Tuesday, July 5, 2011

Back to my opinion- Insurance reform

With a baby on the way and the medical issues that we have encountered I am really interested in what is said about insurance, medical reform, and what people are saying about medical. Especially with new elections coming up, I really want to have my voice heard about the things that I feel are important.

A few weeks ago a man decided that it was in his best interest to rob a bank. He went into the bank, demanded ONE dollar and sat on the couch waiting for the police to come. Why? Because he was sick and needed to have health insurance. He knew he would get the care he needed in prison.

He was a hard working person his whole life. Not rich by any means. But he worked hard. His hard life left him in a hard place when the recession hit. He felt so desperate that he felt his only option was to rob a bank.

While I have never felt the desperation to rob a bank ( in reality.. in words maybe) but the fact that he felt so desperate for care he thought about ruining his life is a little staggering. It is also kind of sad.

A study posted a week or so ago said that they found the even with health insurance coverage many Americans find themselves in medical debt that they can't afford. They used Arizona for the study. They found that though many of the people are insured they still have medical debt that they can't pay OR that they delayed their medical care or didn't GET medical care for fear that they couldn't or can't pay for it.

They note that having a lapse in insurance put people at higher risk for medical debt. COBRA was put into place for that transition purpose but the cost of cobra is VERY costly and itself can cause people to go into more medical debt. Plus, cobra only pays your premium for the insurance, you are still responsible for your "normal" cost of usually 20 percent.

The big thing that sparked some fuel for me was a article yesterday in the Salt Lake Tribune. It was reporting that 4 out of the states current 5 insurance companies have posted margins WELL above their earnings a few years ago. Meaning that the non profit organizations have PROFITS. (Not sure how that works in the long scheme of things.) The article went on to state that they are required by law to have a fall back on the amount in "savings" but all the local insurance companies have way more than required.

Select Health is the LARGEST in Utah. In fact I wouldn't even be that far off as to say they would be considered a monopoly if people would look at it. They are reporting seven times the required amount and are sitting on 279.7 MILLION dollars. Mind you, this is the company that is 1) non profit, 2) provides all of the state insurance for uninsurable conditions and the high risk pool 3) is subsidized for programs like CHIP. They are also the ones that run IHC which runs the local children's hospitals and the programs that help with financial assistance.

With seven times the required amount they keep raising the premiums while paying out less in claims.

An example: When we moved from Arizona to Utah the Ebay plan we had was Select health. The cost of the cobra was 1200 a month. We paid for the highest plan that was equal to what we had in Arizona. It didn't have a deductible, it paid 100 percent of our claims. It also paid our pharmacy benefits. So even with a high monthly cost it was well worth it. 2 years later we on the exact same plan that was offered before, cost is 1300 and we now have a deductible ( considered the high deductible plan because we would met that deductible within a month depending on the month for Tyler. We would met that deductible within 3 months without any procedures for Tyler and just for his care) after the deductible we would be 100 percent covered.

Why would we pay 1300 a month to be fully covered? The honest answer: We can't afford to pay our percentage of the cost. That isn't to say we would have no food, or a place to live. If we paid all our monthly "normal" bills, we wouldn't be able to afford the full 20 percent without having a payment plan. With normal bills we are talking a set check already to IHC that we have paid for 6 years. This is just what would accumulate on my credit type of "can't afford." That bill would just keep getting higher and higher

While we are not above paying for our own health care costs, when is enough enough? Meaning why can't I buy a house and live a "normal" life without having to deny my child any kind of treatment? Why can my credit be trashed by said non profit organization because we are paying what we can on treatment that they say we don't get financial help.

What treatment am I denying you might ask? GREAT question. Because of Tyler's Cerebral palsy we have certain protocols that kids go through to give them the best possible chance of living a relatively "normal" life. Things like walking, talking etc that come usually only come with expensive therapy. At the beginning there are services that help. Early Intervention is a great service given by the Federal Government in any state. Sadly those end at 3. Then we are forced into the school system where the only guideline is to make them "functional." That is left up to us as the parents to go above and beyond functional. How? By getting them outside therapy. That means you have to use the said above insurance company to pay for said therapy on a condition that they don't see as rehabilitating but chronic. Therefore, only 12 visits a year are permitted. Because he will never be "cured" they don't find it a therapeutic investment. If we can't afford the 20 percent a visit how can we pay for the amount it would take to keep him going AFTER the 12 visits are fulfilled? Easy, we add it to our stack of ever mounting bills where we pay a month. And what we can't fully pay off we add to my credit which in turn causes more collection calls than you can imagine.

Tomorrow we will thankfully be getting some care from our local Shriner's hospital where we are going to bill that darn insurance company but Shriner's won't come after me for the portion that they won't pay. Then my son will not be denied something that will ease pain for him. And as his mother I don't have to not worry if I can afford it.

What are you thoughts? What have you found works for you and your family? How do you find yourself paying for those insurance bills?

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