My kids have the flu. It happens. Still, every time I contemplate the course of events that might unfold, I get palpitaty, especially since I know I’ll have to deal with so much paperwork and just general unethical nonsense from my insurance company when the bills start coming in.
I will be the first to admit that I know very little about the healthcare system, other than what I have experienced myself. As the mother of two asthmatic children, that’s kind of a lot. I have been in and out of ERs with regularity, and have had about five different kinds of insurance through my husband’s work since they were born.
So here’s how this incarnation of our health insurance works: We have an HSA (health savings account). Every month my husband’s work contributes to it, and then we do the same. We have a 5000 dollar annual deductible, and over the course of the year, that’s about what goes into the account. We have a checkbook and a debit card linked to that account, and we use those to pay our bills. How we use them is closely monitored by the IRS so we have to keep EVERYTHING and be really on top of it.
We were sold on the HSA a little over a year ago based on the fact that if we don’t spend all of the money in a calendar year, we end up with some savings, and that once we reach the deductible, we don’t pay another penny during that year. It sounded pretty good, plus the company was making a total shift so we had no choice.
Of course the insurance company finds a way, actually several ways to fuck us. For one, whatever the doctor’s office charges us, they reject. Say we pay $128 (this is one of the bills I just paid) for a doctor visit. They should put that toward our gigantic deductible. They don’t, though. They reject the visit. It’s not covered. In this case not a single penny is covered, but usually it’s maybe half or two thirds that they approve. In order to avoid this you have to check before doing anything which they make almost impossible by never answering the goddamn phone. By rejecting and reducing everything, they will literally never have to pay out a dime to us unless someone in my family has a major accident. But then we will have to cover the difference, which will have nothing to do with what’s in the bank due to their weird fucked up system of calculation, and will amount to thousands.
We have to pay them hundreds of dollars a month just to have this “coverage”, in addition to contributing our own money, and we will never reach our deductible. We can’t. We have, however, run out of money in our account several times, given the fact that Lilu’s meds alone add up to 300 dollars a month during cold season.
On a side note, I would like to point out that my quarterly bottle of xanax comes to a grand total of 10 dollars – and you wonder why everyone is a pharmaceutical junkie in this country. Here’s an idea: life saving medications, let’s make those an ungodly fortune. Frivolous bullshit housewife meds and pain killers should be practically given away so that the dependent can suckle at will. Nice plan, pharm companies. Clearly it’s working for you.
Back when I lived in Hoboken and before I knew what was what, my HMO insurance told me to go to a doctor where the instruments were filthy, and where in August heat I sat in the office with my feverish baby and a dozen elderly people who looked like they were dying in their chairs (think the waiting room in the movie Beetlejuice) for several hours without any air conditioning. When I left I had a desperate, panicky feeling I couldn’t shake. I could find someone else, move on, but all those doddering elderly couldn’t do a thing except suck it up.
It’s fucking nauseating to me that my son is on the couch shaking and wheezing right now, and I have to think about the fact that it will cost me 600 dollars out of pocket to take him to the ER if it comes to that. It shouldn’t have to factor in at all.
We are lucky. That’s the thing. The system is crooked and we are privileged to have what we do. Part of me hesitates to write this because I am so aware of that, and I am truly so grateful for what my husband’s benefits do provide. Without the insurance and the account, we would be broken by bills. It just seems wrong that we have to put up with the schemes perpetrated by the insurance companies. Again, I know that my husband’s company means well. They’re trying to save money, and for some employees, this totally works. They’ll never go to the doctor and at the end of the year it’s like they got free money and a tax deduction. For us it’s just barely a functional situation.
What I witnessed in Hoboken really brought to light how horrible it can be when you don’t have money, and what I am going through with my insurance company right now is just one example of how insurance companies manipulate people. Frankly, it exhausts me so much that I can’t summon the energy to fight. They’re too big and powerful, and they just don’t care what I say.