Wednesday, March 31, 2010

A Flaw in the System

Ok, I am the first to admit that I really don't know a great deal about this whole healthcare reform thing. I watch the news from 6-7 or rather have it on in the background while I feed and bathe Isaac. But that's about it. It's my own fault, and I could educate myself. I realize this is a hot topic and big issue that will effect not only me, but my son.

I don't know how to fix the system. But I do know that it needs fixed. Here's my take on what I do know.

First, we have health insurance. We have coverage through my husband's employer. It's not the best plan or the plan I would choose, but it isn't the worst either. When I first got pregnant we had an independent policy that was paid by our personal business (that we no longer have, but that's another story). For my husband and me it started out at about $550 a month for the premium. I chose this plan because when I worked for a certain large corporation, it was the policy we had. It was great. And that was why, because it had a price tag. Over the course of a year and a half that monthly price rose to almost $800. Then my husband got his corporate gig and we started weighing out our options and we thought it best to end my husband's coverage and put him in the corporate plan. We kept me on the independent plan until Isaac was born, and then we switched over. All in all it cost us about $1400 to have the baby buy the time you figured in the premiums and the copayment for the actual delivery. I thought that was pretty good, especially since the whole price tag came to about $19k.

Anyway, after Isaac was born, we switched to the company plan. It's not bad. The coverage is ok, and we have an HRA that the company gives us x dollars for a year. HOWEVER...I hate having a deductible. Last year, I went to the ER for ruptured ovarian cysts or kidney stones (take your pick...they never figured out what it was). Between that and all Isaac's well baby exams and the 2 times he was sick, we pretty much hit our individual deductibles. My ER visit came to about $650 that I had to pay. The cost of three days in the hospital for me and Isaac, labor and delivery, etc had only been $800. I was in the ER for 5 hours. Sigh. Still, I wasn't that upset about it, and was glad w had insurance.

HOWEVER.

My husband went to the ER back during the swine flu pandemic. He had his vitals taken and then sat for an hour while the entire staff watched the World Series. TRUE STORY. So he left. And I called the insurance company and told them. We filed a complaint against the hospital and waited to see what happened. In the meantime, I scheduled my husband annual FREE well adult visit to his doctor. He went and filled out his paperwork, including a paper that said "list three or more issues with your health or questions you have to discuss with the Dr." So he did. And all of a sudden, the FREE well adult exam turned into a serious diagnostic visit that was no longer FREE. In fact, it required a blood panel. The actual appointment was 20 minutes. 20 MINUTES! When the bill for the office visit came, guess how much it was? $350. I was MAD. I called everyone and their brother and filed complaint after complaint and so on. Their response? Sorry about your luck! My mother is an insurance coder. I sent her the claim and she was horrified that they coded the visit they way they did. According to the office coder, it was totally justified and blah blah blah. They used a code for a serious diagnostic visit used for very sick and ailing or injured patients. FOR A WELL ADULT EXAM. Now, unless my husband is lying about what they discussed, it was totally bogus. So I got the doctor's notes. And I got madder.

What is even worse is that while I was trying to resolve the issue, I was only making payments on the bill in increments of $25. Why? Because I had this hope that it would be downgraded and I wouldn't have to pay the whole bill. Therefore, I didn't want to wait for a refund from the Dr, should that happen. I did exactly what the accounts payable representative told me, and yet I still got threatening messages about collections. Seriously? I finally got so sick of it, I paid the whole damn thing. Their representatives lied to me and I was just tired of dealing. And then I wrote a letter to 7 on your side, just to express my opinion. I HATE SUTTER MEDICAL FOUNDATION. They said that if I wanted to make payments, I wasn't allowed to make more than 2. Like I had to pay the whole thing in 2 months.

And then, we got a statement from our insurance saying that they got the hospital claim. It was $179 for my husband crappy ER visit to take his vitals. SERIOUSLY? Come on! it wasn't even a doctor who took his vitals! However, I haven't received a bill from the hospital. I can't pay things that I don't get bills for. And I have no idea what the insurance company actually paid.

With all those issues, we met our family deductible, but it was DECEMBER. So when January rolled around, we were back to $0 toward our deductible.

I will say this much. I do like our insurance company. They are helpful. And they don't pick our plan for us, my husband's company did. And we are lucky we have insurance. And they are nice to us. I like my doctor and Isaac's doctor. I like our dentist and eye doctor. But I think they charge too much. And I know they do it because of the insurance companies. And I know insurance companies charge more because doctors do and because not everyone has insurance. Its a double mandate.

So here's what I think. It doesn't really appear the healthcare bill will have a huge impact on our situation. Maybe if more people buy insurance, the premiums will go down. I think that people need to see exactly what this bill is going to do before they whine about changing it. Do I think it is good that people will be required to have insurance? Heck yeah. You can't drive in CA (legally) without car insurance. So yes, I think people should have insurance. And I don't think sick people should be denied insurance. And if more healthy people buy insurance, there will be more money for the insurance companies to pay for care for sick people.

Sigh. Talking about this made my head hurt. But there is most definately a flaw, many flaws in our system. And the bottom line is, no matter how it changes, someone will always have a problem with it.

2 comments:

Grady Chronicles said...

Definitely a flaw in the system. Definitely in agreement that people should not be denied health care. By the same token- shouldn't people also know exactly what is in a bill and what will come from a bill before they vote to pass it? I feel like it will only affect my family by raising our taxes.

CJ said...

I agree with everything you just said. Someone needs to fix something about the system. Quit whining and let us free!!