Coffee heat rising

health insurance

Worry: What’s our beloved employer up to now?

by

None of this bodes well. Our Beloved Employer, the State of Arizona, is up to something, and it ain’t good. They are actually keeping the nature of the 2009-10 health care plans secret. Open enrollment starts on Monday, and HR on all levels—at the state and at the university—is refusing to tell anyone what choices we will have or what providers they will cover.

What this means is that (once again) the pooh-bahs expect people to be dangerously angry. The last time they pulled a serious number on us, when PeopleSoft was jacking us around to the extent that some people weren’t getting their paychecks at all, they had armed guards present at meetings in which they tried to justify the various ways they were screwing us.

Rumor has it that we will be offered only two health plans, one from Aetna and one from Cigna. Everyone here knows how likely it is that you will get in to see your accustomed doctors if you have Cigna as an insurer. From what I’m told by friends who are healthcare professionals, Aetna is even worse. When Cigna was our only choice (a state of affairs that devolved the last time our present governor was in power: coincidentally, her husband is a senior executive with that outfit), one of my doctors would not see me at all, even after I offered to pay him in cash! I had to go out and buy private insurance on the open market in order to have any choice at all in medical care—and around here, where medical care is about as good as the educational system, you do need to have some control, in the form of choice as to which doctors you will and will not see and which hospitals you will and will not end up in.

Since relatively few Arizonans are sensitive to this fact (in a right-to-work-for-nothing state, employees are just happy to get any health insurance), a limited choice of plans is probably not the issue. Some people will be annoyed, but not to the extent that the Mouthpieces will feel a need to have men toting guns present at public meetings.

No. The issue will be that the cost is going to go through the roof. And that will set people off.

The furloughs have done so much damage that a permanent pay cut in the form of a gigantic hike in health insurance premiums really will cause some serious outrage. We have had our salaries back to normal now for one, count it, one week. Over the past six months, I’ve been working at a $500/month cut in pay. My associate editor announced that she’s looking for another job, because the new little number they’re doing on her has cut her take-home pay to $200 a week.

If they raise insurance premiums to $200-plus for one person (which is what all the plans that are not HMOs other than the EPO presently cost), that will leave her working for…yes! nothing. Zero take-home pay. At that point, she’ll be better off to quit. Applebee’s, where she earns more in five hours than GDU was paying her in a week before its current shafting of her, offers a rudimentary form of health insurance that would carry her over until such time as she can find a decent job. My guess is, she’ll walk right out our door.

A-n-n-n-d… If that’s what comes down, I can’t do all her work plus all the work of the research associate they’re not replacing. Even if it’s only for four months, between September and Canning Day, I may be forced to quit, myself. Supposing Her Deanship agrees to let that much of our workload go and still keep our office open, an exorbitant health care premium will bring an end to my plan to save up enough cash to get by in the coming penury. It’s pointless to work yourself to death if the pay doesn’t do you any good. I’d probably be better off to quit, myself.

What a place!

We’re told the university system is getting $154 million in stimulus funding (quite a lot for educational institutions in this state, which tells you something right there: it’s a tiny, tiny drop compared to the amounts forked over to revive the automobile industry and to lay down more asphalt across our state). GDU is supposed to get the largest part of this.

When Her Deanship was canning me and again when she was raving on about how brilliant I am, several times she murmured that “there might be something” come December. Apparently they hope to find a way to salvage some part of our program if they get some money. But I’d have to think once, twice, three times about any such offer.

First, I really resent the prospect of another $300 to $500 cut in pay. Now, I realize that I’ll be paying something like that for Medicare out of a vastly smaller income. But it’s the principal of the thing: at least on Social Security I won’t have to work for my pittance. (I’ll have to work to scrape together two other pittances in order to survive…but we’ll overlook that for the time being. 🙂 ) Second, I’ve come to feel so angry about the way that outfit has treated my staff that I can barely stand to drive out there and walk onto the campus. And third, I’m tired of waking up at 4:00 in the morning and not being able to sleep for worrying about…well, about shit like this!

Helle’s Belles. I’m going back to bed. Too late to drug myself: I have to drive a car in a few hours. But damn it. There’s a limit to these three-hour nights.

Awww, C’mon! Am I really that dumb?

by

Seriously. How dumb DO they think we are? And more seriously: could they be right??

Late in October I dropped by my doc’s office to get a flu shot. I was there for all of 10 minutes, 8 of them spent in the waiting room.

Friday, comes a statement from my insurance company: the doctor has charged my insurer $86. The insurer is disallowing it, claiming the Her Doctorness is not in the RAN+AMN network. So now I’m expected to pay this bill.

Yup. You read that right. EIGHTY-SIX BUCKS for a $10 flu shot.

So I shot off an e-mail to her, she also being one of my coreligionists who sang in the choir with me ($86 for a flu shot: ain’t that Christian?). She replied that she was shocked and would get after the office manager. And so she did. Yesterday morning, comes this missive from that worthy:

I am very sorry for the inconvenience. We deal with hundreds of insurance plans and our front office MA should have known that we are out of network for Ran+Amn. You must understand however that your card also has BENEFITOPTIONS and BEECH STREET in large letters. We do participate in these plans and it is the ultimate responsibility of the patient to make sure hisor her primary care physician is on the plan.

Grocery store flu shots are less expensive because they are purchased in extreme bulk for the masses. They also have a greater incidence of sideeffects, Dr. Wallbanger [my doc friend’s senior partner in the practice] tells me.

In our practice, we normally do a nurse visit taking the vitals of thepatient receiving the flu shot. Insurance billing requires that we bill $40 for this procedure and insurance pays whatever they like.

Billing code 90471 is administration of the flu vaccine and the going ratefor insurance billing is $26. The rate for the vaccine itself is $20.

We administer flu shots in our practice as a service to our patients, andwhen billing insurance there are set amounts for each service provided.

As our front desk did make the error, we will write off all but $20 of the remaining balance for your flu shot.

Total price for a cash pay flu shot is $30, you already paid $10, so
remaining balance is $20.

Again I am very sorry for the inconvenience.

Okay. Are you following this?

Item 1: The head partner in this practice is actually suggesting, with a straight face, that the vaccine he’s getting is BETTER than the second-rate vaccine dispensed at Walgreen’s or Safeway, where, if I’d had the time and patience to track down a flu shot clinic event, I could have had the shot for a $10 copay.

Oh, dear Dr. Wallbanger: can you spell S-P-E-C-I-O-U-S?

You understand: he and his office manager assume I’m so stupid I will buy this story.

Item 2: We’re told the insurance company requires that the practice overbill, in the amount of $40, for a grand total of 2 minutes of a junior college graduate’s time.

And Item 3: We learn that really, we shouldn’t believe anything we’re told by the front office staff. Just because the staff says the practice is in-network doesn’t mean it is in-network. In other words: it’s the patient’s responsibility to read our minds. And BTW, try to read RAN+AMN’s corporate mind, too, since that worthy organization does not publish a list of participating providers online, at least not that three Google searches will bring up.

What’s being said here is either “we try to gouge your insurance company and if we can’t get away with it we still overcharge you but only by about half of the overcharge we try to extract from your insurer” or “we think you’re dumb as a post.” Or maybe some combination of those.

Okay, okay, I admit it: They could be right!

This afternoon I donned some garden gloves and rolled the compost bin into the alley by way of trying to salvage it after the Great Bee Fiasco. By the time I got it where I wanted to dump the contaminated compost, wisps of white vapory stuff that looked like smoke were leaking out around the lid. It kept on leaking. “Is it on fire?” I wondered. Felt the side to see if it was hot: no, not especially. So I waited a while till this phenomenon settled down.

Finally opened the lid. White airborne powdery stuff was still floating around inside.

Waited a while longer. Then rolled the thing upside down and tried to dump out the compost.

No luck. It really needed to be pulled out a fistful at a time, not a practical option with weird (stinky!!!!) white powdery stuff drifting in the air.

Went into the garage to drag out a little hand-sized pitchfork-like thing. Held my breath and tried to fork out the bin’s contents without inhaling any powdery vapor.

This did not work well, and soon I was fairly certain that if I breathed much more of the “beekeeper’s” crud, it was gunna make me good and sick. Rolled the composter over to the bulk trash pick-up place, where it will sit for the next two and a half months, providing the Trash Cop doesn’t wander up the alley before the next pick-up is scheduled. He hates that.

By the time I finished, my throat was burning and I felt dizzy. Luckily, I’m going to dinner at the home of friends, one of whom is a nurse-practitioner. A psychiatric nurse-practitioner (where was she when I was busy hiring the bee dude?), but a nurse nonetheless. Matter of fact, this is the very friend who gave me the composter as a lovely and much-valued gift, some years ago. She should be able to recognize if I start to croak over during the salad course.

The bee dude’s bill is in hand: Contrary to his listing online as such, this guy is no “beekeeper.” He works for an outfit called “Atomic Exterminating Company.” Atomic, indeed: young Dr. Strangelove nuked my bees, nuked my composter, and damn near nuked me.

Well: Dumb tax, eh?

I’m still left with the question of how we’re supposed to know when service people are lying to us! I guess that requires you to be smarter than this Ph.D. is.

Insurance: Never a dull moment

by

Just got a notice from the Great Desert University that my health insurance plan–the only one that covers my doctor–will be dropped this August. Thank you so much, beloved employer.

Well, I knew it was too good to last. After a long series of health insurance fiascos (including one year when the only provider they offered was so awful that none of my doctors would accept it-one doctor refused to see me at all, even after I offered to pay him out of pocket), the state started self-insuring a couple of years ago. They’ve had an EPO plan run by Schaller-Anderson, which, incredibly, covered all my doctors, including the Mayo Clinic, for a monthly premium of $24. This was a huge improvement over the $220 I was paying for the PPO, which sorta allowed you to go to your choice of doctors but two years ago quit covering the Mayo.

When Aetna acquired Schaller-Anderson a few months back, I thought “Okay…say goodbye to that!” Right on.

So now I’ll either have to find another doctor (which I do not want to do) or once again buy incredibly pricey insurance on the open market. The last time I bought my own insurance, I ended up with an MSA (medical savings account) plan. Though it offered total flexibility and generous coverage, it was very expensive–premiums were about $250 a month, and you had to deposit $1500 a year to a savings account with piratical fees. It’s probably moot, though. At this point in my life, I’d be surprised if I could get health insurance outside a group plan at all.

Other than the Mayo, healthcare providers in this state leave a lot to be desired. When I had acute appendicitis, I almost died while sitting fruitlessly in the waiting room of a much-touted major regional medical center. After sitting there over four hours in exquisite agony without even so much as a triage, I left and got some friends to drive me to the Mayo Clinic’s ER-the EMTs would not take me there, even though it’s no further from my home than the Third-World hospital that offered no medical care. By then the infection was very advanced and my appendix was about to burst. The Mayo’s physicians performed emergency surgery, and the care I received was excellent from beginning to end. And “end” could have been the operative word: for older adults, a burst appendix is a life-threatening event with a much higher mortality rate than for younger victims.

I want my choice of doctors, and I want to be able to see the doctor I’ve been seeing for the past 40 years, who happens to practice at the Mayo. When HMOs first started to take over the healthcare industry in this country, he saw the proverbial handwriting on the wall. Coincidentally, the Mayo opened its Scottsdale clinic about then. He had been trained at the Mayo, and as soon as he could he rejoined that organization. It’s a hellacious long drive for me to get to his office (the hospital is much closer), but I must say that the care I’ve received by and large has been worth it.

he state, of course, would like to herd us all into HMOs. I will pay out of pocket before I go into one of those things.

My mother died hideously in the “care” (a term best used ironically) of the first HMO organized in Arizona. As it developed, the doctors had a financial interest in the operation: if it made money, so did they; if it lost money, they lost money. So, it ran powerfully contrary to their personal interest to diagnose a patient with an expensive terminal illness. They simply refused to admit the obvious–that she had cancer. And it was so obvious, my cat could have diagnosed it. But the problem was, if they allowed that she had cancer, they would have had to treat her, and that would have cost the HMO a ton of money. So they denied she was sick at all-the day before they were forced by my father’s demands and the implicit threat of a lawsuit to open her up for an exploratory, her doctor told me and my father that that my eminently sane and practical mother needed a psychiatrist. When he did find her (predictably) full of cancer, he dropped her cold. They stopped providing doctors to see her or to advise my father and me on her care. I had to openly threaten them with my lawyers–repeatedly!–to get even the most basic nursing care for her.

She would have died anyway, but she didn’t have to suffer the way she did. Thirty years ago, there wasn’t much they could do for cancer, but they did have pain-killers. Even had they refused to treat her, they could at least have given her morphine, so she didn’t lie in bed suffering the tortures of the damned through the last weeks and months of her life.

After that and some other amazing experiences in the American healthcare system, I’m very picky about the kind of insurance coverage I get. I’m willing to pay to the max to get coverage that will allow me to go to any doctor I choose and that will pick up the tab for the astronomical bills presented by the kinds of illnesses one is prone to later in life.

So, this time around I’m going to look at concierge practices, where you pay a fee upfront in exchange for getting a doctor’s attention. In theory, you can get appointments promptly and the doctor schedules more than 10 or 15 minutes to talk to you. You still have to keep your insurance, but you might be able to get a lower-cost plan or even just a major medical plan. The annual fee is usually around $1,500…but that’s a far cry from the $2,640 a year I was paying for the PPO that canceled my doctor.

There are a number of drawbacks to concierge medicine, one of which is the obvious social issue: it pushes the practice of medicine even further toward elitism. The rich get care; the rest of us take what we can scrounge up, which often ain’t much. In my part of the country, precious few doctors subscribe to this system, and it’s hard to know what their qualifications might be. Or disqualifications. In the MDVIP network, for example, most of the physician members in my area practice at John C. Lincoln hospital, a scary affair whose Dickensian ER is…well, overworked, shall we say. That’s where a doctor decided, after a cursory exam and no tests, that the appendicitis just starting to make itself known must be inflammatory bowel syndrome and prescribed a drug whose manufacturer’s label said, loud and clear, that it was contraindicated for women with my symptoms. I can hardly wait to go back there!

Do I demand “Cadillac care”? You bet. It’s my life and my health we’re talking about here. And in America today, “competent” care is defined as “Cadillac care.”

By and large the offerings are abysmal. In Arizona, for example, only one hospital has been rated by HealthGrades as truly excellent: the Mayo. John and Cindy McCain go to the Mayo. You and I don’t, because our insurance won’t cover it. Three hospitals were rated as “distinguished” (a cut below “excellent”) for their clinical practice: the Mayo, Scottsdale Healthcare-Osborn, and Del E. Webb in Sun City. Only one of those is even remotely within driving distance of the central part of the city, where I live. In the entire state, just three landed “distinguished” ratings for patient safety: the Mayo, Yavapai Regional Medical Center in Prescott, and Yuma Regional Medical Center.

I guess I could get bare-bones major medical coverage and then pay my doctor at the Mayo out of pocket. In only two years I’ll be eligible for Medicare, which does cover the Mayo. If I raid my savings and pay off the Renovation Loan now-meaning I won’t be buying a car anytime in the near future-I could take the $220 a month I would be paying for the PPO and set it aside to pay medical bills. It’s awfully risky, though…all it would take is a heart attack or a tumor to bankrupt me once and for all.

I also could sign up for the flex plan, which in the past has been a bit of a waste. I sure do hate to cut my take-home pay drastically, given that it provides me a grand $29 of play in my budget. Contrary to claims, I’ve never found the flex plan did a thing to save on income taxes; every time I’ve subscribed, it just meant cash gouged out of take-home pay that I was forced to spend on medical stuff whether I needed it or not. This has led to many unnecessary doctor’s visits and purchases of redundant pairs of glasses.

I’m thankful that I can afford to pony up $1,500 for access to a doctor, if indeed I decide to do so. But…am I the only person who thinks that this is a damned ridiculous pass for the alleged greatest nation on earth? If America is so great, how come we can’t provide decent health care for all our citizens, at an affordable price?

1 comment left on iWeb site

TM

I agree. My father has recently had some major health problems and was transfered from a Mesa hospital to Scottsdale-Osborn, one on the “distinguished” list. He had to remain in the hospital for 10 days and the discrepancy in care was startling. Even the food in Scottsdale was better. In our society, unfortunately, the almighty dollar rules all…even for products and services such as healthcare.