Moderation in All Things

As I have stated in previous posts, our healthcare system is dominated by what I term the Big Three: Insurance Companies, Pharmaceuticals, Hospitals.  As with most communication, and by the fact that I am passionate about the need to re-vamp our healthcare approach, I may have sounded a little too strongly at how the system being dominated by the Big Three with focus on profits has a potentially adverse affect on the health of our country.

There is no question that the Three developed as the needs of our population arose.  Our Democracy is based on a capitalistic foundation.  Thus it would follow that pursuing profits would be an inherent part of any business.  We, as a country, also put great stock in the Scientific Community.  Thus it would follow that pursuing new means of coming up with cures would play a dominant factor in medicine.

However, as with any pursuit or endeavor in life, when the focus leans too much in one direction, it can have adverse affects on the opposite side and I do believe that at this stage, the focus of the Big Three has veered too much on the profits and finances, ultimately undermining the service side of their work.  If a doctor is required to bring X amount of $s into the “firm” and that can only happen by seeing X amount of patients in a given day and/or suggesting so many procedures or specialty visits, then the patient and his/her health is affected (not to mention the doctor’s, whose life has the added stress of having to bring in so much money).  Nowadays, often, young people go into the field of medicine because it assures a good living.  Even if a young person has gone into the field for idealistic reasons, ie, helping those in need, the demands of the system and the focus on the money side of things will quickly overwhelm the original intent of the young person going into the field.

When my grandfather practiced medicine, he was a General Practitioner.  He was the one that people went to if they had a tummy ache, or a toothache, or a wart, or were about to give birth.  If his patients didn’t have the money to pay, he might receive a side of ham instead.  If he did not have an answer, he would suggest a visit to someone who might have a more specialized background.  Litigation against doctors did not exist back then.  As far as I know, my grandfather never lost a patient on an operating table.  But people were much more accepting that death COULD be an outcome.

So the times they have changed.  But just as they have changed into this extreme scenario in which it is now considered natural to spend 15 minutes with a doctor and leave with a prescription and/or to try everything that is being offered to keep someone alive (regardless of statistics that may help families recognize that there is very little chance for survival),  maybe now is the time to re-focus our attention on the promotion of health, rather than playing catch up to ill-health and permit change to again occur.  (In fact, I believe the ability to change and see things in new ways is one of the elements that makes our country so great).

This, then, is the basis of my passionate writing on this subject.  Thus, just as I make the point that it is time for our system to moderate itself, I, too, plan to moderate my writings on the subject.

© Yvonne Behrens, M.Ed  2013



Insurance Companies: Got You Coming and Going

insurance: photo by Alan Cleaver

Recently, I received my monthly bill from my insurance company and found that they had increased my premium by approximately $50.

About five years ago, my husband and I both found ourselves no longer receiving insurance through the companies we were working for because the companies were closing their doors.  Thankfully for my husband, he was at an age where he could receive medicare benefits.  But I was in the “doughnut hole” of insurance coverage.  I had to seek an individual policy and fully pay out of pocket for that individual policy.

Every year, my premiums have gone up.  As I do every year, I called them to ask why they had increased my premium rates since the only thing I cost them was the paper and stamp they used to send me my premium bills.

The first year I had asked that question, the reply was, “because you are a year older.”  I screamed “Ageism!”  Must have been marked on my records, because that is no longer the answer I receive.

This year, the answer I received was, “We increase everyone’s premiums every year. This year the increase is much higher because of President Obama’s Health Reform Act and, in general, healthcare has become more expensive.”   Hunh?  Has the Health Reform Act even started?  I thought it was in the high courts being challenged as unconstitutional. “Are you telling me that the Obama Healthcare Initiative, which is presently tied up in the higher courts, is the cause of health care going up and my premiums going up?”  “No. That is not what I said.  We are needing to cover the costs and healthcare has gone up this past year.”  Hm.

My existing policy included free preventative care, which meant a free physical, a  $3,000 deductible, an 80/20 on pharmaceuticals, and catastrophic coverage at 80/20.

Oh, two weeks earlier, I had received a letter telling me that I could choose to remain in my present coverage and I would be grandfathered.  However, should I choose another option, I would loose the benefits of that current plan.

Grandfathered. That was the term they used when I was teaching and there was a whole new system introduced around our retirement funds.  We older employees were given the option to remain “grandfathered” in the previous system.  The older system benefited the employees more than the new system and so “grandfathering” was a good thing.  I was understandably feeling a little nervous about changing anything on my insurance coverage.

However, my outrage at the price increase was stronger than my fear of change.  So I timidly inquired whether there were other options out there that might not cost me as much in premiums but also provide for catastrophic.  The “customer advocate” did not know the answer to this question, but she could transfer me to a “Health Plan Agent” who might be able to tell me.

It turned out that there was a very similar plan to the one I had.  Not only was it similar, but it included dental!  To boot, the premium per month was going to be $75 less than the latest premium on my old policy.  Eureka!

But this did not make sense.  Why was I being offered a better deal that was cheaper than the policy they so graciously offered to grandfather me into?  Also, the only way I found out about the plan was because of the query into the price hike of my old policy.  The answer  I was given was that they had created this new plan and because more people were signed on the new plan than on the old plan, they could provide it for less money.

They sent me a 26 page application form, which I dutifully printed out, filled out, and sent back to them via fax.  When two weeks had gone by and I had not heard back from them, I called to find out what may have happened.  They had no record of the document, but after another hour and a half, I was informed that I should just fill out another document and fax it (not the original one because of some slight something or another that was different).  Again, I did this, and again I waited.   A few weeks later, I received a welcome letter congratulating me on my choice, and “our customer care advocates are here to assist in any way they can if you have any questions.”

I eagerly looked to see the premium amount and to my horror  it was $60 more than the recent hike on the old policy!  What happened?

So back to the “We are here to serve you Health Care” Adviser, who told me that underwriting must have determined that for some reason, a reason that she, in her role, was not privy to, the need for the price hike, but if I wished, she could transfer me and I could ask them.  The underwriter informed me that I had been accepted at level 2 (because I had a back problem situation in 2006).  “But I have not had a back problem situation since then!  Does that not count?”  “If you have gone to a chiropractor anytime during that period of time, you continue to be considered Level 2”  Groan!  “But the Agent told me this policy would cost me $230!”  “Sorry.  I don’t know anything about the agents and I am not sure why she would have told you that.”  “But I usually go to my chiropractor as a preventative.”  “That is not how we define visits to chiropractors.”  “What should I do to clarify this?”  “Not my department.”

I gave up.  I just gave up.

I decided that I could not continue with a system the deck of which was so stacked against the consumer, there was no way of playing ball with them.  My husband, were he still alive, would have insisted I bite the bullet.  But my sense of justice or of the injustice was too great.  I would not play the game the way they presented it to me.  Another month went by and by this time, I had been uninsured for three weeks.  Treading on thin ice.  Okay, okay I will stop with the analogies.

Unfortunately, because we live in a country that really does require one to have health insurance and since I am at an age where one really should be covered by health insurance, I found myself once again making a call to my insurance company to try and explore another means of getting insurance coverage.

After the third transfer which followed the, “Sorry not my department,” response, I found myself speaking with an agent who actually seemed to know something.  It turned out that I had marked the wrong box for premiums on my application, inadvertently opting for a higher premium with a lower benchmark for the catastrophic and, because I had seen a chiropractor in the last twelve months (it did not matter that it was for an unrelated issue from the one that branded me a level 2 originally), underwriting was still assessing me at level 2.  Hence the price hike.

However, I learned that I could possibly get down to Level 1 if I got the Chiropractor and my primary physician to both write letters stating that I was no  longer being seen for my back problem.

(to be continued)