20/20 Takes On Health Insurance

I really like John Stossel's reports on 20/20. They're always pretty interesting, and he usually makes a lot of sense. Earlier this year, he did a report on education, stating how when there's competition, services are better... for example, in other countries when schools compete for children to attend, whether public or private. I know for a fact that the private sector can educate children more effectively, because for the same cost that the public school educates a child, Kindercare provides full-day Kindergartens at most of their centers, and will throw in breakfast, lunch, and snacks.

For his health care segment, I was not surprised that he did a good job as well. He first pointed out that it's not good to be without health care. He brought out a lady that left her job, was on temporary insurance, and then found out that she had cancer. After her temporary insurance ran out, she was left with paying for everything out of pocket. While nobody in our family has cancer, thank God, we did deal with losing our health insurance when my husband lost his job earlier this year. Just our luck, we ended up with two fevers at 103 or greater and one case of severe dehydration in an underweight infant, and ended up with 3 emergency room trips. We now have health insurance so all is taken care of again.

For several years now, I've found most private health insurance offered by employers to be way overpriced. I turned down health insurance while working at Kindercare because it would have cost half my paycheck. Health insurance at my husband's last job would have cost $700 a month out of our pockets, and that was after his job kicked in enough money to fully cover my husband.

Why is that? I can shop around and find high deductible policies that cover my entire family for around $200-$300 a month. Why do employers offer the low-deductible policies and charge their employees an arm and a leg for it? During most years I wouldn't even use $8400 in services, which is what the insurance policy offered by my husband's prior employer would have cost him every year. I don't even think that we'll reach a total of $8400 in health insurance costs this year, and that includes 3 emergency room visits and several well-baby checkups.

Health insurance costs a lot because people use it for everything. He brought up a good point... what if there was grocery insurance? People would be buying steaks instead of hamburger. The same thing is true with any time someone else is paying for services... I receive WIC, and although I always buy the cheapest milk and eggs that are at the grocery store, I buy my preferred brand of tuna fish and don't really look at the price. If someone else is paying for it, you are less likely to shop around.

Why do we include the smallest things in our health insurance coverage? If everyone paid for their own well visits and checkups, it would lower health insurance costs. Similarly, people should pay out of pocket for things like birth control and viagra. These are things that a lot of people will buy, but if you have to pay for them out of pocket you're going to shop around. You're also going to think twice about whether you really need something or not. When we were without health insurance this summer, for example, we really thought long and hard about whether we were going to take our kids in. I waited each time until I thought that there was nothing that I could do at home, and they really needed to be seen or they might die. While I don't think that people should wait until they think that they are on the verge of death before they see a doctor, sometimes if you just have the sniffles, you really don't need to be seen.

Britain, France, Canada and Cuba are looked at by Michael Moore and others as examples because they have free health care, but because it is free to all, it is substandard. People have to wait for months to see a specialist, even for life-threatening conditions. Emergency room waits are longer than ours here, if you can believe it. The wealthy and well-connected might be able to get better care, as Michael Moore was able to in his movie, but ordinary people are going to hospitals where they try to save money by washing the sheets every other day... one suggestion to save money was to flip the sheets over and reuse them. Gross!

At the end of his report, John Stossel talked about clinics popping up in grocery stores and pharmacies, where you pay cash and see a nurse practitioner. I wish I would have known about those months ago. My daughter wouldn't have had to suffer temporary hearing loss and spend over a month with an ear infection because we couldn't afford a doctor. We could have saved 2 emergency room trips, I'm sure, because we could have taken in my children when they had fevers and gotten a prescription for antibiotics. Probably not when my son was dehydrated because he needed an IV, but the other two trips could have been saved. Since we live in a major metropolitan area, I'm sure there must be one of those within driving distance of us.

I think that clinics are a great idea. Just as it would be preferable if routine doctor's visits were something ordinarily paid for out of pocket. Competition would reduce prices. It would save doctors offices money as well, because they wouldn't have to pay so many staffers to haggle with insurance companies. Of course, you're always going to have people with medicaid, but wouldn't it be better if instead of having a $700 a month health insurance premium, you had a $300 a month health insurance premium and covered routine doctor's visits, viagra, birth control, and other small items out of pocket? Do you really spend $400 a month on all those things? Maybe some people would have to because they get sick a lot, but if everybody did it, doctors would lower prices to try to draw customers.

HSAs are a good idea, in theory. My husband's job last year had a really nice HSA program where you were given a debit card and could pay for health costs with that. It allowed you to roll over money that you had if you didn't use it all in one year. When my husband worked for the state, however, their HSA program really bit. You would lose all your money at the end of the year if you didn't use it, and you had to fill out a form and mail it in if you had a health expenditure, and they would reimburse you. We decided to opt out of that one because in most years we don't really get sick that much, and having to go through the whole headache of reimbursement wasn't worth it.

This is just my opinion, but why couldn't we have a hybrid type health care system? Allow for private insurance (private clinics are illegal in Canada). The government could offer coverage for major medical expenses to every family making... say... under $100K a year, or those that lose health insurance because of a preexisting condition... with a catch. The government's health plan would only cover major, life-threatening medical expenses, like cancer. Of course, we know that in countries with government health care, the line to be seen is long, so anybody with enough means to afford private insurance would probably want to pay for that, because they wouldn't have to wait as long to be seen.

It would be preferable if more companies would offer higher deductible plans that cost the employers less per month. Then people would have to spend the first couple of thousand dollars out of pocket, but they would make better choices and shop around. They would save a lot of money in the long run, because $700 per month after your employer's contribution for health insurance is ridiculous.

Health Care Saga Over...

In a dramatic end to the health care saga, I called AHCCCS in the morning to find out why we weren't allowed to see the doctor when we were supposed to. I guess they hadn't signed us up for a health plan yet. Nevermind they ask on the application form if you have a health plan that you'd like to go with...

They told me that it would take up to 72 hours for the information to filter to the health plan's computers, but I could take my daughter to the doctor anyway and they'd have to call to verify the insurance. Urgent care said that dd would have to be in the computer, but it was the fastest 72 hours I have ever heard of, because she was already in the system, less than 2 hours after I had gotten off the phone with the health insurance people.

At the pharmacy, it was another story. Evidently the pharmacy side of the insurance and the doctor side don't talk with each other. Fortunately, one person at Walgreen's was knowledgeable enough and knew how to get it fixed, but it required a 45 minute wait. I'm okay with waiting as long as it works out eventually. I had a coloring book for dd with me so she was okay too.

So now she's on cefdinir once a day and is taking tobramycin ear drops 3 times a day. Hopefully her hearing will return to normal shortly.

Arizona's State Health Care: The Good And The Bad

Me and the state of Arizona have been duking it out over health insurance since last May when dh lost his job back then. The program, AHCCCS, is a really great program once you can jump through the hoops to get in... but getting through all the bureaucracy is a mess. Today, I thought my woes with getting into their system would be over... but no such luck. I have to call them on Tuesday and yell at them (not literally, but figuratively).

We are previous customers of the Arizona state health care system. They know who we are, we have insurance cards, etc. I do want them to verify who everyone is and if they are eligible. Last year we had to show them our passports to verify that we are US citizens. Great! Since this program is tax-subsidized, I don't want to have to pay for non-citizens to get in this system.

The problems started in January when dh started working for the state. They have a good health insurance program, so we went with their program, as I'd rather not use the state's program if I don't have to. I suppose since he was working for the state, the health insurance money came from the same source, but I guess that doesn't matter. Even though that was what we were supposed to do, it turned out to be a big mistake.

When dh lost his job, I immediately went to the office to reapply for health insurance. They told us that my son still had health insurance and was never dropped from coverage (since he is an infant under 1 year old, he had no premiums).

Later on that month, I took my baby to the doctor, using our health insurance card that supposedly he had. The doctor told us that he didn't have any coverage... so I used my other health insurance card from dh's job that was supposed to have been expired. Funny how the expired health insurance card worked, and the "active" health insurance card did not.

My dh got a new job about a week later, and about a month after that, we were told that they would deny us for health insurance if we didn't apply for unemployment and food stamps as well. What one has to do with another I don't know. So we were denied and we had to reapply.

Another month passes... around early August we find out that finally we were approved for health insurance. Everyone except for my son... who was supposed to be covered all along but now is still stuck with no insurance. So I call the office to find out what was going on.

Monday
Me: I'd like to find out why my infant son wasn't approved for coverage.
AHCCCS: You'll have to talk to your eligibility specialist, Nicole. Here's her number... lemme transfer you.
[transfer goes to a number that doesn't exist. I try calling the number myself and nothing]
[I call back]
Me: I'd like to find out why my infant son wasn't approved for coverage.
AHCCCS: He wasn't approved for coverage because he already is approved for Medicaid.
Me: I've been to the doctor twice for him and they keep telling me that he doesn't have insurance.
AHCCCS: You'll have to talk to your eligibility specialist, Nicole.
Me: I already called her at xxx-xxx-xxxx. The number doesn't work.
AHCCCS: oh she has a new number. It's xxx-xxx-xxxx. Let me transer you.
[transfer doesn't work. I call the number back and nothing.]
[so I call back]
Me: I would like to find out why my son wasn't approved for health insurance. I already tried calling my eligibility specialist and she is not answering her phone.
AHCCCS: Let me transfer you to her supervisor then. His number is xxx-xxx-xxxx.
[transfer goes to an answering machine. I leave a message and nobody calls back.]

Tuesday afternoon
Me: I would like to find out why my son doesn't have coverage.
AHCCCS: Let me transfer you to your eligibility specialist, Nicole...
[of course the number doesn't work. Third call to them for the day is a little different...]
Me: I'd like to find out why my son wasn't approved for health insurance coverage. He doesn't have coverage with Medicaid even though he is supposed to. I've already tried calling my eligibility specialist but she never answers her phone. I've already tried contacting her supervisor but I get his answering machine and he doesn't call back.
AHCCCS: Let me look up your account and see if I could help... [pause] he was disapproved for coverage because he's eligible for Medicaid, but he doesn't have that either. Let me make a note in your account and flag it to say that he needs coverage.
Me: Thank you. I also have to change my income. Can you help me with that too?
AHCCCS: Oh, just fax your letter to xxx-xxx-xxxx.
Me: Thank you!

Wednesday
Nicole calls. I guess they were changing her phone system over. They're supposed to add coverage for my son and reflect my income changes.

We get a letter 4 days later saying that he has been added and our income change has been noted.

So my question is... if they already knew who we were, why did it take a month and a half to review our paperwork in the first place? Especially when they can add my son and change the income amount in less than a week?

Unfortunately, the story doesn't end there. Our first day that we're supposedly eligible for coverage is today, September 1st. So I take my dd to urgent care to have her ears looked at since she's had an ear infection for well over a month now. We have been counting down the days until this day. We show up in the morning, wait around for an hour... and are told that our insurance card is not active.

Oh yes, I'm doing some (nice) yelling on Tuesday. This is ridiculous.