See, this is exactly why I didn't bother with having insurance for such a long time -- it's so much more straightforward to just know that I can't afford any care at all.
When the revolution comes, the insurance executives are first against the wall.
I'm not sure what should happen next, and I'm really busy, so I don't do anything
This is what's diabolical: they make it seem like your fault. "But open enrollment ended on the 17th, and you submitted this on the 18th, sorry," or, as in this case, "you were frustrated with us and didn't follow up maniacally, sorry." Basically, there are a bunch of trap doors that you can fall through that let them deny you care.
Trying to be reasonable: I'm not sure there's another way to run an insurance company, but obviously (cue baa), the system of which they're a part isn't working.
Man, don't get me started on what passes for health care in this country. I'll just direct you here and here and here for a few of my run-ins. And then tell you one insurance company story:
Back in spring 2002, when I was on sabbatical 1800 miles from my ostensible place of residence, I developed a blood clot in my calf. Weirdly, I knew immediately what it was, though at first I assumed that I was being a total hypochondriac, so I waited three days before going to the emergency room, where I was roundly ignored for three hours, because everyone else assumed that I was a hypochondriac, too. They finally rolled out the ultrasound, figuring that I'd have to pay for it if nothing turned up and my HMO refused to cover it, so what the heck. And lo, a clot. So the HMO covered the emergency room visit minus the usual co-pay.
But here's where it got annoying. I got sent from the emergency room to a doctor's office, because the doctor on call said that the clot should be treated with massive doses of blood-thinners, and that I should be restricted to bed in the process, but that there was no reason that this bed should be a hospital bed, so they were going to send me home and send a home health-care practitioner to give me injections twice a day. And that would cost the HMO x amount.
While in the doctor's office, he got on the horn with my HMO in order to get this course of treatment approved. And they refused, saying that if this wasn't an emergency, I needed to wait until I returned to California in order to be treated. And he said, dude, it's a blood clot in her leg; she can't travel. They said, is that an emergency? And he said, yeah, it's an emergency. And they said, if it's an emergency, she needs to be in the hospital. And he said, but she doesn't need to be in the hospital. And they said, if she's not in the hospital, we won't cover it.
So they checked me into the hospital for four days, where the only thing they did was wake me up every two hours to take my vitals and give me an injection every twelve hours. And it cost the HMO somewhere upwards of 10x. And they paid every penny of it. And since that time, my premiums have tripled, because of the crisis in health care costs.
So if you're looking for somebody to man the barricades with you, I'm there.
No nightmare healthcare stories, just good wishes, FL.
Okay, I'm a total ass. What I meant to say was wow, that sucks. I'm sure everything will work out, but I'll be thinking of you in the meantime.
Best wishes, Labs. And I hope it is also appropriate to chime in with KF to say "Health care in this country fucking sucks."
Now taking nominations for guest bloggers!
Don't have cancer, dude. That would be so gay.
3: Exactly. It's a perverse incentives problem -- the insurance companies have an incentive to deny care, and the consumer doesn't have the power to punish them by moving to an alternative insurance company. My sympathies.
A minor bit of practical advice, which you may already know: I don't know how pushy you are, presonally, but IME, and based on the stories I've heard, insurance companies are notorious for greasing the squeaky wheel. Devoting a couple of hours here and there to phone whoever you can talk to about denying the authorization for the CT scan, explaining your doctor's reasons for thinking it's necessary and talking politely but firmly about the incredible levels of personal liability the denier of the authorization might be subjecting themselves to if you do have a significant health problem may get you the authorization you need. It's a hassle, and it's a sin and a shame that the system works that way, but it might help.
I'm hoping, if worst comes to worst, that you will donate you enormous cock to science. And yeah, best wishes! Watch out for that cute nurse on the night shift -- she's trouble.
Labs, don't be sick, you're too beautiful for chemo.
Um, seriously, best wishes.
Labs, my advice, join the military and become disabled. Thereafter the VA covers everything. This works for me, I never have to deal with an insurance company the rest of my life.
Oh, and I was trying to type "Labs" and it came out "Fabs" at first, (better than "Flabs"). Good luck with your abs.
That would be so gay.
Though not as gay as Brokeneck Mountain. I'm sending all my spare good health mojo your way, Labs (please ignore the fact that I'm a 37-year-old smoker/drinker with a questionable diet, no exercise routine, and insomnia).
the consumer doesn't have the power to punish them by moving to an alternative insurance company
Somehow it seems to me that I see a lot of "market-oriented" commentary about health care that does not appreciate this fact. (Not baa, though I'm not sure I'd call baa market-oriented either.)
Oh, and speaking of guilty parties, 's been too long since I went to one of those.
I was tempted to riff on the tumors-as-projectiles and the uprising theme, but it's too damn macabre. Good luck, FL.
While you're waiting for the CT, you might want to angle for a colonoscopy if you haven't had one recently. I'm totally not kidding.
Ditto good wishes, and what LB said.
And also, from recent painful personal experience: If you or someone close to you has the energy and inclination to be a good recordkeeper, it is so worth it.
A friend of mine was hospitalized on an emergency basis while staying with me a few months ago; the insurance company later claimed this was "out of network" and billed her $3400. It was only due to the compulsive tendency to write things down that she was able to prove they'd told her otherwise before she went to the hospital. (She had the first name and "incident reference number" given her by the insurance company rep.) Presto. Bill lowered to $600.
Not a good way to run a health care system, for sure. But oddly, keeping track of minutiae such as exactly what medication they've given you and how long you waited for x test or results can help distract you from the tedium of sitting around a hospital.
you might want to angle for a colonoscopy
Sounds like that's the one thing the insurance company isn't denying him.
Word, boss. Hold 'em steady. We salute.
My comment was dumb. What I meant to say was "Get well soon, and damn the Man."
colonoscopy
But Michael just performed one at the meet-up. I was told I'd be good for another decade...
Thanks for the good wishes. I'm sure it'll be fine, and it might even lead to more posts about humiliating medical procedures.
Yeah, definitely, best wishes from the lurking crowd too.
If you start feeling like you're "full" and "don't want to eat" for a couple weeks, buy a gun and demand a CT.
That happened to someone I know recently -- when they finally wrung the CT out of the doctors, it was definitely advanced cancer. Not one of the good kinds, either.
So yeah, bestest of wishes.
Lurker, lurker, lurker, never mention not-uncommon symptoms to a hypochondriac (or anyone else, for that matter), especially when you follow it up with "advanced cancer." Yeesh. "Full" and "don't want to eat" are symptoms of a bunch of benign things too, like duodenal ulcers, for example.
Best wishes!
I don't know your age or any of your health history but assuming you are otherwise reasonably healthy and youngish the chances of cancer are really rather small. I hope that can ease your fears somewhat.
I was told I'd be good for another decade...
We're all sure you're excellent, but what does that have to do with a colonoscopy?
"Full" and "don't want to eat" are symptoms of a bunch of benign things too, like duodenal ulcers, for example.
Or, of course, a heavy lunch.
humiliating medical procedures.
The worst that ever happened to me was having a tube shoved up my dick and removed. Twice. I don't EVER want that again.
29- Or of having gone to an all-you-can-eat buffet. But maybe that's not so benign.
Lurker, lurker, lurker, never mention not-uncommon symptoms to a hypochondriac (or anyone else, for that matter), especially when you follow it up with "advanced cancer." Yeesh. "Full" and "don't want to eat" are symptoms of a bunch of benign things too, like duodenal ulcers, for example.
Seriously, yo. All of a sudden I'm worried about myself because I'm feeling full and not hungry. If I had to bet I'd say it more likely caused by the lunch I ate an hour ago than by advanced cancer, but now I'm all stressed out nonetheless.
LB, did you know that not only am I as crazy as you are, but we both make the exact same kind of bad joke? If you also collapse into laughter after telling them, we may be long lost twins. Or you're the missing evolutionary link between me and Bphd. Or something.
And then there's the number of awful things portended by "flu-like symptoms": everything from plague to Lyme's disease. Lesson? Avoid diagnostic literature and squirrels.
LB, did you know that not only am I as crazy as you are, but we both make the exact same kind of bad joke? If you also collapse into laughter after telling them, we may be long lost twins. Or you're the missing evolutionary link between me and Bphd. Or something.
Or, you guys would be a hit on the Poconos circuit.
I saw an ad for some snake oil once that asked "Can you frequently breathe more easily through one nostril or the other?" The truth is that is just about as common and benign a condition as 'Does one testicle hang lower than the other?"
Aargh, you mean the tens of thousands of dollars I spent on testicle-equalizing surgery was wasted? But my practicioner assured me it was vital!
32: Yeah, that's my boyfriend's worst medical experience, too. He says he looked in the mirror afterwards and his face was literally paper-white.
Do you sometimes feel dissatisfied with your life? Do you occasionally feel unusually tired for no apparent reason? Are there people who you find unbearably annoying, even though you can't say quite why? Do you sometimes forget things that you really should know? Are there days when nothing seems to go right? Are you extremely hungry some of the time, and lacking in appetite at others?
If your answers to three or more of these questions is "Yes", you are at risk. But we can help you -- if you act now!
Jeremy,
Geez, American Doctors, all they think about is money.* Ancient Chinese cure for same condition - go jump in a cold lake.
* Which is the penultimate punch line to a great joke.
I find it sort of fitting that J.E.'s last comment was #42.
Or, you guys would be a hit on the Poconos circuit.
I've been accused of being an elderly Jewish man before; I don't know that anyone's ever made it clear that the elderly Jewish man in question was Henny Youngman.
If you also collapse into laughter after telling them,
Pretty much, although it's more of a noiseless snorting process.
If by "practitioner" you mean "prostitute", and by "surgery" you mean "sex", then it was most certainly not wasted.
Tia,
I refused general anesthesia for knee surgery a few years back just to avoid the catheter. I was serious. I dunno if I'll ever take general again.
Look on the bright side -- at least you don't have something that's "almost certainly not" testicular cancer. Phantom symptoms appear like you would not believe.
At least that's what... my friend... told me.
Tia, I think it has long been obvious that Emerson is the path to enlightenment.
Indeed, to your health, Labs!
My sister was diagnosed with having a wheat allergy, one of the symptoms of which was "fatigue, especially in the morning." Hey, maybe I have a wheat allergy, too!
Best wishes, Labs. I'll refrain from making a joke about the abdominal snowman, not because it's not funny, but because I'm no longer six years old.
I refused general anesthesia for knee surgery a few years back just to avoid the catheter.
They don't pump the anaesthetic through your penis, silly.
They don't pump the anaesthetic through your penis, silly.
Didn't Liquid Sky have a couple of scenes that where semen was equated with heroin? Or maybe I'm thinking of something in Burroughs....
Re 29: Listen, I apologize for bringing it up like that.
(And when I say, "couldn't eat" or "felt full," I'm talking about not being able to get anything more than soup down for like, a week and half but still believing the (first) doctor when he says "it's constipation").
Alls I'm saying is, after something like that, I am feeling hypochondriacal myself. And with good reason. Just 'cause you're paranoid doesn't mean... etc.
So, again, and seriously: best wishes.
54
Then what WAS that shadowy guy doing in my hospital room?
Yeesh, now I really fear hospitals.
(Not to discount KF's terrible experience in 4 but every time I scroll past it I think of "Not for use on unexplained calf pain!")
In 46, "heath" s/b "health" obviously.
59 -- Oh, I thought it was a Bareback reference.
a_ (may I call you a_?),
The good thing is that 999 times out of 1000 (or whatever) it really is constipation.
I'm no Doctor of course but I do some work with training Med students and I get to hear feedback from their Profs and they are taught to always suspect the common things first. For one thing that is almost always what the problem is and for another they do NOT want to use the C word unnecessarily because it is so devastating to hear.
stay strong Labs. so that when I take you down, I will not be denied my rightful glory. and also because you are swell.
IMPORTANT .. pass it along ...
Quote from Bush in 2004 --
"A wiretap requires a court order," President Bush declared in a statement in 2004. He added, "When we're talking about chasing down terriorists, we're talking about getting a court order when we do so. It's important for our fellow citizens to understand [that] constitutional guarantees are in place... because we value the Constitution."
Ooh! Are we playing telephone? I love that game.
dangling elephantine testicular varicose vein.
10: LB, This is good advice in general, but the truth of the matter is that—if the plan is self-insured and subject to ERISA—then there's really almost no liability. ERISA was designed more for pensions than for managed care and is based on the principles of trust law. You are only entitled to the benefits you were denied and some attorneys fees, partly because Scalia does not believe that make-whole restitution can include anything like consequential damages. So, if someone (not Labs, of course) did turn out to have cancer or something that would have been caught by a CT scan, he can sue for the cost of a scan. Even if you suffer a stroke and need expensive home care.
bg, you're the worst Telephone player ever. That wasn't even close.
Ugh, Labs, I'm so sorry. The insurance companies are totally teh suck, and I agree: first up against the wall come the revolution.
Sadly, my experience doesn't bear out Lizard Breath's recommendation to be the squeaky wheel. I would call, be told "we cover that," go get it done, call back to file the claim, be told "we don't cover that, and whoever told you we did was wrong" etc. etc. etc. for MONTHS. Finally I got so frustrated I just paid the fucking bill myself.
Assholes, all of 'em.
A friend has all the eposides of "The Awful Truth" on DVD, and he showed me an awesome one in which Humana (I think) was denying a pancreas transplant to a diabetic even though they were supposed to cover everything diabetes-related, which this was (he would have died without the transplant). They did Moore's usual trick of having the patient confront Humana execs directly, personally asking them to spare his life, and when that didn't work, they came back to Humana headquarters and passed out invitations to the guy's funeral, and then staged a "funeral rehearsal" right in front of the building, which of course the local media attended and covered, leading to the shaming of Humana. One week later, he got his transplant.
Michael Moore is really great at what he does.
73: Oh, I know. It's still a good way to rattle people, and maybe get them to reconsider the use of their discretion.
What everyone else said: insurance companies are scum. Best of luck, FL.
I've had some good, some bad experiences with insurance- for most people, the good don't stand out because when the system works (like, say, Medicare) it's all done in the background and you don't even have to think about it. It's when they screw up that it sucks.
Screw up- I went to the doctor, paid $15 copay, but he did two things at the same visit, so the insurance company decided I owed two copays (despite the fact that this is actually not their policy, as they later admitted.) The sucky part? They never bothered to tell me that they were charging the extra $15 until after they decided to send it to a collection agency and mark my credit report (no bill or anything until a collection notice)- I got them to wipe the charge, but I have to appeal the credit history with the credit agencies.
The good experience? We had a kid, with minor complications, and paid a total of about $30 from pregnancy to bringing him home.
When I had my wisdom teeth out, there was some weirdness regarding the insurance paperwork (on their end - two months earlier I'd been mysteriously unenrolled and re-enrolled in the span of one day) that was just enough to convince their computer system that I wasn't eligible to have any of it paid. I made a call a month for six months or so, each time with the same result: "Oh, you're right. We'll get that straightened out." Next month, back to square one.
Finally, following a letter from the oral surgeon saying they were turning the bill over to a collection agency, I called and stated through clenched teeth that this had made half a year of the same goddamn phone call and that if it didn't get resolved *while I was on the phone* this time, I was showing up the next morning at their Raleigh office (and I listed the exact street address for her) with a baseball bat. While this were pure hyperbole, I nonetheless assured the poor woman on the other end that it was not and that I really was teetering on the edge of exploding.
I got to speak with a corporate vice president and received a letter of apology a few days later. So, y'know, sometimes threats of random berserker violence get the job done.
61: Yeah, I know, and you're right. Again, I apologize -- shouldn't have said it (ogged, if you want to delete this and all my other comments, feel free?).
I'm just ... well, a bit disconcerted by the fact that I was just in close contact with someone who was in the 1-in-1000 category. Ergh. So this lurker is a bit gunshy, that's all.
Again, apologies.
SP,
Yowsa! $30 out of pocket for childbirth is fan tan diddly iddly tastic!
You've got me channelling Ned Flanders. Where or when did this happen?
Let this be a lesson to you, would-be delurkers.
Contrary to common wisdom, the best health care system I was ever a part of was Kaiser Permanente's HMO. Loved it, worked right every time, and the red tape was transparent as an end user. Predictably, they closed up shop in North Carolina.
Joe Drymala gets it exactly right.
Joe Drymala is banned to hell!
86: My first son, who was born through the Kaiser system, cost ten bucks, including all pre-natal visits and the delivery.
I was wondering what this handbasket was for.
My kids may have been free (well, entirely covered by my insurance premiums) -- I might not remember a de minimus co-pay, but I don't think there was one. I took the cheap route regardless, though, and went with a midwife service (who I heartily recommend to anyone knocked up in the NYC area.) It was wildly cheaper than doctors, which was kinda cool.
That's quite a wifi signal you got there, JD.
It's for lowering the lotion down into the pit. Now put it on.
Damn. Nothing but PCs, using Internet Explorer.
No sh*t?
Yeesh. My current go around is over some dental work. The Dentist did a crown-buildup but can't do the crown until an adjacent extraction site is ready for a bridge. Dentist wants to be paid for crown buildup work done, insurance company won't pay on crown buildup until the crown is put in place.
I'm caught in the middle.
Running Windows 3.1, if the last commenter I banned is to be believed.
i installed wifi, but like Starbucks and Logan, you have to pay to use it. You're all like "oooh free wifi" and then "$40 bucks a month? are you shitting me?" suckas.
Blue cross blue shield- the $30 was copays on prenatal vitamins ($10 per 3 month supply). For some reason they have copays on regular doctor visits but not on prenatal checkups. The complications required an extra ultrasound, which was fully covered. Childbirth seems to be one thing that insurance is willing to be really generous about, maybe because the costs are pretty predictable. Labs, you should get pregnant!
Oh, I think we did pay $75 for a baby first aid / CPR class we took, and some amount for a natural childbirth class, but those are kind of separate. I mean, technically they also didn't cover the food my wife ate in that time- bastards!
Hey, look, it's my lord and master.
That was 2004, by the way. An alternative theory, they're generous because there are a lot of regulations- I remember debates from the Clinton era about "drive-by births", so there are a lot of regulations about how insurance has to treat you when you give birth.
M insurance horror story happened years ago with my medical insurance. At the time my medical coverage came with my job and I always assumed it was great. Silly me.
A severely pinched nerve in my neck coming out of the blue put me into the hospital and surgery. When I recovered I found out that my medical coverage required a second opinion for spinal surgery or they would only pay 50%!
On the one hand I was extremely grateful for the relief from the pain but on the other hand I was out about $10K because I hadn't gotten a second opinion before the surgery. I explained that when I was admitted to the hospital I hadn't slept for about a week from the pain and wasn't thinking straight and didn't think to check my coverage.
Bottom line is that they only paid half.
Read the fine print.
Damn right, JD. Now go write me up some call scripts for the insurance people. They're in circle 7.
Sure, the birth of the kids is free, but you still have to raise it, buy it food, etc. It's sort of like those cheap printers with the expensive cartridges.
Don't be fooled, folks! Tweedledopy, this means you!
Sure, the birth of the kids is free, but you still have to raise it, buy it food, etc.
Wait, insurnace doesn't cover this???
Get well, Labs!
HMOs suck. Especially ones affiliated with universities. Especially when the system assumes that if you're a student and ill, you must be trying to get out of a homework assignment. Look, if drinking fluids was curing this, I wouldn't be wasting time in your office.
Urple -- yes, it's like you catch a chronic disease, and they cut you loose after 9 months. You always find these things out too late.
Actually, a lot of hospitals do use maternity as a loss leader, or did once.
My fucking university provides light boxes to students for SAD--but my health insurance doesn't cover them, and the university *only* gives them to students. Fuckers.
JE, I bought child insurance from that nice salesman who came by the house yesterday.
My university seems to regard mental health help, so I've heard, as 'preventing you from committing suicide while on university property.'
Preempting baa:
You all are still currently alive, right? The healthcare system is working fine.
Fontana, hope all is OK. Sounds to me like an enormous parasite.
But Michael just performed one at the meet-up.
You're also clear from testicular cancer, as far as my nimble fingers could detect.
don't be sick, dude. Sartre says you only have cancer if you accept you have cancer!