Saturday, August 1, 2009

My Experience with Private Insurance

There was a long period of time from my late thirties and into my mid to late fifties when I had to buy my own health insurance as a self employed individual working as contract labor. Sounds very glamorous doesn't it? If you're an actor or model or voice talent or make-up artist or stylist working in Utah with an agent you're contract labor. If you get a part in a movie or on a TV show that's a union production, for that brief time when you're on set, you're covered by the production company should you be injured or become ill while actually working. But really, the bottom line is you're responsible for your own health insurance.

When I first signed up for coverage in the '80s there was only one insurance company offering individual coverage in Utah, and that was United Healthcare. My premiums started in the $300 range. I thought that was high but it was the only game in town. As long as my internist proscribed my antidepressant, United Healthcare covered my treatment. It was when my depression wasn't responding to the antidepressant I was on, and my internist referred me to a psychiatrist, that United Healthcare began increasing my deductible and co-payments at an alarming rate. I began to see my insurance provider as my adversary. Every year my premium went up close to $100 a month. My copay went from $5 to $10 and then $20. I knew I was bipolar, but my primary symptom, or at least the one that made working impossible, was severe depression. Until I started seeing a psychiatrist I had been able to keep the word "bipolar" out of my medical records. Once that diagnosis started appearing in my records, my premium doubled. In one month it went from $500 a month to $1,000 a month. At that point I had to give up coverage.

It was just prior to that last doubling of my premium that my biggest client went out of business. This decreased my income 80%. So, I had to drop my insurance; I simply couldn't afford the premium anymore. Then I discovered that my mother had vascular dementia. As her only living relative I became her only caregiver, the one person responsible for her. So she became my full time job, a job that is depressing even for those not inclined to depression.

Without my medications, caring for my mother drove me over the edge into psychosis. I was hospitalized at the University of Utah adult psych ward for two weeks. This was the beginning of the precipitous plunge into bankruptcy. I couldn't afford the drugs I was on. At this point my drug bill was almost $1,000 a month. I couldn't afford to pay my medical bills. So next came the slow process of applying for disability. Within one year I was bankrupt and disabled. And then I started getting the help I needed to stay somewhere close to the balance point of the seesaw I was living on.

Once I started getting a monthly check from Social Security Disability and getting 80% of my medical bills paid, I was able to hang on by my fingernails. Without that public option I don't think I would have survived that terrible time in my life. It is one thing to have an illness that is expensive, incurable, and tricky to treat; it is another thing to be treated like a deadbeat who can't pay her medical bills and doesn't deserve to live.

Even with the public option of Medicare, I have to make difficult choices regarding the allocation of scarce dollars. My illness is still expensive, but as long as I make a good faith effort to pay my bills, I am treated like a person with value and dignity. I'm never refused treatment. I choose my own doctors. My drugs are now affordable because of Medicare part D and the extra help I get with drug costs because of my low income--no donut-hole for me, thank god.

I can't work anymore. But I can tell my story. And it's a common story. I am not alone. Anyone who has lost benefits when they lost a job, knows what I'm talking about. If you have children, insurance is an absolute necessity. Children cannot go without some kind of health insurance. And we should never have to choose whether we get the medicine we need or buy food. It's that basic for a lot of our citizens. We have reached the bottom line. We need single payer healthcare. But if that's off the table, we must have a public option for those of us most at risk. Healthcare shouldn't be a choice, it should be a human right.

9 comments:

The Peach Tart said...

Mr. Peach Tart and I are both there. No health coverage because we're both self employed with pre-existing conditions. Premiums for us with a $5000 deductible over $500 a month each

Utah Savage said...

If I were younger than 65 I'd be selling my house and moving to Canada right now. I have my public option. It's still a lot more expensive for me than it should be, but it's so much cheaper than if I had private insurance. But even with my public option, it cost more than If I lived in Canada. I'm starting to think this country is too stupid to survive as a world power. I just can't stand the idiocy of this populous. It's starting to frighten me with all the stupid talk. Birthers, Deathers? Jesus, what a bunch of morons!

Suzan said...

Thus, why so much of our taxed prosperity goes to the Pentagon.

I'm with you in spirit, Utah.

I'm starting to think this country is too stupid to survive as a world power.

S

no insurance

no healthcare since '92

Fran said...

Thanks for sharing your story. So many people have that one *slippery slope experience*.... the diagnosis that becomes the item that prevents any other insurer from offering coverage.

INsurance companies like to Cruise the gravy.

But when you hear other people's stories, even things like common kids ailments- ear infections, some companies found reason to deny coverage.

One time did I actually do well by insurance... just a few years ago.... I had to decide if I would get my work coverage or my husband's..... his had an in house pharmacy w nothing more than a $10 co pay (mine was $30 or more) & doing the math for the prescriptions alone, his policy made sense. But my policy had better major medical coverage.
After agonizing over it, that year I decided to take both policies.
I am a diabetic & the high roller of medical expenses in my family.

That year I had a cyst rupture an ovary & an expensive surgery & a 5 day hospital stay. Long recovery from a full on abdominal incision.
What one insurance did not cover, the other one did.

That following December, the new year insurance rollout @ the husband's workplace added a new exclusion- no more double coverage. They would no longer duplicate or pick up what other insurance
did not cover.

I happened to stumble upon a loophole, but as soon as they could, they shut it down.
I'm glad to have gotten coverage under the wire-- it would have cost me thousands of dollars, at a time I was out of commission & unable to work.
Still they made it vanish just as soon as they could.

Hey! I opted to pay two premiums to get that coverage, which was a financial hardship.

The irony of this story is even if a person had TWO health insurance policies, you are still not covered, once they find a way to disqualify benefits.

BTW- Once they said they would not double cover, I switched to just my workplace coverage.
Since then they switched from a co pay & 100% coverage, to a higher co pay & 80% coverage.

Paying more for less.....

Utah Savage said...

Fran, ...Paying more for less... That is the American healthcare story and without a public option it will remain that way and get worse over time. As it has gotten worse over time. It's bankrupting all of us.

Madam Z said...

I used to work for a small insurance company. To be competitive with the large companies, they had to keep their premiums low. Medical expenses kept rising, and in spite of angering many of our insured by denying some claims, the math could not withstand the difference between income and outgo and the company went broke. Obviously, bigger companies have an advantage because of economies of scale, but they still must guard their bottom line. It's a business, after all, and cannot survive long if it operates at a loss. If the government takes over health care coverage, what will happen when, as is inevitable, outgo exceeds income? The money has to come from somewhere. The government's only sources of income are taxes and borrowing. No one wants to pay more tax. That leaves borrowing, and we're already drowning in debt. Health care is a business. Doctors, nurses, pharmacies and hospital employees all must be paid. Besides the salaries and the building and upkeep of facilities, you have huge malpractice premiums to consider. I repeat, the money has to come from somewhere.

Part of the reason Canada's system seems to work is that Canada has only 1/10 the population of the U.S. The bigger the population, the harder it is to manage. Can you just imagine the bureaucracy that would be required to administer a program of socialized medicine in the U.S.? And of course, that would add greatly to the cost of the program.

I agree that the present system is a mess, often with tragic consequences. But whatever is done to alleviate it needs very careful study and planning. It should not be rammed through congress, willy-nilly, just to get something done fast.

Fran said...

But here's the thing-- right now we ARE paying huge amounts to insurance companies and co pays with absolutely no regulation or caps of costs.

If instead of paying into for profit insurance, we paid into a pool that had regulations.
No pre existing condition exclusions.
Bids for bulk contracts for big pharma to come up with the lowest cost to get awarded the bid.
Having Doctor's education bills comped so they get a break & give back to the community.
Right now each piece of health care is isolated, and unchecked.

If we pooled our money-- and got decent care as a result, we have the power to stop all the exclusions.

There are too may millions of Americans with *nothing* health care wise. NOTHING!
While we piss away money for wars.

Comrade Kevin said...

I agree. Right now, my parents have given me an extended loan, agreeing to pay out of pocket for a private plan to cover my bipolar, since I lost Medicaid coverage a few days ago.

Naturally, I can't be covered for anything bipolar related for a full year because of a pre-existing condition and this has forced me to be creative to try to find ways to obtain the prescriptions I need just to function.

Linda McGeary said...
This comment has been removed by the author.