Wednesday, August 19, 2009

Sick and Tired

Like many Americans, I’m confused about the health care reform legislation currently taking form in Washington. I understand that one of the main goals with this reform is to provide insurance for people who don’t have it/can’t afford it. What I’m not seeing clearly spelled out (and admittedly, perhaps my work-life demands are getting in the way of me researching this properly) is: what about those of us who have insurance but the insurance is crappy? As in, the premiums increase every year, the deductible increases every year, the amount of coinsurance increases every year, and yet if anything you get less care?

Right now in the Blah Blah’s employer-provided coverage, we pay insurance premiums and then we also have a $500 deductible apiece, on top of which we each have to pay 20% of any medical costs beyond that, up to $3,500 per year per individual or $5,000 per family. What that means is that if we had serious medical problems we’d have to pay up to $2,000 in deductibles, plus $5,000 in coinsurance out of pocket. There is also a lifetime cap but I haven’t yet paid attention to that because our insurance carrier changes almost every year as costs go up and the company negotiates with various carriers to get the best deal.

Now, the insurance premiums are no joke either. At my job to pay for yourself and a family you can expect to pay some $1,800 for premiums per month. The company will pay your premiums, but not those of your family. Fortunately for me, Sweet Dub’s job offers a better deal on insurance and will actually pay for part of the premium, so I’m covered through his employer rather than my own. I realize we are privileged because we both have jobs that offer insurance, but it sure doesn’t feel like I’m getting what we’re paying for when even with insurance, I’ve paid over $7,000 out of pocket this year for having a baby in October and having her end up in the NICU.

Yes, at least we have insurance, but I fight with the insurance company at least once every couple months. The latest thing we’re dickering about is me having a mammogram. Isn’t it recommended that women age 40 and over have an annual mammogram? (Answer: why, yes – yes it is!) Particularly if they (like me) have a history of breast cancer in their family, or (like me) have had a suspicious lump biopsied in the past. And yet, I’m having to fight with my insurance company over whether I have coverage for this procedure, which was recommended by my primary care physician and my gynecologist. They want me to pay 300 bucks and some change for this screening.

I’ve been trying to get caught up on the health insurance reform storm, I swear I have. I have heard so many horror stories of people who are uninsured, and as we’ve seen with the recent Remote Area Medical Foundation visit in Inglewood, which wrapped up yesterday, there is a huge need for free and/or affordable medical care here in my own neck of the woods. But I want some reassurance that those of us who are “insured” are also going to get some help. Am I missing something?

6 comments:

Bridget said...

Don't worry...you're not the only one who is confused. *sigh* We are on sucky Cobra for now (though a moment of thanks to Pres. Obama for the subsidy) and I'm currently paying off a pediatrician for childhood vaccinations that should be covered. Next time I'll just take them to the county clinic...perhaps they'd be cheaper WITHOUT the insurance.

Lisa Blah Blah said...

Bridget: Ecch, I hate it! I'm sorry you're on COBRA - well, I'm glad you have SOME insurance but sometimes it seems you get screwed over worse when you have it. Anyone who thinks the system works as it currently stands has clearly not had to go to the doctor in the last 5 years. Sending good health/insurance vibes your way...

linda said...

We had the same situation with insurance-the high premiums, deductibles,etc. Then my husband was injured and we had to go on Cobra. I understand what you are saying and agree. I am in a fight with the insurance company because they say I didn't write a note regarding my employment status and so won't pay a bill. I had sent the note in long ago and they pay other bills but they seem to not notice this fact.
Healthcare reform should be across the board. I don't think having insurance makes healthcare any more affordable. It just insures that you will be in debt by January when deductibles come due and all the family have the flu.

Lisa Blah Blah said...

Linda, thanks for writing. I hear stories like yours every day and it just makes me enraged. As my husband says, "Why are we all not rioting in the streets because of the health care system?!" You know why? Because everybody is worn out from fighting with the insurance companies!

Kristen said...

I am delurking to say, I totally agree. I blogged about it recently, but long story short, we are insured and just had a baby. It cost us over 20k in premiums and deductibles. It's insane. I am honestly hoping for a public option because anything would be better than the crappy coverage we pay out the nose for right now!

Lisa Blah Blah said...

Kristen, I am torn between saying thanks for delurking, and getting mad at you because I now have read your blog and have had to add you to my blogroll! :-) You have a beautiful family. Congrats on the newest baby and I do hope you will get good news about Keanan soon!

And on the healthcare thing: yes, I finally figured out "Oh, that's why there's the big hoopla over the public option, because people could then choose to drop the ir private insurers!" What can I say, I am really sleep-deprived and my neurons must be firing only sporadically. Mmmfscchblgg...