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State of the Union’s Healthcare….

Allow me to raise a little awareness in my blog this morning…. A lot of this will sound very familiar to any woman in my audience. The rest will sound familiar to any man who’s had to pay for health care in the last five years.

At the end of October, I had a routine physical exam, focusing on the parts of my body typically used for recreation and procreation. Since I left my full-time job in January, I have been without health insurance. People have asked why I didn’t take the COBRA insurance, but at $800/month, it seemed extremely expensive for two relatively healthy people in their thirties. Plus, I have no children to get the sniffles and fevers and immunizations and bring home every germ under the sun.

In addition, it’s been about a decade since I had health insurance that worked. By “worked,” I mean of course health insurance that did not reject every claim I submitted to them, even if the claim was perfectly legitimate. For example, when I went to a sports medicine doctor to look at my feet, convinced they were both broken after walking a marathon in 2004, the insurance company seemed to pick and choose which tests they would cover, and even though I was told that the MRI scans of my feet wouldn’t be done until they were sure my insurance would pay for this exceedingly expensive test, I still managed to end up with a $500 bill in the mail a month later.

I hate relationships of contention. These are the relationships where you’re always going to have to negotiate, where you can never just say “this is what I offer,” and the other person says “that’s what I need, I’ll take it.” I don’t even like haggling for goods in Mexico. I despise writing contracts where the client continuously asks for things that they know I can’t deliver. And I really, really hate working with service companies (like health insurance) where the service you’ve already paid for is routinely denied to you. Incidentally, fighting with health insurers? Great way to increase your stress levels, something that doctors will tell you contributes to more health problems than anything else except smoking and obesity.

What’s more, I haven’t heard great things about the health insurance companies from the viewpoint of doctors, who often have to fight tooth and nail to get paid.

So, let’s see. We have a middle-man with whom patients have to fight for coverage, and doctors must fight for payment. And every time I’ve spoken to a health insurance agent, I hear nothing but moans about how slim their margins are. I’m not sure, but it seems to me that this isn’t a good arrangement for anybody.

In the course of a year, my husband and I each spend about $1000 in medical and dental care, and I spend about $500 more on birth control, which we both benefit from. Thus, health insurance became a low priority item, and we sock away some of that $800/month into savings, in case we ever need to pay for medical care, and use the rest on better diet, vitamins, and exercising more. And driving safely, since a car accident is the most likely way we’ll incur large medical bills right now.

This brings us to October, when I had a bunch of routine doctor’s appointments, including my OBGYN. In my particular case, the practitioner is a midwife, because I trust midwives for routine stuff, and can usually get an appointment with one sooner than with the MD. When I went in, I explained that I was self-paying and no longer had insurance. I was gratified to see that the medical office gives a 20% discount if you pay in full at the time of service. So, if I go in that day and my appointment costs $200 (which it did), I paid $180 and was done.

Except, of course, for the lab work. Since I was self-pay, I was asked if I wanted a PAP smear. For those in the audience not aware, a PAP smear is a culture taken from “inside” and checked for various diseases and irregularities, including cervical cancer. This is the first time since I started having these annual exams that I was asked if I wanted one done, and they are a routine part of the yearly checkup and covered by nearly every insurance company as part of the “well woman” visit. Of course I said yes. It’s a minor piece of prevention, right? So they do the smear and send it off to the lab.

A month later, I get a bill from the lab, a $60 charge for the smear. Of course– I’d forgotten that the lab doesn’t get paid up front. I wrote a check and mailed it the next day. Total for my “well woman” visit? $240, less than 1/3 of what my health insurance would have cost me every month.

Yesterday, I received another bill in the mail. This one was for $147.12, for “MPV DNA PROBE HIGH RISK.” For those unaware, MPV is a sexually-transmitted disease that causes cervical cancer. The “high risk” part refers to the disease, not to me, as I learned when I called the doctor’s office and asked them about this test, which I hadn’t asked for, nor agreed to.

It turns out, this is a test that is routinely done, if the pap smear is abnormal. Mine wasn’t– I already received that postcard from the doctor. And I was told casually over the phone “Oh, don’t worry about it, your insurance company should cover it.”

I gritted my teeth. Is this why insurance costs $800 a month? I explained that I don’t have insurance, and it’s rather a lot of money to throw around when I didn’t ask for this test and, apparently, didn’t need it. According to my midwife, the test shouldn’t have been done– someone in the lab, probably, did the test because they can and because it’s another billable procedure for which insurance companies supposedly close their eyes when they sign the check.

Of course, I would like to know which insurance companies “just cover it,” because no company I’ve ever been with would have overlooked a completely unnecessary lab test.

Anyway, the office is going to call me back on Monday with the results, whether I have to pay or not. As with all things medical, positive means I have a long battle ahead of me.

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