join me in my focus for the 2008 election. NATIONAL HEALTHCARE. PERIOD. I will not be deterred by the war (though wounded and traumatized veterans will benefit under a single payer system far better thant the LIMITED VA benefits they have now). I will not be deterred by gay marriage, the economy or the price of gas. My single focus will be NATIONAL HEALTHCARE and I am starting right now by writing to my elected officals, the DNC and RNC and I’m giving them a “heads up”. I am about to become a major pain in the ass. I want to see written documentation of every elected officals “healthcare policy”. I will not accept an email “blurb”. I will bombard inboxes with my requests. If an individual declares candidacy, I want to see, in writing, their healthcare policy or the policy they support. Join me in becoming relentless.
Democracy only works if we work at it. Think of what we could accomplish if those of us who agree that the time has come for national healthcare spent just 1 hour a week staying on top of the issues, and sending out e-mail. Create an e-mail address just for this issue and get to when you can. If we pull together we can a least feel we participated in trying to achieve a fundamental right, where literally, lives are at stake.
Join me. Please.
This link will take you to a healthcare consulting firm which provided an abundance of information for the 2004 election – sole issue, HEALTHCARE. It is a lot to read, so make some coffee:
http://www.healthcare-consulting.com/2004ElectionVotersGuide.html
Here is the link to Physicians for a National Healthcare Program:
http://www.pnhp.org/
Here is the link to find out how the elected officals in every state vote on the issues:
http://activote.ontheissues.org/AVA/officeholders.htm
Here is the e-mail address of every elected senator:
http://www.senate.gov/general/contact_information/senators_cfm.cfm
Click here to contact your congressman:
http://www.congress.org/congressorg/home/
The DNC:
http://www.democrats.org/
The RNC:
http://www.gop.com/
Sorry if I’m coming off preachy.
I live in Texas and I have been reading your blog and Dooce for a while now (love ‘em, by the way). Hearing about your current situation prompted me to call my insurance agent hubby this morning and ask, “Is this true?” I knew my Dad had to get insurance through our state high-risk pool after battling colong cancer, but I didn’t a child would be turned down for something as minor and common as plagiocephaly. Boy, am I naive. My suggestion to you is to get an insurance agent to help you out by “shopping” around to get you the best deal for your family. My hubby just helped our self-employed friend reduce his rates for his family by half. It takes some tenacity and creativity, but it can be done. Good luck to you! My thoughts are with you.
Jon, to answer your question at the end of this post, yes, it is the perfect time to start marching and gathering petition signatures and writing letters. Why? Because it’s an open field on both sides for the 2008 election. This is a long enough time for a politician to compose a coherent strategy, and a long enough time to have a real impact. Less than 1/3 of Americans have adequate, private insurance. Of these, lord only knows how many are trapped in corporate hell just to keep their bennies.
(My incredibly talented husband has always dreamed of starting his own business, but it scares me too much- my dad was self employed and I spent my entire childhood uninsured. The health care crisis, among other things, is squashing the entrepenurial American spirit.)
The fact is, the government is already the country’s largest insurerer- 120 million people are covered by Medicare, Medicaid, and government employee insurance. Virtually the entire 5% of high-cost patients are already covered by Medicare, so it would cost LESS than most people think to extend coverage to everybody.
Especially if the debate is framed as “What do folks want more, universal health care or the Iraq war?”, imagine all the good squeaky wheels could do.
If the rights to “life, liberty and the pursuit of happiness” were outlined in the Constitution rather than the Declaration of Independence, would health care then be a right?
We can make this THE issue in ‘08 if we get it together, kids…what’s stopping us?
I totally feel for you on the HI front. We own a small business in NY and pay $650 a month for $1000 deductible, $3000 out of pocket for 2 of us. Now with one on the way, our premimum per month will go up to close to $800 a month. That’s more than our mortgage, and we have a 2 year old house! Health care is crazy in this country and we’ve pondered moving to Canada.
Good luck.
Christine
Wow. You can chalk me up as one of those people who has never had a problem with insurance coverage. I hear and read the stories, but it’s still really difficult to relate. I have no answers. I AM starting to not take my health insurance for granted, though, as I’ve done in the past. I feel incredibly blessed to rarely pay anything for doctor’s visits (sometimes a $15 co-pay), pay nada for giving birth and have a $10 co-pay for prescriptions. We’ve used the ER a couple of times and that was $75. What do we pay a month? I’m looking at my husband’s pay stub and we pay $163 a month (if I’m figuring this right) for our medical premium.
Man. I hope The Hubs never quits his day job.
Canadian too. It’s possible that someone has already mentioned this, but hey, I’m at work, shouldn’t even be taking this time.
Only the provinces of Alberta and British Columbia have health care payments over and above taxes.
Are the taxes killing me? Nope. But then I’ve never lived outside of this system. I don’t have a good sense of how much a bite your government takes. To an outsider it might feel like robbery, I just can’t tell.
The service varies. When I had heart irregularities it took 6 months to get the proper test. I was under 40 so they didn’t take it seriously. Mind you the condition went away before the test so they could have been right. When I busted up my arm it took 3 days to get into surgery. That felt reasonably speedy. I wasn’t bleeding to death or anything.
Basic doctoring is really hit or miss. I’ve never found a GP that I liked so I’m stuck going to Medi-centers. The doctors there are by and large recent immigrants and the newly minted who’ve yet to get their own practice. It’s quick, just walk in and wait 1/2 hour or so, but the quality varies.
This province is actively trying to privatize health care. 10,000 people came out to protest the bill that was the first step in this privatization scheme and our beloved provincal legislature did it anyway. Not good. All in all, I’m reasonably happy with my healthcare situation, but it’s getting worse. One by one the provincal government is taking away coverage. Anything dental, eye exams or ambulance rides, all come directly out of pocket unless you have blue cross or the like.
I’m reading all these comments and all I can think is: How come that the world’s first economy cannot (or will not) take care of their own citizens’ health?? It is not easy to understand.
Jon: I believe it’s very positive that you brought this up- so many people sympathise with you, and so many of them are on the same boat that maybe from this point many of your readers wil regard healthcare not only personal drama (which it is) to a social problem, nationwide.
One correction: here in Canada, all health care insurance is *not* free. It depends on the province you live in. It’s free in Ontario, but here in BC we pay $96 per person per month. The government is promising to cut long waiting times, because people are literally dying while waiting for some surgeries. And in many places it’s impossible to find a doctor, so people use walk-in clinics (open only certain hours) or the emergency room (where you have a 6-hour wait on average). I still think it’s a better system, because there’s enough of a public uproar happening that changes are being made.
in some ways the system is already as you mention – the rich are paying more. i am a paramedic in an urban system and i would say the vast majority of people that i see on an ambulance are people that are either already supported by the government (through medicaid or medicare) or people who don’t have insurance and have no way to pay (or plan to do so) – the homeless. these people don’t see a doctor, they don’t get regular preventive care, so they use the ambulance as a taxi and the emergency department as their doctor’s office. those costs need to be offset somewhere. the hospitals lose millions and millions of dollars on people like this. our legal system does not afford us the opportunity to refuse someone who wants to go to the hospital because they have a blister on their foot. if they have a complaint, we have to take them.
to a large extent, the disaster that is our health care system is linked closely with the disaster that is our legal system. for starters, doctors get paid a huge amount of money, but also get a huge amount of money taken out of their salary to pay malpractice insurance (funny, yes, it’s the insurance company that wins on this yet again). people can sue medical professionals for the smallest thing. while i agree that there are cases where egregious errors have been made and there should be some action taken, it’s not the norm as far as lawsuits go.
so the people who do have insurance do pay more. that said, there is still something wrong with that system as the insurance companies are in the business to make money. that’s what insurance is all about. you have insurance on your car _in case_ you will happen to get into an accident. your rates go up if you have a record of getting into frequent crashes. why? because the insurance company has a much higher chance of having to pay out of you, and therefore will not make the money it wants to off you. same thing with health insurance, especially with tricky aspects like depression. if you have already been diagnosed with depression, the health insurance company realizes it’s a life-long illness that needs money to be medicated, they won’t want to touch you with a barge pole. in their mind, it’s really no different to diabetes.
i lived in the uk for several years and was exposed to the nhs. i can’t say that it’s the answer – there is a reason why more and more people there are getting private insurance…because the nhs has many severe flaws to it, just like our own system. it’s great if you just need your average checkup, but like in canada, if something serious goes wrong, the system may not be what you need. regardless, that is a whole separate discussion that i could launch into – what is wrong with the nhs.
obviously this is a subject close to my heart (especially when i take those sort of people to the hospital that have a blister on their foot) – if you want more information, let me know.
Another happy Canadian here to sing the praises of our system.
“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?”
As an Ontarian, I cannot answer the first question. I don’t have the first clue as to how much healthcare services in this province cost becuase, like my compatriots, I’ve never seen a bill. We don’t pay a sepcific health premium or anything like that; a portion of our tax dollars are allocated to healthcare funding.
As others have pointed out, healthcare here does not include dental or vision or prescription drugs, but damn near everything else is covered. Obstetrical care (including abortions, and wouldn’t that make W’s head explode), hospice care, routine dr vists, Emergency services, you name it.
When I had my Diva Girl, I was a student living on student loans. My OB was the chief of the department at that hospital. I had monthly, then bi-monthy, and eventually weekly visits, all at no charge to me. Plus 2 ultrasounds and the regular raft of tests. Zen Baby was delivered by a midwife, in a hospital. Again, all costs completely paid for by my province. The Ladies are also completely curent in their immunizations, again, thanks to Universal Healthcare.
Yes, there are wait times for some things. But as I pointed out last post, it’s a triage format. Often, if you are made to wait, it’s because the medical professionals think you can. If they believe your case is critical, you can go from discovery to debulking surgery in a matter of weeks, with only a spate of tests causing that delay. (If I were an American, Zen Baby would more than likely be dead.)
Taxes aren’t insane. I’m pretty sure they cap at rought 40%. Certainly nowhere near the 70% nmber your conservative apologist was spouting last post. And our standard of living here is good. People have nice houses and SUVs and pretty shoes and can afford to take in a movie or gorge themselves at McDonalds. Wlamart and Best Buy are going strong.
And the healthcare is, in my experience, excellent (see above re: Zen Baby and dead.)
I didn’t read all of the posts above, so I might repeat something already said. Gov. Mitt Romney of Massachusettes is trying to get a universal health care system established for his state. The fees are scaled by income (I think that he said the poor would have to pay $2.00 ?per week? for their coverage) and it would cover 100% of all residents. The Bush administration is offering 1 billion for the trial – providing Romney can get the bill through the state legislature and get the plan established.
I’m with you, it is ridiculous that a nation as rich as ours has as poor a health system as we do. Heathcare should be a right, not a privilege of the rich.
I am canadian and feel pretty lucky. We do pay (in manitoba) 14% taxes on every purchase as well. If you need to go to the emergency room you will wait 6-8 hours minimum unless you are shot or bleeding profusly. It is also a bit challenging to find a doctor. BUT no bills ever, no concerns about costs…
Ang — You are so right! My husband has been an RN for over 20 years, and has seen doctors drop out of private practice like flies in the last 5 years, due to rising malpractice costs.
And what role do the prescription drug companies play in all this? I would love to know if other countries are bombarded with advertisements in every possible medium for this drug and that…amazing that we are a “say no to drugs” society here in America, unless, of course, that drug is made by your friendly local pharmaceutical company….
Also, there are many people that are taking advantage of the system, and are getting free health care on our tax dollar that they really don’t need. Drug seekers flock to our emergency rooms, many get monthly checks for disabilities that may or may not really exist, and the like…what does that do to the rising cost of healthcare in America?
And don’t get me started on how the poor seniors are being horribly confused by the Medicare options and coverages…
Yes…we need change, and petitions, and loud voices, and ANYTHING to make our health care system work!!! I would love for our administration to quit being so arrogant, thinking they have everything all figured out, and ask some of your countries how we reform our healthcare system!
I’m from the USA and lived in England for the past 7 years – I now live in Canada. Yes, the UK’s socialised medicine is good in some respects, but teeth-grindingly appalling in others. The care you get is shoddy and the waiting lists for even the most mundane procedures are insane (24 months for an angioplasty? You’ll be dead by then). However, I will say that if it is an emergency, you’ll be fine. So enter the hospital from a car crash and you’ll get the best of treatment. A good friend of mine did an intern rotation in England while I lived there and actually watched nurses not wash their hands between changing sheets and bedpans and re-dressing a wound. Another example is that a good friend of mine is dying from uterine cancer at the moment because she got an std from a boyfriend at 17. She wasn’t allowed a pap smear until she was 21 – now it’s too late to cure it and she has 5 years to live.
Health care is crippling both England and the USA but I must say that I feel quite satisfied that if I do spend my money, I get the best of care, and that is certainly not guaranteed in England.
I also forgot to mention that our recent Liberal provincial government charged everyone $300, $600 or $900 (based on income) for health care. I can’t remember if that was a one time thing, or yearly. Being a student, I was exempted.
Honestly, I don’t even know if it went through. Perhaps it was simply suggested.
you prove my point of why i am under my husbands insurance and carry my own policy for an extra $281 a month…i am completely un-insurable due to a pre-exisiting medical condition according to the state of california…i was able to jump on his, i guess because it is illegal to deny a policy when it is under group coverage at a company…i carry the extra policy in the event my husband ever lost his job. crazy? i don’t think so. i sleep better at night and can hustle $281 alot easier than a couple grand.
i think that mars comment on getting a broker to help you shop around…there might be something out there you are not aware of.
best of luck…