Here is a personal story for you about health insurance coverage.
This is not one of those terrible stories but this is one of the more common ones that goes on everyday for people who have health insurance.
I must give you a little medical background first. My husband had an allergic reaction about 30 years ago. He is a frugal man and a person who tries to avoid hospitals at all costs. But after turning blue and other good things like that, he finally allowed someone to drive him to an emergency room-no ambulances for him either. Anyway he got there just in time. They gave him one of the “your heart is stopping shots”, you know, straight into the heart. Then he spent quite a while in ICU. So that is the early part of the tale. We never found out what caused it. He got the carry-these-pills-with-you-at-all times, take-one-and-call-an-ambulance-if-it-happens-again sermons as he was leaving. He did keep the pills with him for quite a while.
One evening recently he woke up with itching and burning, spreading fast, huge blisters forming etc. The pills would be no good after 30 years even if we did still have them. So, we go to emergency. You know this only happens when the Dr.'s office is closed. He got treated in short order. This time we were quicker the heavy doses of medicines worked and he didn't have to stay. Given another set of don't-take-a chance instructions again, we left. Things are fine thus far and we feel getting there more quickly this time saved a lot of fun for him and money too. We also are pretty sure this was a true emergency so that argument shouldn't come up.
So now last week we got the usual notices from the insurance company, Cigna, that they had received the bills and guess what-not paying one red cent. We have high deductible, $5000 family, but family does not include our son because he is 24 even though he is back in school full time, so family in our case is 2. We have high-patient-pays-about-everything-all-the-time deductible, but-we-will-negotiate- for-you insurance. Kind aren't they. The more they can negotiate for me the lower the chances I will ever see the $2500 deductible. Duh.
So I just sent the med center over $800 and the Dr's part will be over $300 when that bill comes. (I do not begrudge our med clinic, a good one, nor the ER Dr. one cent.)
We are retired and not quite old enough for Medicare. We are not wealthy. But we feel we are in fair financial shape. Yes, we saved and we invested for 30 some odd years. But $1100 to $1200 is a tad more than pocket change to us. Guess what. Once we reach the $2500 per person deductible they will start to pay 80% maybe. We always figure we will just pay most of any medical bills, so what do you do? We are not terribly unhealthy so just figure we will pay it and lump it.
In a short time we will be Medicare people. Guess what else. My husband worked for a company that had retiree insurance, one big reason he stayed with them when he didn't want to do so and when they were trying to figure out how to get him out. He hung in there because we knew we needed the insurance. They called it then, “the golden handcuffs”. Now when I say retiree insurance I don't mean it is all paid for; we pay some, and the company pays some. We were informed, several years ago, that when we hit Medicare we will no longer have much coverage, just call it basically gone, from the company insurance. We will no longer have the opportunity to get the drug coverage, we will no longer have dental insurance. The company does not pay for dental they get us a good deal and we pay that ourselves. And on it goes. The options we have had through the last 5 years have slowly disappeared anyway.
We have been a thorn in the side for quite awhile anyway. We live in small, rural area, with a great county med clinic and a good doctor but we cost the insurance company more because we can't be forced into an HMO-too far away.
Now I want you to know my family and I are lucky, well maybe not just luck, but some is luck. We are lucky that our health is fair-to-middlin; we are lucky we have any insurance still. We know these things. We are better off than most of the people we know.
What started me thinking about all this? The Med. Clinic just called because they realized we had a large bill and wanted to know if we needed help or wanted to set up a payment plan. I thanked the lady and said no. I told her we didn't figure on much ever from insurance we just keep hanging on to the insurance for the big catastrophes. Well, the catastrophes that the insurance company won't drop us over. I told the nice lady that called that these things are partly why the insurance company can figure I will do what I can, in my little way, to get “HEALTH INSURANCE REFORM”.
Now that I told you this little story go to a PBS station find the Bill Moyer's Journal, kind of a rerun but needed, on why we need “health care reform”. It will definitely remind you of why as President Obama says, maintaining the status quo is not an option.
link to PBS is; here.
Washington Week in Review was just excellent this week also here is the link to that show. www.pbs.org/weta/washintonweek/ here
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