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Insurance


Sunday, June 23, 2013

We have health insurance through Du's job. We used to pay less in premiums when I also was working at the University, since they doubled the employer's contribution, we basically paid nothing for our health insurance. But then I retired. Now we pay a few hundred dollars a month for health insurance--I still consider it very reasonable. I remembering asking Du before I took the plunge to retire, "Are you going to get sick?" "No," he assured me. Then a month after I retired, he was in the hospital and ultimately diagnosed with Stage 4 Prostate Cancer.

This is such bad news in so many ways. Of course the death sentence involved with this diagnosis is devastating. I can't imagine my life without him. I can't imagine my life without him still feeling strong and pretty good most of the time, as he is now. I can't imagine a time when we can't go places together, as we did this weekend, traveling to Kansas City for a Royal's baseball game. It really scares me to think of him growing sick and weaker. No...it terrifies me.


Du at the Royals' Hall of Fame in Kaufman Stadium, in front of the display honoring George Brett's 3,000th hit.

And to add to all this worry, is that darned health insurance. When he can no longer work, we will not have health insurance. When you are faced with a health crisis like this, you shouldn't have to worry about money, but that is a huge fact of life in this country, with the horrible mess our health care system is in. I don't even think it's fixable. So all I can do is hope. I hope he stays well for a long time and can keep working. He will be 65 in a little over four years....if he can work until then, he can get Medicare. I hope when he gets worse, breaks a hip or something, that his job will allow him to continue to work, perhaps from a wheelchair, doing the paperwork that is part of his job as Pressroom Manager. I'm afraid bankruptcy is in our future if we lose that health insurance, because there is no way anyone, except maybe Angelina Jolie, could afford the bills we have been getting. When I see the original charge, and then the percentage the insurance pays, and then ultimately, what we owe (which at this point, is literally nothing, since we met our $2,000 stop loss limit), I am astounded.

His hospital bill for four days in February was well over $25,000. The scans in March were $5,000/each, and he had two, and will need more to check to see how the cancer is responding to his treatment. We traveled to the Cancer Treatment Center of America (CTCA) in April, and spent four days, investigating possible treatment there, the bill just arrived for that. It was over $30,000. Of course the insurance got them to cut it back to around $22,000, of which we owe $120. Now $120 sounds like nothing in comparison, and it is. We can afford it, but I wondered what charge it was on that bill from CTCA that the insurance company did not cover.

So I called the insurance company Friday. She was very friendly, and checked on it for me. The University is actually self-insured, but pays Blue Cross/Blue Shield to administer the plan. Of course, the University gets to set all sorts of restrictive limits on what they will cover...and they take full advantage of that power. They cover nothing having to do with treatment of obesity or its related problems, which is very short-sighted, but how do you fight a policy like that?

It turns out we met with a nutritionist twice at CTCA, and the cost was $60/each visit. As far as the insurance lady could tell, that was the $120 charge that the insurance did not cover. Now it is a well-known fact that not only can diet increase your chances of getting cancer (I regret all those years of high-fat foods and red meats in our diet), but we have also discovered that a good diet now will increase Du's longevity and we are doing everything we can to eat right: No processed meats, lots of fish and chicken, Brazil nuts and pomegranate juice, all of which have been shown to be effective in the fight against prostate cancer. We learned about all of this through the nutrition counseling we had at CTCA. But because the University does not cover "nutrition education" we have to pay that charge out of our pockets.

I may do some more research and file a protest about this--just on matter of principal. The University "says" they promote healthy habits in their employees, but they do little to support that monetarily. When I used to walk on my breaks at work, I felt like a criminal for leaving my desk, for even 20 minutes, although I always considered it was my break time, since I never took a break normally. There is little support for exercise plans, or memberships in health clubs and/or weight-loss groups. And now they refuse to pay for nutritional counseling in cancer patients. Seems like a slap in the face to me.

I have read other blogs, where weight loss coverage from insurance, helped a person get off various drugs, and obviously avoid a multitude of obesity-related problems in the future, ultimately saving the insurance companies a bundle of money. Yet the University refuses to recognize this possibility--that they might save money in the long run if they helped people get control of their weight. I, myself, am off of four of the five prescription drugs I took for high blood pressure. I was also headed for diabetes and high cholesterol problems at my weight, and all of this has been avoided due to my weight loss. So....look at all they are saving on me....and yet they are still refusing to pay for nutrition counseling. Good Grief. They are a University, aren't they supposed to be smarter than that???
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Member Comments About This Blog Post:
CLPURNELL 6/27/2013 11:24PM

    emoticon

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GRAYGRANNY 6/25/2013 1:48PM

    So many of us are in the same boat and those that are to see that the problems are taken care of could give a rat's butt for they have all the insurance (paid by uhhhh US) that is you & I........so while we give up and lose it all they go on with a happy life.........how very wrong is that!!!!

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TEMPEST272002 6/24/2013 11:28PM

    I'm so sorry you have to deal with financial stress on top of dealing with hubby's illness. My hubby had a critical illness & I remember very well how scary and overwhelming it all can be - even without the financial stress (universal health care in Canada). Nutrition really does play a huge role in health. It's great that you're being pro-active with what you eat.
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DUXGRL1 6/24/2013 11:01PM

    I totally agree, that makes no sense at all and is maddening!

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CARRAND 6/24/2013 7:26PM

    The health care system in this country is a mess. With good insurance it's the best in the world. Without insurance - not so much. Will the Affordable Care Act help you to continue your insurance, even if your husband can no longer work? I sure hope it does. Or at least it will help you get insurance of some sort. I feel so bad for you.

My husband had a kidney transplant. Thank goodness we have good insurance because without it, he wouldn't have gotten a kidney transplant and he'd still be on dialysis, (or dead).

I got off most of my meds by losing weight, too. My weight loss is saving the insurance company money, but they didn't help me to lose. Refusing to cover weight loss help is really short-sighted.


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ELVISINTHEHOUSE 6/24/2013 2:49AM

    You're right. It's a national shame. The last thing you two need right now is the added stress of worrying about health insurance and being able to afford care. Stupid, stupid, stupid not to pay for the dietitian It just doesn't make any sense....like so many other things we have little to no control over. Best of luck to you and Du.
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SLFGOLF 6/24/2013 1:02AM

    It's a shame that insurance companies don't always look at the long term benefits of different things, like nutrition counseling. It does help to effect long term medical costs. We have been able to get some alternative medical treatment covered when the doctor works with the insurance company and explains why we are doing certain things, but that doesn't always work.

Regarding the insurance in the future when your husband can't work, you'll have to look into Cobra for awhile when he first stops working. He should be eligible for that for at least 18 months after quitting work. That will carry you for awhile longer.

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CHARTHESTAR 6/23/2013 11:09PM

    You would think!!
nutrition- the main thing that keeps us healthy or makes us sick.
hope they get with the program.

Just like not covering OTC items. making you go to the doctor when it is something you can treat yourself. it is JUST NOT RIGHT!

prayers to you- enjoy every minute of your time.

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MSLZZY 6/23/2013 9:30PM

    All the smart people in the world do not see things as we do in the trenches. Thank goodness the insurance is still covering as much as it does. But is there a future
in health insurance with all the changes coming. I can't see it and I work with it
almost daily. It is enough to scare anyone.

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DOODIE59 6/23/2013 7:11PM

    I'm really sorry to hear your anxiety about continued insurance coverage. That should not be foremost in your mind during this tough time.
I AM glad to hear you two are still enjoying your outings -- that's wonderful:) Keep living those special moments.
Hugs,
Deirdre

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WALKSINLIGHT 6/23/2013 6:22PM

    Today is one of those days - you have your good days and your bad days and you have been handling all of this so well, have so much faith and courage but you are right, those medical limitations are wrong - at a time when we are all being pushed, when obesity has been recognized as a disease - yes insurance should and I believe now must pay for nutrition guidance/health care - keep digging in to it, keep fighting and I will keep praying for you.
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KAYYVAUGHN 6/23/2013 5:46PM

    I think that insurance companies make it so complicated so we don't understand all those rules and regulations. You and your husband are in my prayers.
Kay

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SNOWYOGA 6/23/2013 5:08PM

    I'm really sorry and agree with LINDAK25 Sending prayers your way emoticon emoticon

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LINDAK25 6/23/2013 4:49PM

    I've always felt that insurance was like paying protection to the mob.

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VONBLACKBIRD 6/23/2013 3:05PM

    And medicare isn't all that great either. It covers about the same as regular insurance and you still have to pay for it, but just not as much and they dictate to you what you can and cannot get with the coverage. Many elderly people cannot get knee or hip replacements as they try to "fix" it with braces and medication beforehand. Sad state our entire health care system is in.

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KASEYCOFF 6/23/2013 2:40PM

    I lost all health coverage when my first marriage ended in divorce. I spent years living in terror that I would get sick or need surgery and lose the house - the only house my kids had known. They were 15 and 17 at the time; fortunately they were covered under their father's policy. I got lucky: no major illnesses during those years.

My second marriage enrols me in Britain's National Health Service. It's not without its problems - what bureaucracy isn't? - but the relief that coverage provides is unbelievable. No out of pocket expenses, no deductibles, no minimums, no percentages.

Believe me, I know just what you mean about worrying about the medical insurance, in addition to everything else going on in your life. I don't know the answer. But my daily prayers always include "God Bless the N - H - S."
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ROSEWAND 6/23/2013 2:32PM

    What about COBRA, if your husband had to
stop working in the future? Would he qualify?
Also starting this fall under the new federal
healthcare legislation, you both could apply
for insurance in the new health care exchanges
that are being set up now. There will be only
age rating not health rating or gender rating.
That is a big change. They cannot charge
you extra or deny you because you have
a health condition.

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DIANNEMT 6/23/2013 2:23PM

    There is no reasoning with big business about smart coverage! And no reasoning with insurance companies, either. DD was approved for a surgery in 2011. We couldn't do it in the time left that summer so had to completely reapply for the "permission" and it was denied the 2nd time--they would not look at the old photos, etc and didn't get good quality photos the 2nd time. (Doctor said we sent good ones, insurance said we got faxed copies and no one would budge to get it approved.) We gave up on doing it for now.

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KATRINAKAT23 6/23/2013 2:21PM

  Is it possible for you to go back to work? Maybe that would relieve some of your money worries.

I am sending positive thoughts to you and family. emoticon

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KERRYG155 6/23/2013 1:27PM

    I hate dealing with insurance but am certainly glad we have the health insurance through work. My husband plans to retire in 2 years and our insurance will then cost a bundle. It would be nice if he would consider that expense into his retirement plans! I had a test done a couple weeks ago that "cost" about $4000 and took about 5 minutes. I had to pay $300. I'm really glad you got to go enjoy that Royals game. My mom went to one a few weeks ago. Keep on enjoying life as long as you can-that's about all we can do.

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FLYINGB16 6/23/2013 1:11PM

    I wish I had an answer. All I can do is agree with 100% of everything you said in your blog. I don't know how to fix the system but it absolutely needs to be fixed. Fingers crossed (and prayers) that a continued healthy diet will prolong the healthy active time you have with your husband and hopefully keep the insurance coverage until he qualifies for Medicaid.

Hugs,
Bonnie

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