Monday, June 8, 2009

Medicare Explained By One Who Knows

You may not realize this but fashion models are considered contract labor. We have agents to promote us and manage our bookings for a hefty 15% of our earnings. But all the rest is up to us. And in order to get the best possible tax help a model needs a tax accountant who specializes in Entertainment Industry tax rules. Then we have to provide for our own insurance.

While I was healthy and working I bought my medical insurance from United Healthcare, the only large insurance company providing coverage for individuals in Utah at the time. In the beginning my monthly premium was $325 a month. I thought that was pretty high, but it was the only option. Then I started getting hefty premium raises every six months or so. It was not that I was sick, it was just "a little adjustment for the rate of inflation" according to the billings person at United Health Care.

I ran into a rough patch. In a six months check-up with my internist, where urinalysis and blood work were done, I seemed to be having a "sugar spill" in my urine. This required further tests and a visit with an endocrinologist. More tests were done. And in the end, it turned out to be one of the many strange permutations of stress and depression. Then I got a notice that my insurance had gone up to $500 a month. But the drugs for depression were very expensive, so I kept the insurance. But I also kept getting more and more depressed. I was referred to a good psychiatrist who diagnosed me with bipolar disorder and put me on a good mood stabilizer (another very expensive drug) which made it possible for me to keep working so I could afford my insurance. I was chasing my tail.

Within a month of getting that Bipolar diagnosis Untied Health Care doubled my monthly premium. At $1,000 a month for just me, I had to drop private coverage. Then I couldn't afford to pay for my therapist, get my drugs filled, or pay for follow-up care. No psychiatrist will prescribe without follow-up care.

As I grew more stressed by the depression and the rising bills, I was able to work less and less. Finally I was bankrupt. Fortunately I filed before the rules were changed for individuals filing for bankruptcy. So medical bills and the cost of private health insurance ruined me economically. Not having insurance made it impossible for me to pay for my drugs and this led to a lengthy hospitalization for psychosis. Which was the result of untreated bipolar disorder.

I was advised to apply for disability. I applied with all the documentation they required and they turned me down after a three month wait while they decided my fate. A friend of mine who's a social worker told me that all first-time applications for disability are turned down, no matter what. Proforma. I reapplied and was turned down again. After further conversation with my friend I discovered that there were attorneys whose specialty was disability law. So I got a disability attorney. They assess your case and if they're pretty sure they can prevail they take your case for a percentage of the lump sum award. If you finally get on disability they reimburse you for the time from your first rejection to a successful outcome. This whole process took over two years, so even though my monthly disability stipend is the minimum possible, three years worth is a tidy sum. The payout is based on your earnings at the time of your award and for the three previous years. These are the lowest earning years for most people who end up on disability. So I got roughly $700 a month to live on and Medicare. It is Medicare that saved my life. And that is not hyperbole. Once I was on Social Security Disability and Medicare parts A, B, and D (the only good thing G W Bush did in his entire presidency) have saved my life. Once on Medicare I was eligible for the fabulous care by Valley Mental Health and the Master's Program for bipolar patients over 50. They saved my life, and that is not hyperbole.

Medicare is far better coverage than my $1,000 a month private insurance. Every referral from my internist had to be okayed by some bean counter at United Health Care. Under Medicare I have never had to wait while a bureaucrat has weighed whether or not my well being was worth the cost. And if I needed help finding the part D private piece of the pie that Bush gave the private sector, a "bureaucrat" at Medicare patiently helped me find the one that would cover all my drugs at the lowest cost. In my case that's Etna. Since my income is so low, I get extra help with drug costs, so there is no "doughnut hole" for me. If the public sector were picking up the cost of the part D coverage it would be simpler and therefore less expensive for taxpayers. It was giving part D to the private sector including the drug companies, that has made part D a problem for so many. It is the drug companies and the private insurance companies who lobbied so hard for their hand out from the Bush Administration that has driven up the cost of that program and made it a bureaucratic nightmare for so many senior citizens and their families to negotiate.

I have the experience of both options--private and public. I'll take the simplicity of the public option over the bean counters in the private sector any day.

25 comments:

CDP said...

I'm sorry to hear about all you went through, but this was as eloquent a case for single-payer national health care as I've ever read. I'm glad you got the care you needed.

Utah Savage said...

I want this message heard. If you twitter would you pimp my piece? We must have a public option.

Steve said...

i'm glad they saved your life.
wouldnt be the same without you

Utah Savage said...

Steve, you're so sweet.

susan said...

Patients are tokens in profit-loss equations and insurance companies (and their lobbyists) are vultures. The medical system has become so turned around since Ronald Reagan that its main goal now has become not a cure but the denial of coverage.

Utah Savage said...

Susan, it's so obvious to us, why isn't it that obvious to everyone? Oh yea, if your income comes as campaign contributions, then maybe, but why would anyone else believe that a bean-counter has their best interest in mind. It's all profit and loss to them, and probably incentivized by bonuses for money saved through declines for treatment.

Cat said...

It sounds to me like after the long hard battle - you won. I do agree more people should be made aware of this - so Consider yourself Pimped on my tweeter today! (ooh that sounds dirty!lol)

The Peach Tart said...

Mr. Peach Tart and I both find ourselves without health insurance because of the thousand dollar a month premium for two self employed individuals.....this travesty must change and single payer has to be an option...otherwise...it will be the same old big insurance companies gouging us and then dropping us when we get sick

sunshine said...

I'm so sorry to hear about all you had to go through to get where you are today! That's a terrible story and from what I understand all too common.
Even though it ain't perfect, I'm grateful for what we have here in Canada.
((Hugs))
Laura

Nan said...

The people who bitch about the dangers of socialism and a universal single payer system (e.g., Medicare) have either never had a health issue beyond a routine annual physical that required dealing with the typical insurance company or are deliberately, willfully ignorant. I've heard a lot of people complain about various insurance companies; I've never heard a patient complain about Medicare.

I have a post on health care kind of floating around in my head; if I manage to get actual words on a screeen today I'll be sure to link to you.

Utah Savage said...

Thanks for showing up you guys. This is a really important conversation because this week they start the debate on healthcare.

Nan, I'll link to you too. We need to tweet and retweet this issue. All you twitterers get busy.

The Lazy Iguana said...

The insurance companies are shitting their pants because they know a public option will put many of them out of business.

but that would be "socialism". That is what the right claims anyway.

Insurance companies meanwhile do NOT provide any medical insurance. They simply take in more in premiums than they pay out in claims.

So I do not get it.

Speaking of shit....

Shithead2

Utah Savage said...

Lazy Iguana, you just made my day. How I love your great photoshopping skills. I think it's so funny that google is posting ads for Newt and all his rightwing projects making he and St Ronnie into icons of rightwingishness. They are still posting ads for Newts crap right above your lovely image of Newt the doodoo head.

CDP said...

Sure, I'll tweet this. Those who are scared by the "GOVERNMENT BUREAUCRATS WILL CHOOSE YOUR DOCTORS!" rhetoric need to understand that private insurers already make all of the decisions, and they're guided by bottom line concerns and little else.

yellowdog granny said...

i just filled out all my forms for texas medicaid...they have 3 different programs and i will soon find out which one i will get.takes about 3 months..i should be able to get the one that pays for the $96.40 ss takes out of my check and the 20% that medicare doesn't pay..which will really really help...
im sorry it took you so long..i know my daughter is going thru the same thing..

Sherry said...

i'd be hiding under my bed or worse if i had to deal with the paperwork. truth, yes i would.

Mauigirl said...

I think this was a great explanation-I too have noticed that Medicare seems pretty simple when I take my mom or aunt to the doctor. You make an excellent point through the story of your experience. Sorry you had to go through it though!

Of course sometimes it's hard to deal with the government before you finally get the coverage. It took months to get my mother-in-law on Medicaid! But worth it in the end and at least they paid retroactively.

Utah Savage said...

Mauigirl, once into the system, the system takes very good care of you. With a lot of private policies they want to micromanage things like emergency room visits. Not medicare. Private sector has negotiated with certain doctors to limit tests and follow-up care. They call that a good outcome since it's a cheap outcome. Every penny's counted by the private sector. My loss of access is their gain.

Lisa said...

What a great personal story illustrating both options. The obstinate refusal of Americans to recognize that there are other legitimate and better ways to deliver health care perplexes me like no other policy issue.

jadedj said...

I am so sorry to hear of you plight. I ditto what Nan said. I am so fucking sick of hearing the sky is falling because we might become a socialist nation. Total bullhockey! The assholes who are spouting this shit, are well taken care of. Did it ever occur to the nimwits who beieve this crap that the very people (reps and senators) who are screaming, soicalism, socialism, socialism, are the people who are covered...by government insurance...as government servants (so-called). God, I've got to go take my BP pills.

susan said...

One of my co-workers has a sister (RN) who works for Blue Cross of WA and her job is denying claims. She's quite proud of how much money she saves the company. Unf#*kingbelievable.

Randal Graves said...

Socialist!

zeppo said...

Boy, that sux... This is a travesty that the U.S. is the only "western industrialized" country where someone can lose their house and go into bankruptcy because of health issues. And that is even if they do have health insurance! This is ridiculous. Does the economy of this country exist so that insurance companies can rake in billions of dollars while finding every excuse they can to not pay out on justifiable claims?

I have no real hopes that this will really change, tho. There's just too much money fighting against a change to the system that allows them to make those obscene profits. I might be wrong. President Obama does seem to be putting a lot of emphasis on getting a solution, some solution, to this problem. Maybe....

As for this nation becoming 'socialist', does anyone remember the Tennessee Valley Authority? Amtrak?

Suzan said...

Good for you!

Just so sorry to hear about all your trouble. You are an angel who deserves so much better.

May it all be in the past.

Love ya,

S

Susan said...

The CEO of United Healthcare makes over 3 million dollars a year. It takes a lot of claim denials to pay that salary.