Efficient Awesomeness

Posted by admin on September 6th, 2007 in Advice / How To, Health, Internet

Of all the things that college failed to prepare me properly for in life, I think the biggest failing was not briefing me or at least warning me about how to get good health insurance. Unless you majored in health insurance, I think you’ll probably agree with me.

My parents always covered me under their work health insurance plans. It was great, they paid a little bit extra every month, and we all felt safer knowing that we were all covered under some group plan that offered awesome rates and low deductibles and co-pays. I heard of those words at the time, but I had no idea what they really were, and really, they didn’t affect me. My parents put up the money whenever I needed to see a doctor anyway.

Then I got to college and suddenly the college wanted to make sure I was covered with some sort of insurance. Simple enough, got some copies of proof of insurance that I guess my parents had somewhere, and voila, problem solved.

Then came graduation, and suddenly, I wasn’t eligible to be covered under my parents’ insurance plans. Well, that can’t be too hard, I thought, I was able to get a good paying job and find an apartment all on my own, insurance will be just like choosing which cell phone company I wanted to go with — research the prices, look at what they offer, and pick the best one.

Having been pretty masterful at my internet research for cell phones, cars, computers, etc., I went into researching health insurance with a lot of confidence. After an hour, that confidence was pretty much gone.

What happened? Huge teams of sneaky and malicious health insurance underwriters whittled down my mental reserves till my head was swimming in words that had confusing and differing meanings depending on which company I was looking at. Suddenly the words, “deductible,” “copay,” and “premium” were super important, and yet I had no clue what they meant. I tried to wrap my mind around all the possible scenarios. “So I pay a monthly premium which gives me a certain priced copay whenever I go to see the doctor, but when I met some deductible, I could stop paying the copay, but I’d still have to pay the premium, and my premium does or doesn’t count towards my deductible?”

The restrictions are difficult to understand, and they come without explanation. For example, I only qualify for copay at certain kinds of doctors, but when I go to them, the premium only sometimes counts towards the deductible. What happens when I have an emergency and I can’t choose a hospital or doctor on the preferred list, do I need to constantly tell people near me that if I suddenly go unconscious, they have to send me to a preferred hospital? What the hell is HMO and PPO? Why did these guys make so many words that I’ve never heard before?

From one service provider to the next, the plans were completely incomparable to each other. There wasn’t a standard PPO plan or deductible/copay plan that they all conformed to or attempted to compete on. Every company had their own system of packaging and terminology. Perhaps the health insurance companies were afraid people would wonder what the hell they were buying from them, so they invented dozens of words to throw around and confuse people.

Eventually I gave up. I just stuck with the company that my parents had me on all my life — Kaiser Permanente. Seemed simple enough, and since I’m young, it wasn’t too pricey per month. I paid their monthly premium of $134 for an HMO plan and with that I could go to any Kaiser hospital and see a doctor for a $50 copay. Sounded good enough for me. But for some reason, since I moved away from my parents in northern California to southern California, I had to go through some special process and get a new insurance number and fill out some lengthy paperwork. Fine, I did some paperwork, figuring anything was worth having the health insurance.

But then what happened? I didn’t fill it out early enough in the month so Kaiser couldn’t cover me until the month after the next, a full 50 days later. That means that even though I had the money in my hand, and had continuous Kaiser coverage my entire life, they refused to cover me, telling me to go elsewhere for a few weeks. Fine, I’ll go find some temporary insurance somewhere.

Luckily, my college alumni junk mail had some stuff about temporary insurance. So I filled out more paperwork and they approved me right away. Ahh, now I’m good and covered and I don’t have to worry about this shit anymore.

Then I realized I had no insurance covering my teeth! Kaiser doesn’t do that on their general health plan. Well, screw that, I don’t want to pay hundreds of dollars every time I want to see the dentist. I’m supposed to see him at least 2 times a year for cleaning. Oh, but if you pay Kaiser like $20 more a month, you get some dental coverage, though you’ll still have to pay some copay each time. What? Wait, so I have to pay at least $240 a year for my teeth? How is that a benefit when I already have to pay at least a hundred each time I go see the dentist? Why isn’t that covered in the $134 a month premium? That’s already $1608 a year, and that doesn’t include copays or my teeth? And on top of that, all the Kaiser hospitals aren’t even close to my apartment. This is when I started wondering why I decided to choose Kaiser in the first place. So I needed to go back to researching again.

Seems like laziness and health insurance don’t go together, so back to the confusing lingo and plans that don’t quite really tell me what’s going to be covered. I mustered all the brain power I could in reading the small prints on these health insurance websites. And I consider myself a pretty educated individual, I excelled in high school and college, graduating both with many top honors. But when I read this stuff, which I should hope everyone does sooner or later so that they know what’s up with their health plans, I felt like I was reading the US legal code, mumbo jumbo that only the most elite of lawyers could understand. It was like learning to read all over again, and having the vocabulary of a five year old.

Well, after hours of this, I decided to forget understanding exactly what I would get and just go with the lowest premium with what seemed like the most coverage that I could find. I’ll probably get screwed, but I’m in my early twenties, I’m healthy and the premiums seemed like the only loss I would have if I don’t see the doctors.

I eventually went with Blue Shield of California. It was the only plan I could find that actually covered both vision and dental for the low deductible of $1750 with only a premium of $125 a month. On top of that, it was a PPO, a plan that let me choose which doctors I wanted for only a $40 copay, and there were many doctors less than a mile away that I could see. Wow, why the hell did I choose Kaiser in the first place? This one sounds awesome, and I just saved myself at least $1,008 annually (this was based on premium alone).

Being pretty happy with myself, I switched over to Blue Shield and forgot about my health insurance.

But then a few months later I decided I wanted to see a doctor just to make sure I was healthy. My doctor recommended me some immunization shots, and I agreed. And no one asked me for any copay. That’s odd, at Kaiser, I always paid the copay before I could even see a doctor. Did they forget to charge me? I know I’m supposed to pay $40 each visit, that part I at least understood in the fancy underwriting. Oh well, if no one asks for money, I won’t go looking for trouble. And weeks go by. And then suddenly, I get a bill from my doctor and a claim from Blue Shield. Both demanding that I pay my doctor over $200. What the hell? I know I didn’t misread the underwriting that much! I spend an hour calling into Blue Shield and demanding they explain why the hell I owed $200. After going through what feels like secret code language, they say that their underwriters need to review the claim again. But I’ll have to wait a few weeks and see what they say. Great. Thanks for scaring the shit out of me with a $200 bill and now making me wait even longer to get a real answer.

So I wait another week and the claim is adjusted and the price they now say I owe is $40. Ahh, I see. I’m starting to understand why this whole health insurance business is pretty sleazy. The way they work is to overcharge you when they can and then if you catch it, they will correct their “mistake” for you. Well, I thought, that’s not too bad, I am getting a lot of coverage (so I thought at the time) so having to make a few calls every time I notice the bill is wrong isn’t too bad. I did save myself over $1000, after all.

But then a few weeks later, I cut my hand pretty badly on a broken glass, and I realized I needed to go to the emergency room. I’ve been to the emergency room before at Kaiser when I was younger for a somewhat similar injury to my hand, and they made me pay $50 before seeing the ER doctor. With this Blue Shield plan, it was $100. Not too bad, seeing as I could actually get to the ER pretty quickly since there was a Cedars-Sinai Hospital only a few miles away, and this was a hospital that the stars go to, they can’t be too shabby. And I was right, it was the best ER visit I’ve ever had. I was in and out in less than 1.5 hours. And everyone was super nice and attentive to me. I can see why the stars go here. You get treated nice, like a king. And the best part, no one asked me for any health insurance info, or copay or any financial matter till after all the ER care was given to me. At Kaiser, I actually had to provide a credit card to pay them $50 with my injured bleeding hand and actually sign the receipt before I got any care! This new method was much less stressful during my time of emergency, and I approved whole-heartedly.

Until my bill came in. Apparently, there’s an ER doctors fee on top of the $100 copay for the ER hospital fees. What? Why is there two separate bills? Why didn’t I catch this on the underwriting? So I looked back at the small print in my plan to investigate what this is all about and if they actually charged me correctly. What does it say in the small print? It says I don’t have to pay the ER doctor’s fee after the deductible. Oh right, my deductible is $1750, but wait, my premium doesn’t count towards the deductible, and neither do copays. And since I haven’t paid anything that Blue Shield deemed to go towards my deductible, I have to pay the entire doctor’s bill? I call into Blue Shield to get more clarification (as the small print sucks at any clarification), and they say, well, you did save money, we’ve reduced the doctor’s bill so you only have to pay $180 of it. Perhaps their small print should have said that when I go to the ER, I pay $100 plus doctor’s fee till I meet my deductible. It might also help to know that there’s absolutely no hope of meeting your deductible limit unless you have a major accident, and even then, you still might get stuck with big fees.

As I grimaced at the bill I was paying, I kept thinking about the Michael Moore film Sicko, which I’d seen earlier that year. Michael is right about the health industry, it’s pretty screwed up. Just to think, if the US had universal health coverage, all the health insurance lingo would be required to make sense, be uniform, and be clear about what you’re getting. In addition, with universal health coverage, I’d probably have to pay less than I already am, and they may completely do away with copays and deductibles, and hidden fees!

I’m not satisfied with my current plan, but I tolerate it because it’s generally not that much that I have to really pay. But seriously, I’d be willing to pay a little more and not have to deal with the commercial aspect of the insurance. I really believe that in the corporate system that I’m stuck with, there’s almost nothing I can do, including more research, to find myself a more agreeable plan. And unless I get some job with an awesome group plan, or the government decides we can implement universal health insurance, I guess this will have to do.

Then I started thinking about what other people might be going through. Keep in mind, I’m a college graduate, I have the time to sit down and read the small print, I have the time to call up the insurance company and complain, I have the time to look around and research and use the internet, and write about the experience on my savvy chic blog. There are millions of people in the US that have none of those things, who aren’t as capable as I am to make sure they’re not getting screwed.

Even I was confused by the most basic explanation of the plans. There are people out there that are getting screwed on a daily basis, who have loved ones who require serious medical care, and they’re being stalked upon in the time that they need the most help, getting fucked because they and their loved ones want to live. They’re being asked to overpay hundreds or thousands of dollars a month, not because they owe it, but because the insurance company has profiled their less capable customers and realized they’ll pay whatever is asked of them, bleeding them into complete bankruptcy and ultimately condemning to death the people that need the help.

COMING SOON: Tips for getting health insurance.

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