Thursday, September 8, 2016

Insurance Rage

Y'all . . . a rant is coming.  I can't help myself.  I need to vent.
I know I can't be the only one that just shakes her head about the state of the healthcare and insurance industries in our country these days.  I go from being totally disgusted, to having the full on rage, to really just being saddened by the state of affairs.   

To be honest, I'm not super well educated on Obamacare, the healthcare industry or the insurance industry.  What I am well educated about is how much it costs our family, what level of service we receive based on what insurance dictates, and how doctors make choices based on whether they will get paid for services . . . regardless of whether it's in the best interest of the patient.  

As a for instance, let's discuss my recent doctor visit.  My appointment was for my bi-annual breast ultrasounds, or so I thought.  I see my very friendly doctor and everything is going along as per usual.  She reviewed my mammogram films and felt me up . . . pretty thoroughly I might add. Then she lets me know I can sit up, shakes my hand very sweetly and tells me to have a nice day.  
I look at her all confused and ask if I'm getting my ultrasounds . . . because last I heard that was the point of being there.  Well guess what?  I am no longer allowed to get those twice a year . . . insurance says once a year will suffice.  

It should be noted that my mammogram films were already reviewed by a radiologist, and I've already received the letter that they were normal.  Listen, when it comes to things like this, you just can't hear the word normal too many times . . . but come on, does having them read twice seem efficient?  I'm going with a big fat no.

Why have I been getting bi-annual ultrasounds?  Oh, I don't know . . . maybe because both my grandmother and mother survived breast cancer and because it doesn't involve radiation.  

Come on.  Why wouldn't insurance want to me to get them more often?  Wouldn't it be a whole lot cheaper to treat cancer when it's caught early versus waiting until it has done more damage?  Not that I'm assuming I'm getting cancer, but you know what I mean.  

Perhaps I should also point out that the f'ing insurance company doesn't even pay for my ultrasounds because my deductible is outrageous . . . so I write a check to the doctors office every 6 months to cover them.  Okay, fine . . . I usually pay it over the phone with a card but stating that didn't seem to have the same umph!  
I may still just go ahead and have them done in the future and pay outright . . . I'm going to see how much this appointment costs me as opposed to the ones in the past and go from there.  

We, as a family, pay thousands a year to have insurance that doesn't even kick in until I've spent thousands more.  OMG.  I can't even.  Most companies can't afford to offer plans that don't have high deductible coverage because they are getting gouged by the insurance companies too . . . so I'm not blaming my husband's employer.  Lucky them I guess.  

Shall I go on?!?  Why yes, yes I will.

How about a couple of weeks ago when I take my littlest to her 11 year old check up.  She's mentions that she can't see the board as well as she would like at school.  I ask if they review her vision at that appointment . . . a check up . . . but alas they do not.  The personality-less nurse asked me if I wanted them to check it and I joked, not if it's going to cost me another $40 because it's not included.  

Her reply?  "Yes, actually that sounds about right since we aren't sure insurance will pay for it."  I look at her like she is an alien and say, "Forty dollars for you to see if she can read the Big E?  No thank you.  For that I'll take her to an actual eye doctor."  Her response.  "Okay."  I saw red.  I felt my body have a physical response so I just sat their quietly willing my blood pressure to go down.  
Side note about that appointment since I'm letting it all out . . . my daughter was stressed out about getting her 11 year old shots, as most kids would be.  They doctor leaves and tells her the nurse will return to give them to her.  After more than 15 minutes and me sticking my head out of the door twice, the nurse shows up to give her shots.  Who freaking leaves a child sitting in a room stressing over her shots for that long?!?  I'd switch to a different office, but they are all the same.  We switched to this one feeling like we weren't getting treated like we wanted at a previous office.  

I am ever so thankful that my children are older and less prone to illness.  I am also so thankful that when they were little and we were going through the asthma and ear infection stages that we had better insurance with a copay.  

The doctor mentions in Amanda's appointment that she didn't have any sick visits since her last appointment.  I told her that's because it was way more affordable to take my children to an urgent care and pay a flat fee than to come to their office and pay their negotiated rates.  She had no comment.  Shocker.  
Anything else you ask?  Yes, how about this one . . . don't mind if I do.

So back in the winter and within days of each other, both Kyle and Amanda had to have X-rays from school related incidents.  We went to the area children's hospital urgent care located near us. I was super impressed with the facility and everyone we encountered there was fabulous . . . just thought I'd throw that in there.  

We saw a different doctor for each visit but for about the same length of time . . . less than 5 minutes for sure.  The only differences between the appointments were that the wait time was longer for Kyle . . . and it was his arm and Amanda's leg.  

So the bills for each visit come within days of each other.  And guess what?  Kyle's was over $200 more than Amanda's.  Why would this be unless an arm literally costs more than a leg . . . which seems counter intuitive, right?
So I call and it turns out the doctor's coded the length of the visits differently.  Amanda's coded it for a 20 minute appointment, but Kyle's coded it as a 40 minute appointment . . . that's an expensive 20 minute difference.  I explain that they length of time we saw the doctor was basically equal . . . we just waited longer for Kyle to be seen.  

So this gets sent up to the powers that be for discussion and a decision.  Thankfully they realized that both appoints should have been coded as 20 minutes, the lower amount.  They patient advocate I dealt with was fabulous . . . beyond fabulous.  She instructed me not to pay Kyle's until it was corrected, and I got a new bill.  He was seen on February 3rd . . . I still haven't received a corrected bill.  It's been 7 months.  No seriously, take your time.  I'll wait. 
If I didn't have the "benefit" of both children having injuries within days of each other, I wouldn't have known to call and argue the amount for Kyle's bill.  How often is this happening?  Probably more than we'd like to know.   

You guys.  Don't even get me started on over prescribing of medicines.  Doctors don't have time to look for the root of the problem . . . they have to see more patients to get paid . . . by the insurance companies.  What a vicious cycle.  

I should point out that I really do like our doctors . . . I think they are good people who are equally as frustrated by the state of affairs as I am.  I'm sure doctors endure the years of school and hard work because they want to help people . . . but I also suspect the paperwork and legality ties their hands a lot of times.  

Are others as angry as me?  How many upstanding, tax paying citizens make unfortunate healthcare decisions based on the outrageous costs these days?  Gah.  I could take a more political route on this topic, but I have no desire to debate politics here.  Good day sir.
It may sound defeatist, but this is all big business and the little people making rational sense are not going to be heard.  I could go on and on with my rant, but what purpose will it serve?  I need to let it go, ignore the stupidity of it all and work on keeping my blood pressure at a normal level . . . Lord knows I would like to avoid going to the doctor.  

Okay rant over.  I'm not sure if I feel better or not, but I think it's time to go hug a puppy and have a margarita!  Or three.  Cheers!  


  1. here in canada, we have "free" medical...but it's not really free since we get taxed out our asses but we don't have to pay anything when we see doctors/eye doctors/get surgeries, for hospital stays etc. even major things like heart surgeries are not out of pocket. that said, our healthcare could be better as well. minimum wait time at majority of hospitals is 4hrs. FOUR HOURS...and that's just to be seen by a doctor...that doesn't include getting actual treatment. they tend to treat kids much better than adults so there's at least that. specialized hospitals are also better staffed; we have Sick Kids hospital and they're amazing but i also think that's because a lot of companies and rich folks donate to that hospital so they're not grasping for government (funding) scraps.

    the ontario government has recently changed the coverage for a lot of things so instead of a pap every year, it's now every 2. eye exams to every 2 years or pay $50 for an additional fee. mammograms to every 2yrs instead of every year. so i guess we're also feeling the (federal) budget cuts but i do feel lucky to have this health care since most of our hospitals are actually pretty good due to the donations/fundraisers so hospitals don't have to rely on public/gov't funds which is much better.

    this is also why i'm all over my family to practice prevention which is eat healthy, get plenty of sleep and exercise regularly....doctors are too eager to hand out prescriptions to keep those turn-styles going.

    sorry for all of your insurance woes. that really does suck. i heard obama was trying to model US health care as universal but even that doesn't go without some pain. even now, i'm not even sure how many years universal has been in place here, canada has its problems with it but we make do. i suppose that's why naturalpathic doctors and the whole fitness movement has's much easier (and cheaper!) to prevent sickness than to deal with it.

  2. I wish there was an answer to all of this. It stinks. I can't imagine how people making minimum wage afford this type of stuff. Hope you feel a little better after your rant! Oh, and THANKS for the GIF of Erika from RHBH!!!! Love her!!!

  3. Girrrrrrl do not even get me started on insurance and our healthcare. I can rant and rant and rant about how terrible it is!!! And you know what really pisses me off???? My company pays nothing for maternity leave. NOTHING. I have to claim short term disability and save vacation days. I mean WTF? Most countries give you off a year or more but I cant get a few weeks paid time off? I cant afford to take more than the 6 weeks no matter what happens because hello we need my income.

    The whole thing with Kyle's bill being more is just so incredibly ridiculous to me and I am sure that we allllll get screwed this way. Two years ago, I went to an urgent care doctor on a Saturday because I KNEW I had pneumonia. I freaking told him it was pneumonia because I had it before and knew what it felt like. He saw on my form that I was on birth control and told me that no, it was a clot in my lungs and sent me to the ER to have a cat scan done or something. It was all clear. $400 later I am sick as a dog come Wednesday and cant breathe at all so I go to my normal doctor. Upon walking in the room he looks at me, says girl you have pneumonia I can hear it in your lungs from here. I told him what happened and he was so mad about how the other doctor handled it. He was like why didn't you come to me first. I told him because it was a Saturday and I was trying to be proactive because I know you only get worse with pneumonia the longer you want. UGH!

  4. As you may know, I work in healthcare and I hate it I hate it I hate it when it comes to insurance. Thank God I don't work in that portion of it because I swear I would go off on a rant every single day! I feel your pain, I've been in many of the same situations and the ultrasound makes me especially mad! My God you have it in your heredity, how dare they not perform that for you. It's about keeping our Americans healthy so why wouldn't you pay for things like that? Hope you got your margarita Angel, I'll cheers to this with you darling.

  5. Oh baby, this topic boils my blood. I am absolutely sure people are getting gouged at places like those urgent care facilities, like you almost did, good for you for calling, BTW. But, like you said, also more expensive to see the DR.

    A while back I went to the lady DR who saw something that concerned her given some family history of close female relatives, so she asked me to come back more frequently. I was charged a ridiculous co-pay for a "specialist" visit. Which, after talking with the insurance company and making the argument that isn't this co-pay cheaper than cancer or a hysterectomy they said there was nothing they could do & that since none of those things were guaranteed it actually did make sense for them to reject this. I asked my DR if I could pay cash and I did because IT WAS CHEAPER. Which is ABSURD.

    And don't get me started that I pay for a whole bunch of things I will never use at this stage in my life, but can't get less expensive coverage on the open market, so I take my work insurance because for more coverage it's actually cheaper. But then doesn't necessarily cover the few things I do use. &$^%$!@*$#(*%#$^* is pretty much how I feel about all of this.

  6. Insurance is such a hot-button issue. Before my husband and I got married, I paid an assload and a half for my insurance and got NOTHING. Now, I'm so immensely lucky to be on Tricare through the military. It's horrible that taxpayers have to pay for it FOR us, but it's saved us so much. Porter's birth cost us $5. Yes. FIVE. Of an $8,000 healthy baby's birth. It's madness.

  7. Ugh, I am totally with you on the cost of everything. I recently paid a $50 copay to get my blood pressure checked. SO stupid.

    I will say that I don't think any doctor goes to medical school for the money. There are way easier/less time-consuming ways to make money. They go to med school for four years, making nothing (and accumulating loans. We have friends who have loans that are in the $400k range). Then, they are in residency/fellowship for 3-10 years after that making below minimum wage. Chris had to do an intern year, is doing four years of radiology residency, and then has one or two years of fellowship after that. If he wasn't passionate about what he does, there is no way he (or I) would be willing to go through it.

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