Thursday, October 19, 2006

A Very Long Post about A Very Boring Topic. Get It?

Growing up, I didn't like autumn. What good is it to a child? Autumn signifies the end of summer. The end of freedom. The end of warm days playing outside until dark. The beginning of school. The beginning of homework. The beginning of responsibility.

Did I say "I didn't like autumn"? Correction: I hated it.

I finally grew up, got out of school and learned to appreciate the fall. Autumn in New England signifies the end of heat waves. The end of oppressive humidity. The beginning of cool nights that welcome sleep. The beginning of amazing displays of color and the true beauty of nature. We chose to get married in the autumn. I realized that it was actually becoming my favorite season. I loved it.

And then, things changed again.

Autumn still stands for all those things I learned to appreciate as an adult. But it also signifies the time of year I hate the most: health insurance enrollment period.

I've whined about health insurance more than once. More than twice. More, I suppose, than any sane person would whine. See, a sane person would GET IT. A sane person would understand that whining and complaining is nothing but a waste of time.

I guess I like wasting time.

I can't help it. Health insurance pushes my buttons. It's one of those things that keep me up at night. We all have them. For Jete, it's where to locate the ceiling fan on our newly refinished porch. That idea will drive him crazy until it's finally installed. Me, not so much. Instead, I'm concerned that we have medical coverage for our toddler and handicapped son for the next twelve months.

(Feel free to debate which of us is the deeper person.)

This time of year, I'm a woman obsessed. I scour websites, benefits fairs and any scrap of paperwork I can to determine which plan I should go with. I don't take this process lightly. This decision will stick with us for the next year. There's no backing out or changing things, short of getting fired, divorced, or having another baby.

Ha ha ha ha ha. HA.


For many people, deciding which insurance to enroll in is as easy as deciding which value meal to order at the local fast food joint. "This one costs $60 a week, but this one costs $50 a week. So I'll get the $50 one." They eagerly sign up for their company's High Deductible Health Plan (HDHP) because, wow, the premiums are so darn cheap. And yes, for people who never get sick, don't have sick children, and don't have to use their health insurance very often, that's fine.

But for the rest of us, it just doesn't work that way.

I'm a little different to begin with. I'm the kind of girl that would rather pay 9 dollars for a quality hamburger than to get one off the 99 cent menu at McDonalds. Yes, you're saving money, but at what cost? What are you really gaining in the long run? Most of the time, you end up with a cold, scrawny, tasteless meal that leaves you hungering for more anyway.

High deductible plans are good in theory. They want us to believe that we'll make "cost-conscious choices" by enrolling in plans like these. Patients will suddenly choose to get the generic drug instead of the costly brand name. They'll pick the cheapest doctor instead of the pricey specialist.

But really, who does this help? The people who suffer under these plans aren't the upper middle class who insist on the brand name purple pills they saw on TV. It's the families, who can't afford the pricey deductibles to bring their children to the best available doctors. It's the sick, who have to take so many medications and have so many tests that they buckle under the weight of deductibles, copays, and coinsurance.

So far, I've been lucky to avoid the HDHP's because we've had choices. But every year, I see more and more of my options being removed. At my employer this year, I have the choice of one high deductible plan ($9000 maximum out-of-pocket per family), one middle of the road deductible plan ($5000 max out-of-pocket per family) and four HMO's.

(Did I mention I hate HMO's too? But I think I'll save that for another post.)

But really, I know I'm luckier than most when it comes to the number of options that I have. Many people have a single take-it-or-leave-it insurance plan, or worse, no insurance at all. Sadly, I'm fortunate to have the six crappy plans to choose from.

Beyond bad choices, the thing I hate the most about health insurance season is all the lying. The distrust I put on every year like hipwaders. "Yeah, yeah, yeah. I'll hardly have to pay a cent throughout the year. I won't even notice the small bills coming in. I'll get great customer service if I have questions or issues."

"Oh, and no one in Washington ever lies."

In the past two weeks, I had to deal with two untruths slapping me in the face, reminding me yet again why I hate this time of year.

The first was when my company dropped my current health plan. I had a sinking feeling last year when they changed things majorly on our prescription plan. I spoke directly to a benefits representative, expressing my concerns that the changes were a first step towards dropping it completely. He told me that they had no intention of doing that. It was one of their most popular plans, and the employees that used it were very happy with it. They would most definitely have that option for years to come.

And then they dropped it anyway.

Lie #2 came from Jete's employer. They shifted his role a few months ago under a different umbrella. They forced his coworkers to sign a waiver about moving into these roles with the promise that everything would stay the same. They would have the same insurance, the same benefits, blah blah blah. NO changes. No sirree.

While the rest of his company was getting paperwork for their annual benefit enrollment, we still hadn't received ours. We got the flyers from the insurers - shiny brochures covered in smiling faces screaming "Health insurance that will make you happy!" - but none of the meat, the premium and copay pricing.

The other night, I went to one of their open enrollment meetings to find out why we hadn't gotten our paperwork yet. The woman very curtly explained it was because he was not covered under the insurance as of the first of the year.

I sat in stunned silence, thinking to myself (but they promised...they said nothing would change) while she explained loopholes and contracts. The bottom line is that, yes, he will have insurance, but no, they don't know what yet. "You'll definitely have something by January 1st." she said, as if that was supposed to be of some comfort to me.

The thing this woman didn't understand is that "something" just isn't good enough. "Something" may not pay for Ethan's surgeries, braces, therapies, multitudes of specialists. "Something" may not pay for his five different prescriptions each month. I need to know what this "something" is, and soon. I need to be able to plan, to compare, to crunch the numbers and figure out just how much this "something" is going to cost us.

But I guess that's just me being crazy.

In the midst of lie upon lie and crappy choice upon crappy choice, I broke down. I started crying in the middle of the benefits fair. I snuck off to the corner to call Jete about it. He listened to me rant and rave for 5 minutes, and finally said, "Okay." Nothing more.

"You're off the insurance, they lied to us, they won't tell me anything, and we have no way to know when they'll make a decision!"

"Okay." And then he proceeded to talk to me about the porch ceiling fan for 17 minutes.

As I hung up the phone, I decided I needed to blog about this. I needed to reach out to the world at large and, somehow, not feel so alone. My family is great, my friends are great, my husband is great. But sometimes, none of them GET IT. They can sympathize, they can say they understand, but they still don't get why I go so crazy. After all, we'll still have insurance. What is there to get so upset about?

Somewhere out there, someone else must GET IT, right? Someone else must know the frustration of dealing with this insurance CRAP month after month, year after year, with no hope in sight? Someone else must know what it feels like to be so tired, so fed up with the lies and bullshit, that they break down in tears in the middle of a convention center? Right?

Or maybe I just need to GET IT, and stop wasting my time whining. At least until next autumn.


lisa said...

Insurance sucks. I am starting to get that. This year was our first year of really really needing our insurance and it's been great...we've paid only about $600 out of pocket on nearly $50,000 worth of claims for Julia. But it's about to change BIG TIME next year. They're getting new insurance plans and they're going to be way more restrictive. Apparently M's company offered such great insurance that all the spouses of their employees dropped their coverage and went with what M's company offered. So their costs skyrocketed. I'm freaking out already but have no way of knowing yet just what our choices will be.

Not a boring topic at all! Hope you get things resolved soon.

Jess said...

I totally get it.

We're blessed to have really good insurance (when medicare doesn't stick their nose in and screw us over--but I'm not bitter!), and because of that, my husband can pretty much never leave his job. I've got a kidney disease and had a transplant this year, so good health insurance is just vital. So I hear you.

Anonymous said...

I get it, too. 3 of my kids have had neurosurgery. We just found out yet one more child has the same condition and will need surgery, as well. The stress of co-pays and paying our portion for so many kids gets overwhelming. And my dh's job likes to transfer him, but each time they do, his insurance changes & I never know if something is going to be denied or dropped or simply not a covered charge. Dh doesn't "get it" ~ he doesn't deal with it. Like you, all of this falls squarely on my shoulders and it drives me nuts, as well. So no, you're not alone. Keep talking ~ we're listening and lots of us are nodding our heads in total understanding.

Hostile in Ohio said...

I hate dealing with insurance companies. Ours won't pay for anything Ryan needs either, at least therapy wise. Thankfully his eyes are sort of covered, same with ears, but the only help for his delays that we get is through the school system...which isn't much.

I soooo hope that Adara doesn't suffer from these problems...

Meredith said...

I still love autumn but I also hate the health care stuff but in a way, I think I am lucky that my employer only offers three choices: Kaiser HMO in which you can only go to a Kaiser center for anything, Great West HMO, and Great West PPO. For me the choice is the only choice - PPO baby! It will cost me $175 a month to insure my family (deducted from my paycheck) but I won't be without a PPO. I need to know that I can see anyone, anywhere. So far we haven't had to pay more than $250 total out of pocket for any of our son's visits with the specialists and even my suprise abdominal surgery and 2 day stay at the hospital came with only a $10 copay.

M&Co. said...

Insurance sucks. And you've got to get the one that will best serve your family. I hear you on that one. I'm one of those poor smucks with a high deductible health savings plan. It cost less to do it that way, (pay the premium plus donate to the health savings plan) than to buy the one with the much lower deductible. I'm still trying to wrap my mind around the fact that you both have such broad choices.

Kelly said...

Check this out: I had both a PPO AND a health savings plan! So they paid me back for all my co-pays and deductibles! Yeah!

And then Chris changed jobs.....

So now life's not so fun in the insurance dept. They don't even pay dental. And I pay more a month. This really stinks now. (Not to mention, only 1 choice to pick from)

So I feel your pain.

That Girl said...

I surfed onto your blog and read the whole Ethan story (up to 13). Great writing.
I feel you about the insurance - as someone who's son just reached the $1 m lifetime cap on our insurance.
Our company basically told us. Get a different job. You can never work for our company again or we wont pay for your son's healthcare.
But apparently he reached the cap months (and several hospitlaizations) ago but no one fingured it out until I made them find out.
When you cry about insurance, know that I am here crying right along with you.
Good luck!!

Emily Elizabeth said...

I get it. I SO get it. We pay about $600/ mo for our insurance premiums in addition to our $4400.00 deductible (which we have, of course, met) through our GROUP (!) plan. Emma Jayne has supplemental insurance through the county and I am now trying to obtain it for our infant son because, unfortunately, we have actually used our insurance this year, and you know what that means...everybody in our entire group is screwed. Again. My son was hospitalized at birth and had open heart surgery to the tune of a quarter of a million dollars...need I say more?

If I had a dollar for every conversation I've had with our primary insurance, for every fight I've gotten into with the county; and a penny for every minute spent on hold and every minutes of anxiety I woulldn't have this problem any more...I'd be a rich woman and could tell them all to kiss my a$$ - I'm insuring myself from now on! LOL!

I'm not even going to get into my HSA - what a joke!

Anonymous said...

We actually found that our HDHP actually pays better than the more expensive plan. The reason? We know we have over $6000 in expenses every year. We blow the deductible and they cover 100% of everything - prescriptions included. The more expensive plan covers 80% from the start but we'd pay a good portion of prescriptions and they don't count towards our out of pocket max. It ends up we'd have to pay $10,000 worth of expenses (which we easily do) before the 100% kicks in. Even then, we still have to pay for prescriptions,

Anyhow, I get it and every year we face the same nightmare too. Insurance plans are only a good deal for people with healthy kids.

Surgeon in my dreams said...

I understand it. Exactly.

beautiful said...