Friday, February 27, 2009

As with anyone who lives long enough, there are certain issues that will arise even if you have taken the very best care possible.

No matter how hard you have worked, no matter how much you have tried to do the right things and no matter how much you have given. Something will get you in time. Part of the human condition.

Recently I have come to an illness, one I never expected, but that is how it works isn't it. I thought I would be okay and would have the financial resources and insurance to cover this part of my life. I have faithfully bought and paid for my health insurance for the last 40 years with very few claims. In other words, I have been blessed with a very healthy life. That all changed over the past 6 months.

I have been told I am blessed that my disease was caught early and while still small. I have had no signs of any deterioration or degeneration of bodily function so far. (trying to count the little blessings). What that doesn't take into consideration is the QUALITY of life. They can extend the QUANTITY of life but really never consider but actually destroy the quality.

My bills will end up in the 60,000 to 80,000 USD but could max out at 100,000.00 for the procedures I need to have done. My insurance company, being the people they are, will cover 15,000, the rest is all mine. It is unfortunate but true. Since I didn't have to have the procedures done in a hospital but in fact in an outpatient facility they won't cover it(I am sure they worked in the background to make this an outpatient procedure in an effort to cut the insurance cost not because it is good for the patient). If I had to be in the hospital they would have covered it all with the exception of the deductible. It is what they refer to as catastrophic care. I think cancer is pretty catastrophic but what that heck do I know.

If you are insured at work, protect that benefit as best you can. If you pay your own insurance and don't understand the coverage, educate yourself NOW! Do not wait. Know the exact amounts of in patient care, out patient care, How much testing will they cover and what do they consider "customary and reasonable". Ask your agent questions on the limits and then don't believe a word he says, and try to figure it out yourself. Then question them if you have more questions and make changes as needed. Understand that insurance coverage is based on the profit line of the insurance company. If you have a bad policy you may have purchased it during a low profit period, maybe, if the profits are up you can now get a better policy at a lower price. I found this out recently and it was to late for me to change carriers. Under no circumstances expect that the insurance company want to assist you, support you or even talk to you. You will spend more hours on the phone with press 3 for claims, press two for the sound of a flushing toilet, This is their way of avoiding having to talk to the poor souls they deem the great unwashed.

At my age, I had hoped to retire in a few more years to enjoy a bit of my life. With the current financial climate and the insurance, or lack thereof, the bills mounting it seems I will be working until I am 90. Now, I am faced with a medical bill that will exceed the mortgage on my now paid for home.

Consider this, if you have no insurance, the state is highly likely to give you extra money for your care (medicade), if you are not a citizen, the government will most likely cover all your health care needs, if you own nothing, the government will cover your health care needs (indigent care).

If you have insurance, know all the nuances of your insurance policy inside and out, consider carefully analyzing your current financial situation, then study the laws on medicade and balance it with what the insurance companies charge and provide. First and foremost remember the insurance company is not there to serve your needs or be your friend. The "like a good neighbor" thing is a lie, they are there to pay out as little as possible in an effort to have a great profit line for the investers. The heck with you, you're possibly a sick person and therefore detrimental to that bottom line. Understand they will pay more money to not pay your bills than they will to pay your bills. (proven government study) If you have insurance, no matter how bad it is, and generally it is bad, the government is not likely to help you. Your best hope, and it may be your only hope are some patient advocacy groups that will fight for your care, pricing and may be able to assist with the excessive medical fees.

Never, ever believe your insurance agent, he is about three steps below a used car salesman or a congressman, well, maybe the congressman is equal. He is going to sell what he has available with little or no concern for what is best for you. He would sell his grandmother if he thought it would help his bottom line. He is working on a commission, he would sell refrigerators to eskimos.

Never us the phrase "How much will this cost?" near your doctor. He/she will get the look that a deer crossing the highway at night gets when they are hit with the headlights of a car. They will then bolt out of the room stating some to the affect of "what do they expect from me". How about truth and honesty.

Meet with the medicade/medicare people and find out if you will qualify if you drop your insurance. You may be better off in the long run. You will most certainly have better health care coverage. Never under estimate the value of public health care. Some states now have funds for those folks without insurance, none for those who have tried to be good citizens and paid those pesky insurance premiums, no assistance for those who fall into the insurance trap. So, in some cases those without insurance have a blessed condition. Some states are now offering state health care insurance, at reasonable prices but you must be without paid health care insurance for six months in many states. If you can survive that or are there right now, check it out. May be your get out of jail card, go past go and collect 200.00.

Write your congressman, if you have nothing else to do, are bored and want to have a good laugh. Your one vote can never begin to compete with the medical lobby, the insurance lobby or even the gun lobby. Yes, you are likely to get a response, if that is what you call it. They will tell you that health care is one of their major concerns and that they are investigating it and considering the possible options. Loosely translated, we are not about to do anything but this line of "we do care and are working for you" should shut you up for a while.

Think about it.

The bottom line is that when you get sick, it is you against them. If you don't have someone working in your favor, you have a rough road ahead of you since they are all well, full of energy and have oversized staff of people to give you the runaround. You on the other hand are just one person, taking on a multi limbed monster designed to confuse, divide and conquer. On top of that you are in no condition to fight, remember you are in the health care system because you are sick, weakened and fighting for your life in some cases.

Anybody got some pocket change? Hey, where is my government bailout?