Thursday, November 15, 2007

Healthcare is a Bitch

I went to doctor on Tuesday. No, not the gynecologist. I know, I know. Must do that. But those oh-so-joyous plans were preempted by a more pressing need. At the start of my last cycle, I took some Advil for my always-wicked cramps. I found that it gave me a pretty painful stomachache, even if I took half the adult dosing, so I stopped taking them and the pain receded. This month, at the start of my cycle, I took one solitary Excedrin before bed. Just one. And I woke up at 5am with a belly full of fire. I woke up and ate a muffin and it seemed to soothe it, but an hour later it was killing me again. I ate crackers. It soothed it. 20 minutes later it was killing me again. This went on for several days, although I had only taken one solitary Excedrin. It was clearly no longer an upset stomach irritated by a medication.

I had the suspicion that it might be the start of an ulcer, based on the type of pain, the frequency of it, and the location. It felt like strong hunger pangs, although I was not hungry, coupled with burning. So, I made an appointment. I do not have health insurance. In making this appointment, all sorts of things ran through my head. Diagnostic tests, lab fees, medication costs. It could be pricey. I went to google for information and found this.

Here is a sampling of the provided examples:

Sore throat, office visit:
Your throat hurts, you go to the doctor. Price includes visit with physician and Strep test. Test was negative. $109

Tubes in ears
Your child has had chronic ear infections. The decision is made to insert tubes his ears. Price includes office visit 30 days before procedure and 30 days after, day surgery charges, antibiotics, drops and decongestants. $2,719

Chest X-ray
You go to the clinic with a bad cough. Your physician thinks it may be pneumonia and orders a set of X-rays to help make the diagnosis. Price includes clinic visit, X-ray and reading of the results. $183

GI Endoscopy
Conducted by a specialist. Scope exam of the gastro-intestinal track on an outpatient basis. Includes conducting the test and reading the results. $1,398

Broken arm
Your child jumped off the swing set. Price includes ER visit, X-ray, simple cast. $2,523

KayTar has insurance, BubTar and the rest of us do not. Do I understand the risks? Yes, I believe I do. Do I like having to take those risks? No, I do not. You see, the insurance Josh's employer provides is extremely expensive. We pay between $800-$1000 per month for his company provided insurance, plus the co-pays are ridiculously high, therefore not helpful for everyday needs. We do not have that sort of money available to pay out monthly. No matter how tightly we adjusted our budget, which is very tight to begin with, we could not squeeze that much money out on a monthly basis. And so, when we found out what was happening with KayTar, we squeezed out that extra money to get her on an excellent plan. It is expensive for an individual plan, but the benefits are amazing. Her plan ends in February. They said that the co-pays were too high and they haven't seen enough interest in their plan, which basically means they are canceling it because they are not getting THEIR money's worth out of the "product".

Now we are faced with multiple issues. KayTar's perfect insurance is ended, so we must find her a workable plan. This in itself is no easy task. Every plan I have checked into does not cover her therapy needs, at all. There is no coverage for developmental-based therapy after the age of three, unless you qualify for something called "High Risk Pool" insurance. I'll come back to this later.

Her insurance started in August 2006 and will end in February 2008. HIPAA's protection of pre-existing conditions is effective only if you have been insured for 18 months prior to your current enrollment. February will put us right at 18 months, but I do not know if her enrollment DATES matter in this case. I am not sure that it will truly be a full 18 months, based on start and end dates and that makes me very nervous. If her pre-existing conditions are not covered, that means anything related to hearing loss, gastrointestinal problems, neurological problems, genetic problems, feeding issues...basically anything we have fought through for the previous year WILL NOT BE COVERED. Tell me, if none of that is covered, WHY DO WE NEED INSURANCE? We will be paying them for absolutely no reason, because they will not be paying out in any of the areas she has need of. Does that make sense to you?

Part of the reason we've fought so hard for a diagnosis recently, is because we know this window is closing; we know that if her pre-existing conditions are excluded we are sunk; we know that "High Risk Pool" might be the only way we can go. Here is the kicker, "High Risk Pool" only covers certain diagnosis from what I understand. What about kids like KayTar, who are medically needed, who need good solid coverage, but they aren't one of the "lucky" kids who have a label to attach to their symptoms? If KayTar, had diagnoses seizures, then we would be in! But bizzare neurological episodes accompanied by EEG abnormalities, brain lesions, developmental delays, feeding issues, and hearing loss? Try again. And it is also astronomically expensive. Basically once they are in the high risk pool, normal insurance will never cover them again, even if they "outgrow" their issues. They are a health risk, and insurance companies can't really make money off of those kids.

Did you know that our state provides an SCHIP program through the very company that KayTar currently has insurance through? With identical benefits? Did you know that we are eligible for this program if you use our net income, but if you go by our gross income we are just over the line? Just over the line! We don't even receive any of that money! Do you know where it goes? Taxes. We are paying the government to provide services like this for people in need and the TINY bit of money that we give is what keeps us from not being eligible for the programs ourselves. How can that be right?

The bill President Bush recently vetoed would have provided insurance for my kids. Not some faceless huddled masses. These kids. MY kids.



He can ask for $200 million to go towards the war, but we cannot spare $35 million for our children's healthcare. How is that right?

We are responsible parents, trying to make the best decisions in a situation that is not ideal for a number of reasons. Would things be different if KayTar's level of need wasn't so high? Yes, it likely would. But that isn't OUR reality. A lot of things would be very different in an ideal world, but that isn't where we live. We live here, mired in these challenges and I can't understand how our government can continue to hemorrhage money into this war and refuse to put a fraction of it to help children in need. It isn't even about socialized medicine, which I suppose is the big Republican fear. It is about the very real problem created by a healthcare system that is more geared to making profit margins grow, rather than actually provide affordable, worthwhile care. People suffer in that sort of system. People who don't have enough money to be a worthwhile investment for these companies to cover. People who need the coverage too much are denied. "Sorry, you will use this insurance too often. We only provide for people who will pay us ridiculous sums of money to provide peace of mind. We really try not to pay out in the event of actual medical needs." It is not a good system. It is not a HEALTHY system. Sure, there are people who function within it just fine, people with enough money and low enough levels of needs...but what about the people who fall outside those parameters? What do they do? What do WE do?

I went to the doctor on Tuesday. My doctor knows I do not have insurance, so rather than send me for diagnostic tests and lab work to confirm the ulcer suspicion, he called it gastritis and gave me a months worth of medication to help an ulcer heal. He also told me to come back after the month if I am still experiencing pain and we will go ahead with testing. The visit cost me $40. The medications were free. There are good and helpful doctors out there. Doctors that will help as much as they can when they know you are in one of these situations, but the system shouldn't be so broken that they are necessary. If our kids were eligible for SCHIP, Josh and I could take the money we put towards KayTar's insurance and get ourselves on an individual plan. Everyone would be covered. We could afford it. We could live with it. But unfortunately that is not the case, and it might never be. So we have to find a solution right now, in this system, and I don't know that it will be possible.

46 comments:

Julie Pippert said...

Oh Kyla. It infuriates me, I mean, bone deep fury.

I said, when Bush did that, "What kind of person are you, do you have to be, to DENY health care to KIDS WHO NEED IT? I mean, who ARE YOU to do THAT?"

And to hear personal stories like yours.

It's sickening.

I am so, so sorry.

Julie
Using My Words

Becca said...

This INFURIATES me. I can not wait to vote in the next election. Unfortunately I don't think anyone who is in the position to run for president has ever had to deal with this type of situation.

Hetha said...

It's hard to draft a comment here that doesn't use expletives - but I couldn't agree more with Julie's sentiments. Who does he think he is? I thought the guy was a compassionate conservative? I thought the guy was a Christian?

Kristin said...

Yuck. All that would sure give me an ulcer too. Our healthcare "system" here certainly sucks so badly.

How does Josh feel about finding work in Canada :)

Aliki2006 said...

Oh god! This so resonated with me. We pay $700 a MONTH for family coverage. We're all covered. And our co-pays are ridiculous--$40/week for Liam's OT.

I am so sorry you're going through this--I am sickened by our sad healthcare system. We keep thinking about how much more money we'd have if we didn't pay out $700/month for health insurance.

Summer said...

Kyla,

Do you know lots of doctors will diagnose CP so you can get coverage if a more specific diagnosis isn't clear?

I'd talk to her doctors about it.

I hear on the insurance. I was so bummed when Oregon just voted down a "Healthy Kids Plan" here.

I could't believe what Bush did.

Great post. Hope your stomach gets better.

bubandpie said...

This is just so sickening and disheartening.

flutter said...

I'm just sorry.

Mimi said...

Wow. I can't believe how much your insurance costs, for so little benefit. My TOTAL income tax deductions for each month come to only a little more than that, and that's for socialized medicine *plus* everything else.

I'm so sorry for this added stress on your family. It is truly truly ridiculous. I would have an ulcer too.

motherbumper said...

This is the most frustrating post to read. Especially when you write about the recent Bush veto - 35 million is a drop in the bucket to cover the next generation of adults.

I'm so sorry that you have this headache on top of other things. Healthcare should be universal.

emily said...

Hi Kyla,
We're in a similar bind, paying $700 per month for family coverage and making JUST above the limit (literally $100 per year too much) for the Healthy Kids state plan. We thought through our options, and this wasn't an option for us because my husband is a teacher and is on a county-wide non-flexible pay scale, but could Josh actually ask his employer for a pay cut? Surely if you're just above the line, that pay cut wouldn't amount to nearly as much as effective insurance premiums OR doctor bills. Just a thought....

Oh, and I hope your stomach feels better. NO TOMATOES (learned the hard way) !!!!!

emily said...

OH -
I also wanted to add, this post SO ELOQUENTLY captures the problems that SO MANY Americans are facing - you should send a link to this post, or just send the post itself to your congressman, AND to all of the presidential candidates! This needs to be read by people who can take action.

Me, I can't even pass your word verification on the first (or second) try! :)

Chaotic Joy said...

Yeah, The Man is self employed so we don't have full coverage on any of us, just a major medical plan that will cover emergencies. I tell all my doctors that I will be self-pay and I have found almost all of them to work with me and be very reasonable on my expenses. I am glad you found the same thing, and very sad you are in this situation.

Amy said...

Kyla
I was actually thinking the same thing Emily was. As bizaree as it sounds, if you are just above the cutoff would a paycut be the answer. Something to think about it. The sucky thing is that would prevent any future raises for Josh until the cutoff was increased. Does it increase yearly?

I work for a healthcare company that constantly deals with insurance companies. They try to find EVERY and ANY way to avoid payment....even when it is medically necessary and covered by the plan. It is ridculous when their customers pay huge premiums to be covered and then when they use their coverage, they are denied.

I am right there with you in the frustration.

laundrylessons said...

I agree with summer, try to work with your doctor on a diagnosis that may be covered. Merritt's insurance is completely covered through Medicaid because she has so many of the qualifiers. See if the CP diagnosis could work or hearing impared. Seems there should be a way with so many issues. I'm sorry you're having to deal with such a frustrating situation.

DN said...

That sucks. Kind of makes you wonder why bother working and earning an income when you get screwed over like that.

Beck said...

That is sickening.
We have not only Canada's universal health care, but we also have all of the extras - the costs of prescriptions, private hospital rooms, the works - covered by my husband's work. I can't wrap my mind around a society that makes taking care of yourself so very, very hard.

Raehan said...

It is a sin that our country lets hard-working family go through that kind of stress over the cost of keeping healthy. Priorities. We need to demand that our leaders get the right priorities.

It is sickening that they call themselves the party of family values.

Janet said...

What a mess. I wish I could adopt you all and move you up here where the waits are sometimes long, but everyone gets the care and tests they need.

jen said...

dammit, this makes me SO angry.

Kyla, let's do something. We have to do something about this.

This breaks my heart.

~aj~ said...

Oh man, this is starting to give me an ulcer just thinking about it. It's a wonder you're able to sleep at night, with stuff like this on your mind. Bless your heart!

Our health care system is a disaster. I'm so sorry it's affecting your family like this. I wish something could be done...

~aj~ said...

My only thought? Let's all move to Canada!!!! I love it there too! :)

InTheFastLane said...

This is so frustrating that our country is punishing those people who are trying so hard to do the right thing. But, if you just quit your jobs you could live of the government.

You just made this a very personal fight. I hope that the word can get out on why policy needs to change.

Kelly Malloy said...

Insurance and health care have both gotten out of hand! It is ridiculous that children can not get the care they need without wiping out your life savings (or lack of!).

Maddy said...

Medical insurance is the bane of my life. The amount of time and energy we spend on the whole nightmare just makes my blood boil.
Best wishes

Mad Hatter said...

This makes me sick and angry and frustrated. It's just so wrong and I can't believe your country, the richest frickin' country in the world can't fix it.

AHHGHHH! And this is what it's like for the 4 of you as a young (and apart from Kay-Tar) very healthy family. To think of what happens to families as people age and become infirm.

My jaw is clenched on this one and I know this post won't leave me. Ever.

Junie's Blog said...

Our system is far from perfect(so many do not have a family dr) but to have to worry about the cost of things when you are sick is just terrible! I mean, wow! Talk about kicking you when you are down! I'm so sorry this is causing you so much stress Kyla. I have to say I like the moving to Canada plan! ;)

slouching mom said...

Kyla, This is a powerful manifesto. Bravo.

But that doesn't help your family's situation, and for that, I am so sorry.

And poor you, I hope your stomach is feeling better!

nomotherearth said...

I can't imagine having to deal with this crap. Move to Canada..?

Christine said...

oh this post had me practically in tears wanting to scream at the unfairness of it all. no wonder you have ulcers, kyla. how can the world (ie the current government) be so cruel.

ok--deep breath. off to catch up on your older posts now. . .

Sonja said...

I am from Germany and really had to get used to the Healthcare System here... My husband and I both don't have insurance, but we are lucky and got some good coverage for our son for $100 a month... which is still steep, but managable!
Please hang in there...
I guess this is justa little reminder on how imprtant it is to vote in the next election!

Sarah said...

In Illinois, if you make too much money they can give you a spend down amount. I'm guessing you would have already known about it by now if they offered that where you are. I'm sure it wouldn't be 800 a month! That is just outrageous! I am so sorry you and your family are suffering with this in this Country. The system sucks, I hate their version of "you make too much"

kittenpie said...

Kyla, this just makes me so sick and angry, and it must make you so worried, as a mom, too. It's not right. Period. And I'm so sorry you're getting caught in it, along with so many others, because no one deserves to have to choose between health and home.

Lisa b said...

Kyla this makes me sick. No family should have to make these kinds of decisions. c

dawn224 said...

Have you seen this?

http://www.simplecare.com/

(not advertising, but I think it's a great idea)

Mrs. Blogoway said...

I'm so sorry!
My friend wrote an excellent post with some links to things we can all do to change this.

http://traceesioux.blogspot.com/2007/11/balancing-act.html#links

well then, jenji said...

So sorry to read about your situation. I suppose there is no easy answer for providing healthcare in our counrty, as our system of government is so highly polarized that any effort to fomulate a gameplan is left hovering in the middle of a mass of irrelevant distractions (thank you 24 hour media).

What did the doctor prescribe you? Prilosec OTC? Prevacid? An ulcer is a real kick in the pants and I must wholeheartedly agree that Excedrin is a potion whose pH was clearly designed by The Devil. I suffer from migraines and realized the hard way that Excedrin is NOT the migraine relief it claims to be--after one dose, I ended up with gutwrenching pain, dry heaves and an even bigger migraine in the end. Advil will rot a hole in any sensitive gut to be sure, but Excedrin is sure to leave you with a gaping wound, especially if you're ulcer prone. Ironically, a friend of mine is suffering from a hiatal hernia and she lives in Ontario, Canada. However, her condition is so severe that she needs to have surgery, yet she's been waiting for over a year to get said surgery. Canada has it's kinks as well, but at least they're open to suggestions, wherein a veto is a clear NO in any language. I hope you find relief soon.

Good luck to you and your family--
jenji

Family Adventure said...

Kyla, as someone from a country with nationalized health care, this post shocks me to the core. I knew it was bad in the US - but not this bad. This is a system that only punishes hardworking young families trying to work within the rules.

I may be wrong to suggest this - but can't you work with the doctors to get some kind of diagnosis for your daughter, so you can ensure coverage? Even if it may not be entirely accurate?

Also, it's almost worth your husband earning a little 'less', when you think of your savings on insurance. I know that sounds ridiculous, but isn't it?

There has to be a way. I don't know the American system at all, so I really can't help you, unfortunately.

But, not being American, if you'll allow me - I so agree with this nonsense about the war and all that money being spent. It's insane and it has to stop.

You all need to vote to make it stop!

Heidi

Tracee said...

I'm going to link this to Blog Fabulous, So Sioux Me and Quit Coping.

This is one of my pet issues for the coming election and getting stories like yours out is the key to change.

My prayers are with you and families like yours.

natalie said...

Sweet, sweet Kyla...I hear you and I feel your pain. I'm not allowed to get on the insurance bandwagon because my husband is a healthcare provider and I don't want to give away too much information about our beliefs on the internet so as not to affect his business. Trust me when I say how much we BOTH hurt for you and are furious for you. I read your post to H and he just paces around thinking about the injustice of it all.

We have excellent insurance because I work in the public school system. I DESPERATELY want to be a SAHM, but we need the insurance too much for me to quit my job. Despite our "excellent" insurance, it cost more to have a miscarriage than to carry a baby to term, deliver, and stay in the hopsital for 3 days. I'm still, 2 months later, getting bills for the miscarriage. And that's with good insurance. I couldn't agree more that healthcare is a bitch.

Karen said...

I hear ya - and it would provided insurance for my kids too - it stings and we are reeling from the consequences right along with ya - and what I hate it all the talk that makes it sound like families like ours would be taking advantage of the system, b/c we really earn too much and should have private insurance - indeed only we need to afford the roof over our heads and dinners on the table first!

Her Grace said...

I just came to you through So Sioux Me. I'm so sorry for your troubles. This should definitely be a major issue in the election. I don't understand how anyone can't want to provide children (and in my opinion, adults) with health insurance.

I hope you can figure something out.

jen said...

Kyla, we are in almost the same boat. I just blogged about our story, and linked to you.

After we file our taxes for the new year we are DONE with insurance through the state. Currently we make less than 1,000.00 per year under the yearly income cutoff for CHIP. My husband works for a small company, and is also self employed, so they go by our yearly tax info.

No private insurance will insure my child. We can not afford vital therapies, and because we have been in a vicious cycle of him bouncing from SSI, Chips, and then nothing every other month he has gone without thearapy for six months.

Today we are going to a nursing home to admit him because it is our last ditch effort to "make" the state insure him. If they live in a state home for a certain period of time the child goes into a different classification thenthey will give us insurance to take care of him at home rather than pay the costs of full time institutional care. Their way of crying "uncle" I suppose.

The system has officially brought me to my knees after years of struggle.

Lucas has CP, epilepsy, severe develepemental delays, sensory issues, (to name a few,) So, going without healthcare is simply not an option. If the nursing home sittuation doesn't result in coverage our next step will be seeking out a legal divorce. If I am "single" with three kids all my children will be covered. Having to do things you feel are fundamentally wrong because you have to for the well being of a child is what our government has to offer. It is sick.

jen said...

You can read our story at jlogged.com

Emily said...

What a horrible situation. Just awful. Here in London (American expats) we have NHS. It has its issues, it really does. But, everyone is covered.

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