Foreshadowing

Remind me NEVER to assume any day will be normal. EVER AGAIN.

My blithe little post yesterday morning celebrating a somewhat normal day was definitely foreshadowing for what was to come. And what came was a day filled with frustration, big and little, mundane and dire.

If the United States of America's healthcare system worked like the rest of the world's industrialized countries, insurance companies wouldn't be practicing medicine. One Humana employee determined that the test my husband has to get next week, which had been scheduled by A NURSE at the direction of A DOCTOR (both highly trained and multi-degreed health care professionals), had to be rescheduled for two days later or they wouldn't pay for it.

Because of that one decision, two other doctor's appointments had to be rescheduled (one of them twice), and our hotel reservations had to be changed and an additional day added. And that's just on our end. We have no idea how that rescheduled procedure affected anyone else in the system. Did another patient get bumped from the list? Will the operating room staff be required to work overtime? The ripple effect is real, y'all.

All in all, we either took or made about 30 phone calls yesterday. 

I thought all of it might be moot if my husband had a stroke while we were trying to get it all straightened out. 

The dust has settled, but the frustration has not. America needs to implement a universal healthcare system. Period. We won't benefit personally, but our children might and our grandchildren will. And they deserve better than what we've dealt with for the past 24 hours.

Stress-induced overeating did not happen, thankfully. 

But it could have. I have no idea what today's challenges will be. I just know there will be some. May I handle them with some semblance of grace.

Thanks for reading.

It is done

After three application attempts, numerous phone calls, several on-line chat sessions and tripping my way through a muddy website that leaves one asking more questions than is necessary, I finally – finally! – have a health insurance plan under the Affordable Care Act.

Did I save any money? One dollar per month. I could have saved more, but I chose not to use all of the subsidy I qualified for because the way it was calculated was a bit murky. I reported our income, but can't report what we might withdraw from our retirement account. To be on the safe side, I stuck with a premium I know we can handle (the current amount).

Did I get better coverage than what my current policy offers? VASTLY better. A slightly lower deductible, much lower out-of-pocket costs, no limit on benefits and reasonable co-pays.

My old policy was limited to $1,000,000 in benefits and I still had to pay full price for office visits and diagnostic tests.

Of course, since I'm one of the healthiest women I know, I'm still going to

1. be lining the coffers of the already profitable insurance company,
2. not meet the annual deductible amount, and
3. pay cash for the diuretic I take 2 to 3 times a week, since it costs less than the Rx benefit.

Oh, well. I've long said health insurance is really wealth insurance: A way to insure you don't lose everything due to an accident or illness.

There's absolutely no reason anyone should have to go through this. We need single-payer, Medicare-for-all. PERIOD. Maybe someday …

If you don't know what I'm talking about OR why we need it, take the few minutes necessary to watch this video. And then share it, won't you?

Signing up for health insurance

Finally.

I've been trying to navigate the Healthcare Marketplace since October 1. We all know there've been many problems. I got through the process a month or so ago, with the result that I was not eligible for coverage through the Marketplace. No reason given. It was suggested I apply for Medicaid.

So I did, knowing I would be disqualified and thinking all I would need to do is go back to the Marketplace, denial in hand, and get this thing done.

Not exactly.

What I had to do was download, print and complete a multi-page form appealing the decision that I don't qualify to purchase a plan. The basis of my appeal was, simply, that I didn't know why I wasn't eligible.

So I completed the form and decided to give the government one last shot, hopefully to save some time.

I called. And spoke with Karen, who said I could either send in that appeal or she would delete my current application and help me fill out a new one.

I WAS SO FRUSTRATED I NEARLY CRIED. Right there on the phone. This would be my THIRD application process.

She explained it would take only about 20 minutes and she'd be able to tell me instantly, upon completion, if the results were different. And she was pretty confident they would be.

After all, the Affordable Care Act was written expressly for people like me: Not covered under an employer-provided plan, not covered under Medicaid and paying obscenely and ridiculously expensive premiums for a private policy.

So she asked and I answered and voila! The new result was, indeed, new. I qualify for a subsidy and all I have to do now is log back into my account, compare plans, pick one and write a check.

I'm one of the few people I know who still trusts the government. I'm not sure why the process didn't work the first time. I'm just grateful it did, and looking forward to shopping for insurance! From an insurance company! That's still going to make a profit!

I could move to Vermont, where legislation was just passed which will create a single-payer system in that state. And having Bernie Sanders for a Senator would be a nice perk, as well.

But for now I'll stay put and get my gratitude on.

Thank you, Karen, wherever you are, for your patience and understanding and confidence that this would all work out.

About that website, though …

What's up with health insurance companies, anyway?

Have you ever heard so many people say so many bad things about a particular industry as you've heard said about health insurance companies? Maybe cable TV companies. Although according to a recent Gallup poll, these are the 10 most hated industries in America:

1. Oil and gas
2. Federal government
3. Healthcare
4. Banking
5. Pharmaceutical makers
6. Legal firms
7. Real estate
8. Electric and gas utilities
9. Television and radio
10. Filmmaking (seriously?)

I'm not sure if "Healthcare," in the third position, means health insurance or your family doctor. I suspect it's the former and I wish it were clearer. As for me, I love my family doctor. My health insurer?

Not so much.

If you live under an American rock OR if you live outside the U.S., you may not have heard by now that President Obama went on national television last night to apologize to the American people for suggesting over the past couple of years that if we liked our healthcare plan we could keep it.

Those who like their healthcare plans are likely to be those whose employers pay all or most of the monthly premium for a plan that actually covers both preventive and necessary services. Some of those plans are no longer going to be offered, because insurance companies are greedy for various reasons, and policyholders – mostly individuals, but also some companies – are receiving notices that, actually, they don't get to keep their plan. Because ABC Insurance Co. will no longer offer it.

I am one of those individual health insurance policyholders whose policy was cancelled. I found an alternate plan to get me through until the Affordable Care Act goes into effect. In my very humble opinion <snort!>, insurance companies ought to be the ones apologizing. My President accepts the responsibility, which is noble of him, but he didn't cancel my policy.

Aetna did.

[I posted that thought on Facebook yesterday; one commenter said "shitty" was the only word to describe Aetna. Her policy had been dropped, as well.]

Let's get back to my original point.

Suppose you're driving down the road and a deer jumps in front of your car. You didn't see it coming, and you slam on your brakes as the animal does $3500 worth of damage to your vehicle. Your auto insurance agent assures you that your policy will cover 100 percent of the repairs, with no deductible. Not because you've been a "loyal customer" or a "safe driver," but because this is how auto insurance companies do business. A deer strike is never the driver's fault, and the auto owner is not penalized (at least by Nationwide) in the event of one.

You love – or, maybe, appreciate is a better word – your car insurance company, and are happy – or at least willing – to pay the mandated premium for the peace of mind that expense provides.

What if your basement floods, as my husband's mother's did a couple years ago? We didn't know the cause of the flooding, only that we had to move everything in the basement to higher ground my guest room and remove hundreds of gallons of icky water from the area. We honestly didn't even think about calling the homeowner insurance agent, but since she's a family friend it didn't take long for her to learn what had happened. She immediately dispatched a water damage clean-up company to dry out and disinfect the basement. Not because she's a family friend, but because this is how homeowner insurance policies work.

My point being that when you pay hundreds or, in the case of my health insurance, thousands of dollars a year to an insurance company, you enter into a contract that assumes you're going to get something for your investment if and when you need it.

Health insurance companies have, until the Affordable Care Act, spent nearly ONE-FOURTH of each of your premium dollars denying your claims. They will, eventually, pay a legitimate claim, after you (or your doctor's staff) has argued about the legitimacy of the physician-ordered procedure/test/medication with an insurance company claims specialist. That argument costs money, anywhere from 19 to 24 (and sometimes as much as 30) percent of healthcare costs.

No one I know is happy with his or her health insurance plan except

• those covered through their workplace,
• veterans (who enjoy the socialist plan called the Veterans' Administration) and
• Medicare recipients

Dad's name badge from the VA Clinic in
Viera, FL, with an 800-hour service pin.

If you're on Medicare, make sure your Congressman and Senators know how you feel about proposed cuts to that program (and to Social Security while you're at it).

If you're a veteran, thank you for your service. I'm the daughter of a veteran and he was so happy with his healthcare plan that he volunteered at a VA clinic until he was too ill to do so.

If you have been and will continue to be covered by an employer policy, thank your lucky stars.

Just don't get sick.

And if, like me, you're going to eventually, someday, hopefully, maybe be covered under the Affordable Care Act, thank President Obama.

Or Mitt Romney. He thought of it first.

A first

Yesterday was an unusual day for me. I was hungry All. Day. Long.

That hasn't happened since I began the paleo plan. In fact, I would say I'm rarely hungry, and when I am the hunger is appropriate: I haven't eaten in several hours.

Meals over the weekend were fine, but I ate fewer eggs than I usually do. Eggs fill me UP, and I need to put them back on the breakfast menu. I ended up skipping breakfast both Sunday and yesterday, and while I don't necessarily subscribe to the breakfast-is-the-most-important-meal philosophy, I have learned that I'm less hungry and more energetic when I eat it.

My husband and I drove to a nearby town to meet with an insurance agent and buy a short-term health plan for me. Aetna, which had been providing my coverage, is pulling out of the individual policy market here in WV (and in several other states, as well). I'd thought the last day was September 30, but it turns out it's Sunday. This coming Sunday. So we had to scramble a bit to get it taken care of.

It turns out to be a tiny bit better coverage with a significant reduction in the monthly premium. And it will tide me over until the health insurance exchanges go into effect January 1, 2014. You can begin the application process for those on October 1, and I will be first in line.

If ONLY the United States had the political will to pass a Medicare-for-all, single-payer plan. As long as insurance companies have lobbyists, though, that's not going to happen.

BUT IT SHOULD.

Insurance is the biggest gambling game around. You throw money in the pot every month, but the only way you win is if you get sick (health), have an accident (auto) or die (life). I'm not a big health-care consumer at all. I've paid thousands of dollars to Aetna since we lost my husband's employer-based coverage when he retired. I can count on my fingers the number of times I've seen a doctor since then.

And my policy didn't even cover office visits.

I take a Lasix a couple times a week for intermittent swelling of my ankles. Generic Lasix is one of the cheapest drugs on the market, so I don't even use my prescription benefit to buy it – it's on the $4 formulary at Tiny Kroger Pharmacy.

So six more months and health coverage should improve, premiums should go down (or, in my case, I think it will stay about the same as it is for the new short-term policy) and millions of U.S. citizens will still be without health insurance. If you live in a state in which your governor has decided not to expand Medicaid, well, I'm sorry you elected him or her. This map shows who is still on the fence.

It wouldn't hurt to make a phone call. Or 10. The more citizens who participate (Medicaid expansion will provide subsidies to lower income people), the lower ALL our premiums will be. And, theoretically, we'll be able to nip health problems in the bud, instead of waiting until it's so bad we have to visit an emergency room.

Or die.