Healthcare Headache

January 18, 2019 12:30am
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At the beginning of 2019, we changed health insurance providers through my job.

I’ve pretty much had the same insurance back as far as when I first got it on my own (circa 2004?), so I’ve never had to deal with the special kind of hell that comes with changing insurance and making sure all of your doctors are still covered…

…and getting new pre-authorizations…

So said headache that we’ve been enduring for about three weeks now is due to issues that we’ve been experiencing with therapy for one of the kids. I’ll talk about it more in another post, but basically Christopher has been doing ABA therapy for autism at home since last summer and it’s been really awesome for him … and damn, has it been a pain in the ass getting the insurance coverage transitioned for it.

🙁

Case in point – today was literally his first session this year, and we still don’t entirely have everything worked out yet!

We tried contacting the new insurance company for information about the pre-authorization back in December, but they didn’t even know we were going to have insurance with them yet.

When we finally got the new cards and gave them to our therapy provider, first the paperwork was sent to the wrong company … because our insurance network is one company, but it’s being provided by another company and customer care is handled by a third company!

Because there aren’t already enough middlemen involved with providing healthcare in this country… 😛

Once the paperwork finally got sent to the right place, it turns out that the wrong codes were used … whatever that means.

And then the right codes got submitted, and it sat on somebody’s desk with the insurance company for two days, even though at this point Christopher had been without service for two weeks.

When they finally reviewed and approved it, it took another two days to get it back to our therapy provider because the department’s voicemail box was full for the two people who process these things.

Oh yeah, and when they got the approved documents back, someone discovered that the insurance company had somehow approved 2.5 hours PER YEAR instead of 4 – 6 hours a day FOR THE YEAR.

Grrrrrr…

And guess who got stuck playing connect the dots throughout this whole, entire cherade?!

Sara and I were joking earlier that we didn’t realize we’d be learning about medical billing this week, and quite frankly – we shouldn’t fucking have to!!!

Someone else on either side of this transaction should’ve picked up the ball and ran until not only it was done, but done correctly, too. It kills me that neither party looked at that approval and said, “Wait a minute … 2.5 hours??? That doesn’t sound right!”

By the way, did I mention that we’ve also got my company’s HR department amending the new insurance policy because it wasn’t clear what the limits are for # of sessions allowed in a calendar year???

As I type this right now, I think we’re now on the right track to getting this resolved, but it’s really been wearing the both of us thin. Healthcare is important, and no one should have to jump through this many hoops to ensure that they can get medically necessary treatments for their children.

And all of this was after having to ask the old insurance company to even cover it because it had been omitted from the policy and wasn’t legally required due to a regulatory loophole in how the policy was setup.

I hope that someone in my lifetime fixes this mess … American healthcare in general, that is.

I stumbled upon this the other day and on the surface it seems kind of interesting – it’s essentially a group of Christians getting together to help each other pay their medical bills. Nothing wrong with that, right?!

Well…

Much like any insurance program, it starts to raise some eyebrows when you begin to peel back the layers and really try to understand what it covers, and more importantly, what it doesn’t. Right off the bat, they make it very clear that this is a faith-based program and that those who aren’t dedicated to the lifestyle need not apply. In fact, they actually have a list of rules:

  • You must take a statement of faith and be active in your religious worship.
  • You’re not allowed to smoke tobacco, or use illegal drugs, or abuse legal drugs.
  • You’re not allowed to “have sex outside of traditional Christian marriage.”

That said, if you think it’s a little strange for your insurance company (although they state that they’re not actually one) to dictate your sex life, it gets worse when you dive into what is actually covered, and even more so how the whole plan actually works.

First off, things that it doesn’t cover…

  • abortions (no surprise there)
  • alcohol and drug-related injures and illnesses
  • STDs
  • “illegal acts”
  • attempted suicide
  • maternity expenses for children conceived out of wedlock (except for rape)
  • mental health / psychiatry
  • fertility/infertility care (wouldn’t be a surprise except that they lump “birth control procedures and supplies” in here as well)
  • hearing aids (what?)
  • routine and preventative care (despite being known to play a considerable factor in whether you need additional healthcare, their theory is that these are known costs and you should budget for them throughout the year)

And that’s really a summarization of some of the more oddball stuff – the full list can be found here.

So anyways, the way this whole program works is that much like regular insurance, you have a deductible and co-pays, so when you go to the doctor before you hit your deductible, you pay a co-pay and then they send a bill to these people, who typically knock off a discounted rate and then you have to pay the balance until your deductible is met.

You also pay a monthly premium just like regular insurance, which goes into a pool to help pay for the claims of other members. So far, so good.

But where the whole thing starts to get a little creepy is that the whole process of getting your bills paid by the pool is known as sharing, and as a result, as money from other members is matched up with your bills, the service tells those people specifically who their money is going to … so that they can pray for you. 😯

Now admittedly the whole prayer thing is a bit of a weird concept to me as a non-believer myself, but the reason I pick on this particular element is because it screams to me as being so incredibly self-serving and hypocritical when we look back at the rest of the program because although it’s a noble offer to come together as a community to help everyone take care of each other’s medical bills, you only have to skim those bulleted lists that I showed you earlier to see that it isn’t exactly everyone in as much as it’s everyone who thinks, acts, and lives their lives exactly the way that we do.

And this aligns with a lot of the complaints that I hear from the right about paying taxes these days because there are always certain things that they don’t want their money going towards, whether it’s abortions or welfare or the EPA or whatever, and so in this particularly pick and choosey world of healthcare, these Christians have taken it upon themselves to create exactly that sunshine world for themselves.

Frankly as a non-believer looking in from the outside, it’s not a very appealing “community” to me because when I read through all of these rules and exclusions, what I’m hearing is, “We’ll help you as long as you behave, but as soon as you fuck up – when you need our help the most – you’re on your own!”

What kind of sense does it make that a Christian going through issues with depression or thoughts of suicide can’t turn to his Brothers in Christ for help paying for treatment from a qualified professional?

What about people who don’t live perfect lives in God’s name and have sex prior to marriage that results in pregnancy? Should they just have to carry the burden themselves because they were breaking the rules and having sex outside of marriage?

How about someone who has a drinking problem, gets in a car accident and splits his head open, and gets whisked away in an ambulance? Are those bills simply his problem for having a drinking problem in the first place???

Some Christians absolutely think YES, as I found in reading through a large thread of comments reviewing the program where these scenarios were questioned and then countered back as “tough love” in hopes that the punishment of having to pay all of their own medical bills may be a deterrent from future sins … and that kind of thing is where I start to get real cynical when it comes to religion because as far as I’m concerned, you’re not really the community that you say you are if you’re not willing to accept each other’s flaws and work together for the betterment of the entire community.

I mean, a lot of our problems would be easier to solve if we could cherry-pick how we addressed them – fix education by only focusing on the wealthy school districts, fix the budget by only paying for the things that we personally think are important – but the reality is that as much as you don’t want to bother yourself with all of that other stuff around you, it still exists and ultimately it doesn’t do our community as a whole a lot of good if subsets of us huddle up into smaller groups and say, “We’ll look out for each other, but you guys are on your own.”

How is it even Christian to live your lives by a book that says nobody’s perfect except for Jesus, but you should all strive to do better, and then you create this program that specifically excludes parts of your own people who don’t fall in line explicitly with those tenets?

I won’t even address excluding me because I don’t believe in your religion, but the fact that you have other Christians who need real help with these things, but you just turn your back on them and say, “Our program isn’t for everyone – we do what we can…” is insulting to your brothers among you who need your help but are left staring at your backs.

This quote from one of those commenters really stood out to me:

“We are a group of relatively healthy Christians with low monthly medical expenses who are willing to join together to HELP each other pay for extremely high medical expenses in the unusual event that we get sick or injured.”

So if you already have cancer, that’s too expensive and they won’t help you. If you’re an alcoholic in need of counseling, they won’t help you. If you deviate in your lifestyle in any noticeable way to the church, your “healthcare coverage” here could be at stake, too, and as much as we all complain about insurance companies being these heartless corporations seeking to profit off our backs, I really don’t see how this is much better.

And – there’s always the chance of other members voting to decide that the medical procedure that you need might suddenly be deemed immoral and thus not covered!

“One of the reasons I am interested in Medi-Share is because it doesn’t cover immoral procedures such as abortion, but circumcision is also immoral to me.”

Don’t get me wrong – the insurance industry itself has plenty of problems that contribute to the greater issues with overall healthcare in our country today, but I think we all need to work together to address those issues rather than breaking off into smaller groups to say, “We’re good – the rest of you can fend for yourselves, you damn heathens…” In a way it kind of reminds me of Texas constantly wanting to secede from the union, or more recently the pediatrician who refused to care for a gay couple’s baby – we need to stop segregating ourselves and actually come together to collectively solve the problems that we face.

Patting yourselves on the back when you think you’re doing something righteous that’s really exclusionary and judgmental isn’t helping, either.

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