Posts tagged ‘health insurance’

August 23, 2009

underinsured and overwhelmed

I walked to the post box to retrieve my mail. Among the junk mail and some magazines, there was an envelope from my insurance company. Nothing unusual about getting mail from them, and perhaps I should have expected what would be written on those pages. I opened the envelope to find several Explanation of Benefit (EOB) statements for different aspects of the ECT treatment (e.g. psychiatrist and anesthesiologist bill separately), and they read that neither of those parts will be covered because “the maximum amount for this condition has already been paid.”

My ECT treatments are no longer covered by my insurance.

My heart sank, or more accurately, plummeted to some dark place in my stomach, or maybe even to the ground. I cried. Having one treatment is like paying for a monthly mortgage payment, or months of therapy. Thankfully, I have my parents’ financial support for these treatments (among other things), but how can I ask them to pay this much amount of money per treatment? Here I am, in my late 20s, having to contemplate whether this lifesaving procedure is worth having to pay completely out-of-pocket (it’s kind of like a ‘death panel’ of sorts). This is when I realized that not only is there no mental health parity at all, but that I don’t have a way to mitigate these circumstances. What am I going to do? But more importantly and broadly, what do people do when they’re placed in more dire situations?

I watch on the television with those people ravenously shouting against health care reform, and I wonder if they know why they’re carrying signs about socialism and Hitlerism. What’s frightening is that the health-care bill debate has ceased discussing how it will affect living human beings. Beyond those -isms are the faces of the 40+ million uninsured, the underinsured, and countless others who don’t even know they’re underinsured because they haven’t had to put their insurance to test. Though I would not wish this experience upon anyone (and I know it could be much, much worse), I wish some people knew what it’s like when insurance companies deny your application because of your pre-existing condition and even when insured, you’re left to pay for the costs when an illness strikes you. Then, they can ask themselves if our health care system is really working.

It’s a day before another ECT. My twentieth. I ask myself, is this treatment really necessary?

August 11, 2009

Like Your Health Insurance? Maybe You Shouldn’t. – washingtonpost.com

Like Your Health Insurance? Maybe You Shouldn’t. – washingtonpost.com

Thought this was an interesting read.

“The employer-based system has two major weaknesses. First, and most obviously, it means keeping your health insurance is dependent on keeping your job. That means that your health is only insured to the extent that your job is insured — and your job isn’t insured. If you lose your job, or get a divorce from the spouse whose employer covers you, you have to find a new employer who offers a health plan, or you will be stuck in the individual market. Alternatively, if you get sick, you may be stuck in your job, no matter how much you may want or need to leave it.”

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July 27, 2009

My health-care bills and the Health Care Bill

$20,000. What can you purchase for that amount of money? Pay one year off a mortgage, purchase a nice used car, buy a whole bunch of stuff.

I finally got an ‘explanation of benefits’ (EOB) letter from my insurance company about my initial 15 treatments (The hospital accidently tried to file the claims with my old insurance company). According to them, the whole process, including the pre-ECT exams, cost close to $20,000. Upon getting this letter, I thought this may be a good time for me to bring up the whole topic of health care, or more specifically, health insurance and the battle on Capitol Hill.

Because I do have insurance, a large portion of the treatment is covered (When I get the real bill from the hospital, I’ll post the amount). Obviously, this is something I am very thankful for, especially since it wasn’t that easy for me to find insurance – and I’m in my 20s! I was even turned down by several companies simply because I have bipolar disorder. Thank goodness for my insurer, Golden Rule/United Healthcare. Even though my monthly rate is close to $400, it is worth what I save on medical costs. There are some younger, healthy people who may not see the need for insurance, and  they may be against the new health reform because according to the new proposal, it would require that everyone be enrolled in a health insurance program. What they need to realize is that an insurance is just that, an insurance when those unforseen events arise. Obviously, they’ve never seen the base cost of a simple procedure or a doctor’s appointment, because even seeing just the true cost of one prescription would make a person realize why health insurance is so important.

What about for those who need electroconvulsive therapy but can’t get insurance? Currently, over 40 million Americans are uninsured, many not by choice. Under the new plan, insurance companies will not be allowed to turn people down simply because they have a pre-existing condition. And those who are uninsured and cannot afford insurance will be helped by an expanded form of Medicaid. Even those nowhere near the poverty level will be given an insurance subsidy to help pay for their insurance.  Now, ECT clearly isn’t for everyone, but shouldn’t everyone be given all medical options when choosing treatment? I know that had I not had the ECT, I would have been dead by February.

To put simply, I can’t imagine being without health insurance. Without it, I wouldn’t be able to afford ECT nor would I have been able to afford some of the non-generic medications. And I certainly wouldn’t be seeing my psychiatrist on a regular basis. But I see all of these items as being crucial to keeping me alive. Moreover, I’m sure there are plenty of others who need these services even more than I do yet do not get them because they cannot afford or are denied health insurance. It’s easy to say that one is against “socialized medicine,” but does one realize what it’s like to try to get medical care when they don’t have insurance? Do they know just how much medical care costs without insurance? It’s utterly obscene. Call it ‘socialized medicine’ if you’d like, but is it such a horrible thing if it’s going to allow someone to get the care they truly need?

Though I’ve been for health care reform, I admit I haven’t been paying to much attention to the debate. However, seeing that EOB gave me a good ‘shock’ to my senses about just how much relevance this topic has in my life and others and how important it is that I become more aware about this issue.

FYI: A quite concise editorial “Health Care Reform and You” was in the New York Times on Saturday.

April 2, 2009

Financial Abili[t]y for Abilify

“If your anti-depressant only isn’t enough, Ask your doctor about Abilify,” says that soothing male voice on that commercial about Abilify, a drug that was approved for add-on treatment for major depression in 2008. Suppose your doctor does say, “Abilify may be right for you!, then the starting dosage that s/he probably wrote on that little piece of Rx paper should be between 2-5mg. That is the recommended starting dosage when taking Abilify as an adjuvant treatment.

The advertisement makes it look as though the working mother or the Union dad could go back to work again feeling fine once they get this help. But at what cost, financially speaking?

$485.95. That’s the cash price for a 30-Days worth of Abilify at 2mg. The price obviously goes up as the dosage is raised.

If you have health insurance with prescription benefits, congratulations! You will likely just pay the copay that is significantly less than the face value.  But we are not all insured. In a time when over 40 million Americans are uninsured and who knows how many are under-insured, will they even be able to afford Abilify, even if this is exactly what works for them? The hope that there is a treatment out there to help you flashes over and over again on screen. Yet this mere possibility itself may be attainable to you only if you have the financial ability first.

Perhaps that voice-over guy in the commercial should say a little disclaimer: We’re sorry. If you are not insured, this advertisement does not concern you, unless you’d like to trade in your house payments for these little green pills.

March 9, 2009

systemic shock

As I write about having to go through these medical procedures, I almost forgot that my journey to better health doesn’t end at just getting the necessary clinical care from the medical community. It is, in fact, far from over. One’s health care experience just isn’t complete until you get through getting all that paper from your insurance company, that is, if you’re privileged enough to have insurance.

But having health insurance doesn’t always mean that you are really covered enough to go see a health-care professional at any time. I was reminded about this upcoming portion of my HC trip when I picked up this week’s copy of TIME magazine. A lone prescription bottle stands against a stark-white cover, and next to it, a question: So You think You’re Insured?

This cover story, “Health-Care Crisis Hits Home,” written by national political correspondent Karen Tumulty, tells the story of the state of the current US health insurance system by sharing the experience that her brother, Pat, had to endure as he dealt with a diagnosis of kidney failure as well as his health-insurance company. Though I thankfully have not gone through a situation of Pat’s gravity, the story hit a little close to home with me because I pay for an individual health insurance that is not connected to any employer, which means my monthly premium is well over $300 with a really high deductible.

Each ‘little spark’ may be a life saver, but every spark comes at a cost, both physically (in this case, cognitively) and financially.

My statements haven’t come in yet from the hospital. I did, however, get my E.O.D. (Explanation of Benefits) for Dr. J’s part of the procedure. It was interesting to notice that each electric service cost was billed at about the same amount as my single therapy session. And it seems that my insurance company was much more eager to cover my receiving a jolt to the head than my sitting on the couch.

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