Many people during these tough economic times are being “encouraged” to retire early. What does that mean for their health insurance and how exactly does COBRA work?
Do you ever have one of those nights when you can’t sleep and you wind up aimlessly surfing around on the Internet? I just had one of those courtesy of a violent allergic reaction to a protein shake. I didn’t wind up in the emergency room, but I have a new appreciation for the words “itching” and “swollen.” In a rather perverse moment of misery and boredom at 2 a.m., I did a Google search for “insurance horror stories.”
I’d like to tell you I wasn’t fascinated, in the way people who gawk at auto accidents are fascinated, but that would be a lie. Many — in fact the vast majority of these tales — involve health insurance. I read for two hours and I came away with one piece of advice to share with you.
When you are involved in a health crisis for which big insurance payouts are expected and needed . . . and you go to the hospital cafeteria and have a cup of coffee . . . and you put artificial sweetener in that coffee . . . save the little paper packet it comes in, because paper is everything.
Yeah, I know, that’s an exaggeration, but the “paper is everything” part is my real point. I don’t care how much we’ve been promised a paperless world, or how much the Obama administration is trying to get all our medical records computerized – an idea I both understand and that scares the heck out of me — if you can’t document everything, and I do mean everything, you’re not going to get the payout you deserve.
I also saw people time and time again saying, “If only I had taken notes.” Or, “If only I had asked my husband/wife/significant whatever” to take notes. Confusion is the insurance company’s friend. They’ll keep talking until you don’t believe what you know happened.
As it turns out, my late night miserable surfing was pretty instructive in a very simple, practical way. If you don’t believe me, run the search and read a few of the tales.
Oh, and don’t drink anything with the words “cherry blast” on the label.
I’m one of those people who tries not to go near a doctor unless I’m bleeding or broken in some way. I was raised in the day when house calls were normal and I detest with a passion beyond purple the bureaucracy and indifference typical of the “modern” physician’s office. At the same time, however, I do realize that these people really can’t practice medicine as they might choose to because they’re too frightened of legal action, namely malpractice suits.
I also realize that the more of that kind of thing that goes on, the higher the cost of health care and the higher the cost of our health care insurance premiums. This opinion has only been bolstered by the results of a study released earlier this month by the Children’s Hospital of Philadelphia that convincingly proves the prevalence of what is now being termed “defensive medicine.”
Seventy-two orthopedic surgeons agreed to participate in the study and rate the reasoning behind the tests they ordered for 2,068 mainly adult patients. They worked with these people in a range of medical settings from emergency rooms to regular office visits. When the numbers were crunched, 20 percent of the total tests ordered were done so because in some way the patient seemed to want them or otherwise raised a red flag of potential “trouble” with the doctor.
It gets a little scarier when it’s broken down by individual test. Eleven percent of x-rays weren’t necessary, 39 percent of MRIs, 33 percent of CAT scans, 57 percent of bone scans, and 57 percent of ultrasounds. And never mind the cost on the MRIs and CAT scans. Those suckers come with a nice hefty dose of radiation as an added bonus. So what I want to subject myself to because I’m not sure the doctor who has seen 10,000 torn ligaments knows what he’s talking about when he looks at my knee and makes a diagnosis.
Now, understand, I am the original medical skeptic. But this problem is so potentially out of hand, the Obama administration has proposed alterations to state laws to in some way put a cap on malpractice suits. There has to be a decent balance between policing bad doctors and scaring the good ones to death. These are the kinds of studies that really reveal the complexity of health care reform in the United States. There is no on single problem, but a myriad of inter-related problems that all have to be addressed before the whole is going to get better.
At the same time that we’re seeing positive indicators that the recession has ended and jobs are coming back, we also have definite clues that this economic crisis has left a permanent imprint on the American psyche. For many of us, it was quaint to note Depression era habits in our parents and grandparents. I personally knew a man who could only write with a new pencil. He literally bought cases of pencils and gave them away when they’d been sharpened once or twice. Why? As a school boy during the Depression he’d been forced to write with the stubs of pencils other, more affluent children threw away. To him, a new pencil was a sign of economic security.
A recent study by Channel Harvest sponsored by Insurance Journal shows that at least 50 percent of small business customers have actively made cost-cutting decisions on the coverage they provide for their employees and are still demanding more options to save money. The amount these business pay out in insurance dollars has dropped 17 percent since 2007 compared to 8 percent for mid-size and larger businesses. The good thing is that they are still buying the coverage, the bad thing is that they’re doing away with extras and raising deductibles.
Ancillary coverage options, like dental care, are likely a thing of the past as a work-related benefit on the small business level. In fact, the Kaiser Family Foundation says that in 2010 only 71 percent of adults in the U.S. visited a dentist and the bulk of those appointments were not for regular, preventative care, but for an emergency.
What this all means is that the onus for ancillary coverage for things like dental and vision care is going to fall back on the hands of the consumer, who is going to be even more tempted not to pay for it as a cost saving option. Stop and think before you make that decision.
Unfortunately dental issues rarely appear in isolation and can become major very quickly. Vision is our primary sense and there are options for cheaper purchasing of eyeglasses once you have a prescription in hand. Online eyeglass production has grown by leaps and bounds in the past five years and consumer satisfaction with the products has grown steadily.
The point is, there’s always a way. When you begin to consider cutting ancillary coverage options, really look at how much of the average expenses of the service — dental fillings and cleanings, for instance — that you can carry on your own, reserving insurance options for big “disasters.”
You’re probably not going to get help from your employer in these areas, but don’t cost cut yourself out of preventive care. That decision can come back to haunt you in the future.
According to findings by the Kaiser Family Foundation, Americans are neglecting their dental health more than ever. When people start whacking things off their health coverage to lower premium costs and control deductibles, dental benefits are the first to go. Consequently, only 71 percent of adult Americans saw a dentist last year. The problem is as bad or worse for children. In California, for instance one in four children have never seen a dentist — a problem worse for minority kids and low income families.
The problem is also worsened by a shortage of dentists that mirrors the shortage of general practitioners. This is especially the case in small towns and rural areas where a trip to a dentist in a neighboring town is even more expensive when the cost of fuel and lost work time is added to the actual dental bill.
This issue is of particular concern as poor dental health can lead to other health issues. Many dental schools offer clinics where people can get free cleanings, the application of sealant, and occasionally even fillings. More complex procedures that require a specialist are hard to come by for people who can’t pay, but often serious problems can be avoided simply by attending to regular cleanings.
When broken out by state, people in Connecticut have the highest attendance rankings at the dentist — 80.2 percent of adults — while Oklahoma residents are in the worse shape at just 57.9 percent. While it’s understandable that people are doing everything than can to save on health care expenses, find a way to take care of your teeth, even if that just means brushing and flossing regularly. Generally, with dental issues, neglect leads to major problems that can not only effect your general health and quality of life, but can also seriously deplete your pocketbook in an emergency.
Over the weekend I came across an article about Blue Cross and Blue Shield of North Carolina being the first large insurance company to refuse to pay for spinal fusion operations for back trouble. I had my usual grumble in my coffee about insurers deciding what medical care is appropriate for whom and then I started reading a little more about the procedure in question.
It’s intended to ease lower back pain, but apparently is no more effective than considerably less aggressive tactics. There’s also, according to the Wall Street Journal, a rather nasty amount of money being paid out by the maker of the hardware involved, Medtronic, and surgeons who are performing the procedure. According to Medicare, the cost of spinal fusions has risen from $343 million in 1997 to $2.24 billion in 2008.
Blue Cross is particularly refusing to pay for the procedure in patients who have degenerative disk disease because there’s no evidence that the fusion helps them in any way. So why would a surgeon recommend it? Ask the guy who received $13 million in royalty and consulting payments from a medical device manufacturer in the first three quarters of 2010 alone.
I am in no way a fan of insurers deciding what treatment a person does and does not need, but in this case, they may have a point. It also speaks to a point I come back to over and over again, the need for vigilance on the part of the individual. If your doctor recommends a procedure and your insurer denies it, look at the procedure itself as well as the behavior of your insurance company. Is it controversial? If so, why? And if it’s controversial, why is your physician recommending it? Does he have a financial connection with a device manufacturer or drug company?
Yes, people. Doctors have conflicts of interest. Big. Expensive. Conflicts of interests. The one person you can really count on to protect you is you.
Very nice, multi-source review of the new health care debate as the GOP takes over in the House.
Getting ready for a new arrival in the family always involves insurance pre-planning. If the obstetrician and hospital aren’t in the health insurance network, the parents-to-be are going to find out from day one just how expensive Junior is going to be. If you go out of network (and, of course, there may be compelling reasons to do so) most health plans will pay about 60% of the cost of a child’s birth. In-network coverage tends to run about 80%.
If, however, your baby is born prematurely and needs special care in the neonatal intensive care unit the situation may be quite different — even if the unit is in an in-network hospital. Care there may not be covered in your plan because some hospitals contract out to other clinical providers to run their NICU. That company may not accept the same insurance as the larger hospital.
It’s extremely important for prospective parents to verify that all aspects of a child’s birth will be covered by their insurance policies, especially any special post-delivery care. Michelle Andrews in a story for today’s Washington Post, (“Health Insurance Plans Sometimes Don’t Cover Care Needed by Newborn Babies”), interviews the parents of a child born seven years ago in Colorado.
The parents did all their homework. They did the math and expected out-of-pocket costs to run $400 when their son Thomas was born. When the child was circumcised, however, and the bleeding would not stop, he was diagnosed with hemophilia. He spent a day in the hospital’s NICU — administered by a company on contract with the hospital — and his parents received a bill for $50,000.
What are the chances this can happen to you? High enough. Three-quarters of the children who are treated in NICU facilities are born premature. That means one in eight babies in the United States in 2009 required this special care. Medical bills and other costs related to these births reached $26.2 billion total in 2005 or $51,600 per infant. And we all know that health cost shave headed in only one direction over the past five years. Up.
Bottom line. You cannot ask enough questions before you pick a facility for the birth of your child. If you know your child will be born prematurely, which is often the case, it may even be prudent to use an off-network hospital with an in-network NICU. And even if you expect a normal, happy delivery — which is what we wish for you — ask about the NICU anyway. None of us, sadly, are powerful enough to control fate, but we may be able to blunt its blows.
When Federal Judge Henry E. Hudson declared the portion of the health care reform law mandating that all Americans be covered by health insurance in 2014 to be unconstitutional, a part of me approved. Now, granted, his decision, made on December 13, is going to be widely appealed. The Obama administration stands by its legislation and I stand by the goal of the effort. Health care is too expensive in this country. But then so is insurance. The relationship between the world of medicine and the world of coverage is just out of hand.
One thing Judge Hudson said, really stuck in my mind. The crux of his argument was that the provision violates the Commerce Clause of the Constitution. He wrote, “Neither the Supreme Court not any federal circuit court of appeals has extended Commerce Clause powers to compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market.”
We can be required to insure our cars because we are *not* required to own and drive cars. It’s our choice and it’s within the government’s powers to insist we operate them safely for the greater public good. The health insurance requirement basically says we have to have to have health insurance because we’re alive. I’m a Southerner. I have a nasty little states rights streak. I don’t like having those kind of requirements put on my existence. Apparently neither does Hudson. “At its core,” wrote Hudson, “this dispute is not simply about regulating the business of insurance — or crafting a scheme of universal health insurance coverage — it’s about an individual’s right to choose to participate.”
This is a conundrum with which many, many Americans are struggling. We know health care and insurance needs to be reformed, but we’re not sure we want to be compelled to carry coverage we may not be able to necessarily afford. So, what to do in the interim, while the appellate courts debate? Accept that expenses are out of hand. Accept that you likely need some degree of protection. And shop as intelligently as you can for health insurance using the best tools at your disposal to find affordable coverage.
Has the health care and insurance issue been solved by health care reform? No. I’m afraid the real debate is just getting started.
As health care reform moves forward — and faces changes with the mid-term Republican resurgence — people are still looking for ways to manage their insurance costs. Here’s a good video explaining an option many people still find attractive, a health savings account.