Friday, August 14, 2009

Soccer and Insurance

I recently played a soccer tournament in an over-30 division. My regular team played in the over-40 division, and being under 40, I joined another team for the weekend.

I used to be just a little nervous, playing soccer without medical insurance. Two women on my team both broke their ankles just a few years ago, and indoor soccer (which I was playing 2 days a week) is particularly notorious for such injuries. The older we get, the more likely, I suppose, it is that we'll be injured.

Right at the end of the first half of our third game...there was a crash between our 170 lb goalie and their 125 lb forward. Crack. We heard it up in the front half, yards away. We assumed it was shin guard crack. It wasn't. The two women both kicked for the ball at the same time, both missing and kicking each other's lower legs. The smaller women suffered a fracture through both her lower leg bones. They were sticking out the back of her leg. Yikes! She didn't even get up until the paramedics got there. Being a nurse, I guess she knew what she was in for. That's when I realized again that I really don't have any medical insurance.

Truth is, I thought that I could just go and make an appointment and get my annual and pap smear. No biggie, not that expensive. I can afford it. I'll just pay cash. Then I came to another realization: what if that pap smear comes back abnormal? Even if it's just a little abnormal, or it's even a mistake or a false-positive. I'll never get insurance for the rest of my life. THAT'S what's wrong with the insurance system. Besides it being a con, I mean. People's lives revolve around whether or not they can get health insurance. And once you don't have it, it's hard to get it. So I didn't go to the doctor. Not because I didn't have a doctor, not because they wouldn't see me, not because I couldn't afford it. I didn't go because I was afraid of what would happen if I did go and something unusual turned up. Plain and simple. I didn't go to the doctor because of the future of my insurability. And THAT'S what's wrong with our medical system. I can't be the only one. I finally understand what they mean about how our insurance system is making us sick. People can't go to the doctor even if they can afford it.

If you watch news programs and political debates, you will notice something interesting. They use the terms "health insurance" and "health care" interchangeably. It's like somewere along the line we came up with the following equation:


This is both a mathematical fallacy and a medical one. One does not in any way equal, encourage or guarantee the other, in either direction. One guy is a doctor, one guy is a paper pusher. Insurance will not cure you. Insurance should have nothing at all to do with care.

I had insurance once. It was weird. I've been uninsured most of my life, except the brief time as a child when I had MediCal and the time I worked for a large winery. Probably 8 or 10 years of my whole life.

So you can have medical insurance and not be able to get medical care. You can end up not getting medical care because you don't have medical insurance (regardless of whether or not you can afford to pay for the care).

I have never been able to figure out how anyone got the idea in the first place that an insurance company or ESPECIALLY a hospital could be a for-profit enterprise. Insurance is supposed to work in a community sense, where everyone pays in to a pot, and then when someone needs the $ for an emergency, it pays out to help them. It used to be called community. Fine, let the employees and administrators take a nice living out. Cost of business. No problem. But profit? INVESTMENT, for God's sake? How can insurance of any kind be a financial investment to mature and sell and make money on? That's the craziest thing I've ever heard. It's especially disgusting to see a hospital be for-profit, and I can't imagine how that ever happened. The insurance thing is more understandable, but it seems to be in this unique position.

It's the only business where you can take people's money with no intention whatsoever of ever giving them the product or service they paid for. In any other business, that would be a con, a theft. In insurance, it's the accepted way of doing business. How is this possible?

Alternately, in a somewhat-free economy, why hasn't a "fair" insurance company come up? Someone who takes your premiums, puts the money in a pot, and then pays when someone gets sick? Why isn't there an insurance company that does that? I dont' mean paying for immunizations & pap smears. That stuff is regular, planned and can be budgeted for - IF anyone can tell you how much it actually will cost. I can pay the $105 for the DTaP, and I can pay the $149 or whatever for the pelvic exam. It's like buying groceries, just less often. But just try and ask them how much it is - they have NO IDEA. I've paid cash at the doctor's office, only to receive a bill later explaining that I didn't pay for some part of the visit. What the hell? Why can't these people just get a menu? What if a doctor had a list of services, with prices, and everyone just paid for it? The doctor would get paid on time (imagine that!) and you'd get seen. And you wouldn't be getting a bill 18 months later for service #875623 that no one still living has any idea what it was for, but it's $89. The way I see it, if you can't bill me within A YEAR, I don't have to pay you.

Insurance shouldn't cover the little nitpicky everyday things that you know are going to come up. It should cover emergencies. Knocked out teeth, car crash, cancer. These are the things you don't see coming and couldn't afford in any universe anyway.

If our insurance system wasn't so fucked up, I imagine a "fair" insurance company might be able to do business. There are at least 2 tiers of people employed doing nothing but figuring out the stupid forms. True, those people would be unemployed. I'd like to think that they would be free to do a worthwhile job, like firefighter, mother or teacher. At least pick up trash on the highway. Something useful. If they didn't have forms you couldn't understand, they wouldn't have to pay people to do the double data entry, and then health insurance could cost less. If health insurance cost less, then possibly medical care could cost less, because doctors would get paid on time, and in the amount that they charge. If insurance companies just simply paid for the things they said they'd pay for, then the cost of actual care could be more reasonable, because doctors wouldn't have to overcharge the insurance company, who will bargain them down to a lower price, which is still high to cover all the uninsured people that skip out without paying. Did that make any sense? No? Why am I not surprised?

I gave birth to my daughter in a hospital that has this great plan. If you would just simply pay them in cash within 30 days, you get 30% off your total bill. Simple, easy, to the point. I'll bet they even know how much things cost. When I was pregnant, we did some simple math: the cost of HealthNet for the 9 months of pregnancy and postnatal was exactly the same as the cost of paying cash for our prenatal, birth and postnatal care. Exactly the same. If I just paid for the services, I'd get 30% off, so it was actually cheaper to go into the hospital without insurance than it would be to buy insurance. Crazy? Not necessarily. Since insurance is ostensibly for emergencies (c-section, for example), we chose the insurance, since it would cover an emergency that we hadn't planned for. But still, the math that the cost of insurance=the cost of medical care was an interesting revelation. But since the insurance company makes a profit, the cost of insurance must necessarily be more than the cost of medical care. So somewhere, someone is not getting paid or someone is paying more for insurance than they would for care. That's even fine if we are all pooling our resources to make sure that everyone has a doctor when they have an emergency. I just have a problem with the huge profit.

So we decided we needed insurance, because you never know. We won't be young forever, and Caius rides a skateboard. So Lyn goes online to see if he can buy us some insurance. He can't figure out the application, so he sends me to find a local agent, where we could meet them, and maybe they'd help us. So I called and talked with a nice lady who said she'd get a quote and call me back. A week went by, and then I decided that I didn't really want to do business with someone who didn't call me back. I mean, how helpful could she be? To be fair, maybe she wrote down my number wrong or something, but the whole thing was being so complicated, I just tried to pretend it doesn't exist. We can't afford it anyway.

So Lyn finally got online again and tried the application process again. We got the forms, and we're trying to fill them out. Honestly? I have NO IDEA when the last time any of us visited a doctor is, nor which doctor. My daughter's pediatrician didn't even show up when I googled him. I don't know their addresses, phone numbers. True, I could probably find them. It might take a week of work, but I could probably find them. Then I could probably call them, and find out the last time we were there. But they won't tell me what it was for, except if it's my own records. To their credit, Blue Cross had an 800 number, and someone answered and cheerfully helped me. She said to just make something up. If we leave it blank, we'll be denied, but if it's wrong, that's not necessarily a problem. Some of the other boxes I just didn't know. By some miracle, Lyn still had his insurance card from the last time we had insurance. It has some numbers on it, but nothing matched the titles of the boxes they wanted us to fill out. We put some numbers from the card into the boxes on the form. Honestly, none of the numbers on that card have ever matched any boxes on any form I've ever filled out. And what's a plan name? People have told us bunches of times that "Principal Financial Group" isn't an insurance company, but then WHY DOES IT SAY THAT ON THE CARD?? I was about to cry, but the lady on the phone was nice and helpful. Made me feel like it's ok if I don't really know. I probably have lots of papers around from doctors and things, but they don't say anything I understand. What's a 87354 anyway? Sore throat? Birth control? Who knows? We haven't seen any doctors in so long, I don't see why it's even relevant.

Just watch. I'm wondering if we'll be denied because our dates were wrong, then denied later because we were denied before. That's just the type of thing that would happen with medical insurance.


Hope I don't get sick.

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