Americans Only: Uninsured and Underinsured

[liz_marcs]

This is Part 1 of my project, which I'm calling, "It's time for a little truth, baby."

All Americans who are uninsured and underinsured should post their stories in the comments below.

I also invite all Americans who've found themselves unceremoniously dumped from their insurance plan, or who were unable to get insurance for love or money.

All of you, please comment here.

Commenting is set to allow for anonymous comments and comments left by people using OpenID.

As I explained in the "home post," I will not be responding to any comments. I am just collecting stories for other people to read and make up their minds about Health Care Reform in the U.S.

The only thing I'll be doing is monitoring to make sure no one threatens the use of violence against anyone else posting.

Once again, pass the link to the post around to friend and foe alike. And keep in mind that all comments are public, so with that in mind be judicious about your personal details.

Have at it.

Comments

I take a maintenence medication.

[seferin.livejournal.com]

My copay is $50 a month, with insurance, because there is no generic. It works, and is one that I can not go without without aversive consequences almost immediately.

The previous drug I was on did have a generic. The generic was $10 a month. When I left my job, and before I was able to purchase insurance (for $160 a month), I had to pay $214 for it, for a single month's dose. Again, a medication that was not something optional.

That means I will need to pay more than $2000 a year, just for a single medication, if I were to lose my health insurance, because the new med, which works better than the old one, is far more expensive.

[rikibeth.livejournal.com]

I have no insurance. I haven't had any for years. I do the absolute minimum I can get away with -- well-woman on sliding scale at Planned Parenthood, obvious acute infections (strep, UTIs) at the CVS Minute Clinic. I'm not going to take advantage of any free mammogram programs, because if they found something, I couldn't afford treatment for it anyway. Given that, I'd rather not know.

I probably could have used antidepressants this winter. I made do with St. John's Wort.

Mostly I'm just trusting to luck.

[amazonstorm.livejournal.com]

I have insurance, but it depends on my student staus and only until I turn 24. I am twenty three. I have ADHD and absilutely cannot function without my medication (well, I can function, but trust me, I am better on it than off).


I am not looking forward to paying out of pocket for the meds I ctake.


Nor am I looking forward to trying to get insurance...

[(Anonymous)]

Okay. The Good I get ill, I get treated. What you wanted some big long answer to this? Fine fine, My Eldest brother recently had a injury and had to go to the hospital for treatment including a few extra scans as my cousin had a similar injury and some genetic condition arose that made it far more serious than it should have been. his pregnant wife is in the car (Swine flu he wasn't going to hear of her coming into the hospital) Total charge for all these services? Fixing him up and scanning to make sure he didn't have a blood clot?

Petrol and car parking say £10.

When my sister in law has her second baby, total charge for the delivery... Petrol and car parking. Need I go on. These are the events of day to to day life, things happen and we need to see our doctors... The simple truth is this, the political party that says Private Health insurance in the UK is the way to go, is a political party that just destroyed it's hopes of getting even a local councilor yet alone an MP. Hell they won't even get a Euro MP on proportional rep.

Whats even funnier is, there was a program on for the Birthday of the NHS, that went through the founding of it, the political fighting the campaigns to get it killed before it even was born... guess what the arguments where? Government control of peoples health services, longer wait times, poorer service and so on. With the exception possibly of the Death Lists argument you could carbon copy it from the US one at the moment. Stick the two next to each other and remove names and you likely couldn't tell the difference.

Skelron

[(Anonymous)]

Gah wrong part sorry

[spiralleds.livejournal.com]

Now, I've got coverage. As long as I stay in my job. But prior that, not so much.

When I returned to graduate school, all graduates were required to be on the school's health plan. It wasn't a health plan as much as catastrophic coverage with so-so prescription coverage. My recollection was that we paid $1,800 per semester ($3,600 a year). If you had other coverage and could prove it, you could opt out as long as you still kicked in $300.

Instead of giving primary focus to school, for the first three years I stayed at 3/4 time in my job to have health coverage.

When I went on internship I couldn't keep my job with coverage, so for that year and then senior year, I only had catastrophic coverage. Needless to say, I wasn't going in for annual physicals, paps, adjustments to my mouth guard for TMJ, allergy meds, etc., because the out of pocket scared me at a time when I had limited financial resources. (This is one of those times where being able to have a reasonable idea of the actual cost of visits or procedures would have been very helpful.)

After I graduated, I could continue on that 'plan' for up to a year while waiting for a job, but wow, cost prohibitive to someone without a job. (In my case that was the sitch; the system required me to wait, there was exceptionally little I could do to be proactive in getting a job in my field.) And the wait turned out to be a nearly a year.

I ended up seeking out a private provider. It was freaky to do because basically you're trying to trust sites on the internet with little more than google to direct the search. There aren't good resources that point you toward trustworthy sites/providers. I ended up using one site for comparing plans and then going directly to a Blue Cross/Blue Shield site to sign up.

On the one hand, it turned out to be manageable. For about $130 a month ($1560 a year), I had a plan that allowed for catastrophic coverage AND a couple of covered wellness visits a year.

On the other hand, I had a high deductible ($5,000), had to fill out a more than 100 item questionnaire asking for very detailed medical information that stretched back so far it involved me trying to reconstruct medical information from living in three states and five different cities. (Yes, a linked-in online medical history would have been very helpful.) Part of the detail of the form left me nervous. If I somehow overlooked a small detail, would they use it to deny coverage if something came up? Would they even cover me?

They did cover me, but basically with my assurances I had never had any sort of addiction issue, psychiatric issue, and was not currently pregnant (and I wouldn't be covered if I were to become pregnant). And that was with a medical condition (Tourette's Syndrome) that I fear will be used to deny me coverage if I'm not automatically allowed in.

And the thing was, I still didn't feel confident that the plan would work like the paperwork read. I didn't feel confident making my wellness appointment, unsure about cost to me versus what would be covered. So still didn't have the care listed above covered.

And the pregnancy issue is significant in the health care discussion. It was my understanding that the grad school coverage we had was so lame because the group with which we'd had truer health coverage kicked us out because we were driving up the premiums for the whole group because of the high number of my classmates or the spouses of classmates who had pregnancies while on the plan.

Part 1 of 2.

[jennem.livejournal.com]

I'm insured under my husband's plan. He is a public school teacher with relatively good insurance. I just graduated from law school, and my job doesn't start until November, so we're living off of his salary and the remainder of our savings.

I got a yeast infection in June. Not a big deal, except that when I get yeast infections, they tend to not respond well to OTC treatment. I tried the OTC treatment, it didn't work, so I went to the gyno. Instead of testing it, she gave me diflucan. Under my prescription plan, its only $5, so its actually cheaper than the OTC medications. At any rate, the one dose diflucan didn't work. So, I had to go back to the gyno (paying another co-pay), and get a new prescription—this one with two doses. A week later, I'm still itching, so I go back, yet again. This time, the gyno is slightly concerned, and submits a sample for a battery of tests. It turns out to be just a stubborn version of yeast. I get mega doses of diflucan with a re-fill, a prescription for a nystatin cream with steroids, and a prescription for a boric acid compound to use along with the diflucan. It works. Hoorah.

At this point I've spent $60 on co-pay and about $50 on prescriptions (my insurance doesn't cover the boric acid inserts because they hate preventative healthcare and would rather pay $100+ for me to go to the doctor than $25 every three months for my preventative inserts). The lab work cost about $3000. My portion amounted to about $150. Totaled, that equals $260 for a yeast infection.

Rewind a bit. Before I realized I had a yeast infection, I sexually transmitted it to my husband. Its rare (as all of my doctors have loved to tell me), but it happens, and we're just lucky that way. Before we realized he had a yeast infection, he gave it back to me via oral sex. So, now my husband has a topical yeast infection on his penis, and I have an oral yeast infection. To the general practitioner we go! That's $40 of copay for both of us. He gets a dose of diflucan at $5, I get diflucan at $5. He's told to use the cream that my gyno prescribed for me, and the doctors give me an oral swish of nystatin.

Fast-forward five days after that, and my oral yeast infection has gotten worse, not better. Back to the doctor I go! And, out goes another $20. I get a scrip of amoxicillin ($5) because I could also have an oral bacterial infection going on, and more diflucan ($5) and more nystatin ($5). Fast-forward another week, and the right side of my neck is completely swollen. I go back to the doctor ($20) because its probably a swollen lymph node, but it could also be my parotid gland. My doctor feels me up, says it looks like it might be a lymph node, but just to be sure, I should probably go to an ENT, and perhaps the ENT could also help with the oral yeast infection that just won't go away. So, off to the ENT I go ($40, as ENTs are specialists). ENT says, its probably lymph node, if its still not gone in 4–6 weeks, come back and they'll biopsy because you know, it might also be CANCER. (Its not cancer, it was my lymph node and it eventually went down—my lymphs were just reacting to all the yeasty goodness). He refills my nystatin oral swish ($5) and tells me to call him.

In the middle of all of this, they also did blood work to make sure I didn't have HIV or diabetes, because people with those two issues often get nagging yeast infections. Those tests were about $500. My insurance covered all of it.

Fast-forward to July, and I get a UTI. So, I have to go to the gyno ($20). She gives me a prescription, also gives me diflucan because as sure as the sun does shine I will get a yeast infection from the antibiotics. But, my oral yeast infection is still hanging around. I was studying for the bar in July and getting ready to go on my honeymoon, so I headed over to an urgent care clinic ($75) got a new prescription that started off working very well ($5), and went off on my honeymoon.

The yeast decided that it wanted to start resisting the new scrip, so tomorrow, my ass is headed back to the doctor ($20).

Re: Part 2 of 2.

[jennem.livejournal.com]

Not counting the visit I have planned for Friday, I've spent $665 on health care since June. FOR A YEAST INFECTION. Something minor that isn't life threatening, isn't overly painful, but requires prescriptive and doctor's care in order to get rid of it, and because of the nature of the infection and its stubbornness, required additional testing to make sure I'm normal except for being plagued by yeast from hell.

Assuming my doctor's visits cost on average $125/visit (which is on the cheap side), without insurance, I would have spent about $4500 on doctors and lab testing in under two months. That doesn't include the cost of all of my prescriptions.

I repeat...FOR A YEAST INFECTION.

Now, someone please explain to me how our health care system isn't broken.

[lee-rowan.livejournal.com]

We're Americans - but we're living in Canada and the healthcare situation was one of the reasons. I had whiplash and a few minor problems, none of them interfering with my health or function. Result: In Ohio, where we lived, I could pay full rates for insurance--but the companies could and did add 'waiver of exclusion' for anything to do with neck, back, spine... for the length of the policy. In Ohio, an individual policy doesn't have a one-year wait on pre-existing; it's forever. I figured that as long as I didn't get seriously ill, I was better off paying the occasional doctor bill. This meant when I broke my toe (long stupid story) I just splinted it and upped my calcium intake.

My wife is a round gal - just like her grandma, who lived to 92. But her options were a $500/month COBRA payment, or a policy our agent offered. She applied for that, and was turned down for weight, despite a physical that said she's about 5 years younger than her calendar age.

We're over 50. Essentially, in the US, we're uninsurable unless we want to pay a couple thou$and a month and accept that the insurance company would find a way to avoid paying for much of anything. Fortunately, we're also damned healthy--enough to pass the physical for Canadian immigration.

The other issue, of course, is that in Canada we're as married as anyone else who says "I do."

[deborahc.livejournal.com]

To emigrate to Canada, did you need a sponsor or did you have to have a job already, or did you have to prove you were financially self sufficient? I'm over fifty too, and am wondering if they take people living paycheck to paycheck.

[cafedemonde.livejournal.com]

I am insured now, but when I was pregnant in 1992 and I had just gotten laid off from my job...and my husband was laid off the very next week.

Cobra was $600 a month with a $25 copay for each visit and not an option on my little over $1000 a month in unemployment benefits, and my $585/month rent and $300 car not

So I got a temp job and that gave paid me around $1600 a month. He was in construction and at the union hall daily waiting for work and would get a job maybe once a week. Bottom line, money was tight.

I tried to get Medical and they told me I would have to pay $700 out my own pocket monthly before the benefits kicked in and told me to sell my car to pay for medical.

I'm sure things are better now for people in the middle, but I bet there is still loads of room to improve. If you pay taxes you should not have to worryt about getting sick or hurt and going broke.

[txvoodoo.livejournal.com]

I'm insured, which means I didn't have to pay something between $60 & $70k for surgery and tests last year.

Nope, not me. Instead, I have a supposed out-of-pocket limit of $2k.

Wanna know how much I've been billed for? It's between $15,000 & $20,000.

My insurance company does a combo of things: denial of certain tests/procedures/meds, or delay of payment so I get dunned by providers, or saying that X is actually part of my co-insurance which isn't limited by that silly little out-of-pocket limitation, no! And the OOP thing doesn't mean what I think it means. I thought my Rx plan was $5/$10 - but not for MY special drugs! Nope, they're $75 and $125.

And we pay about $375/month for insurance - hubby's employer picks up the other half.

Bitter? Me, bitter? Oh nooooo. And this is supposedly GOOD insurance.

And I'm holding off on another set of tests, because I'm already dinged with 2 pre-existing conditions, and don't want ANOTHER one on my record until it's law that they can't deny me coverage for that.

[isiscolo.livejournal.com]

I have had similar experiences. Amazing how many things are "not covered" or "excess over reasonable and customary charges" or fall into separate bins with separate co-pay amounts.

[liptonrm.livejournal.com]

I'm 30 years old, a law student, and uninsured.

About seven years ago I began suffering from bizarre symptoms that would periodically leave me in a disabling amount of pain and fatigue. At the time that the symptoms first exhibited I was insured and underwent a battery of tests and saw a number of doctors only to be met with confusion and disbelief at every turn. Suffice it to say, I went undiagnosed and I eventually stopped trying to discover what was wrong. I decided that I could handle the periodic flare ups well enough and left it at that.

A few years later I was laid off and decided to go to law school. By this time I was well past the age where I could piggyback myself onto my parents' insurance program. I mostly trusted to luck to see me through. After two semesters of law school my good old mystery symptoms remanifested themselves with a vengeance. I became so incapacitated that I couldn't handle the daily grind and had to withdraw from the semester. I was fortunate enough that time around to get right in to see a rheumatologist who quickly diganosed me with fibromyalgia, a chronic condition.

I'm still uninsured and now I shell out around $100 a month from my fixed student income on prescription medication that is semi-effective. And I can't look for a part-time job to help cover my medical expenses because I'm hardly keeping up as it is. I'm actually kind of lucky that I had bad reactions to the fibromyalgia-specific drugs that they advertise on TV because those drugs cost a whole lot more than the generic opioid that I take on a daily basis. I'm also fortunate to have parents who can help me financially when I absolutely need it.

But I worry about what could happen if I was in a car accident on my way to class or came down with pneumonia and ended up in the hospital because I put off going to see my GP until too late. There are a million things that could shatter my tenuous bubble in an instant and there's little I can do about it besides cross my fingers and pray. Things could be a lot worse but they could be a lot better, too.

[gehayi.livejournal.com]

I have coverage--Medicare and, as a backup, Anthem/Blue Cross. That said, my premiums for Anthem are 217.95 a month--a hefty chunk of change when you have 968.00 per month to live on. That averages out to 242.00 a week. I got paid more than that when I was just starting to work and earning minimum wage.

I also have thousands of dollars of health care bills dating back five years. I was hospitalized for seven months--this means tests, therapy, and scads of nursing homes, since hospitals are not geared for long-term care any longer--and, well, Medicare didn't pay everything. I had to take out equity in my house (including a mortgage that I cannot pay off, and another debt I don't need) to pay some of the bills.

I cannot get consistent care. For example, Medicare will not let me get the massage drainage therapy I need on a regular basis. I need it like a diabetic needs insulin, but I am only allowed to receive it sporadically. The problem is that once my body starts responding to the therapy and the swelling caused by my defective lymphatic goes down, Medicare immediately decides that I don't need the therapy that is making me better, because obviously I'm cured now. The fact that I have a genetic and progressive crippling disease, and will NEVER be cured, is irrelevant to Medicare. It is frustrating. I try to do self-massage, but I am not a trained massage therapist and it is NOT the same.

My health also affects my employability. For years, even before I was classed as fully disabled, I had trouble finding work, because I have two pre-existing conditions (lymphedema tarda and petit mal epilepsy/absence seizures). There is nothing wrong with my mind or my willingness to work, but my having two conditions that are incurable drive up any company's health insurance premiums. Even when I could work, I usually couldn't, because no one could afford to hire me.

The present health care system doesn't provide complete insurance, doesn't provide complete care, and effectively prevents qualified people from working. If this is a functioning health care system, I'd hate to see what a broken one looks like!

[rainkatt.livejournal.com]

Lost my job in February. COBRA was going to run about 425/month. I could maybe swing that, but it would be tricky. Currently, I still qualify for the subsidized version, which just went up to $190/month from $170/month, but the company was just acquired by an Indian company, which I'm pretty sure leaves me out in the cold, not that I've received any information yet. In that case, I'm completely uninsured, and not sure what happens next.

I might be able to get some kind of former spouse CHAMPUS, and downloaded the forms when I first lost my job, but that still costs... I don't know. I have that no net feeling...

[bellatemple]

I have coverage through my full time job. I've had coverage through both of my last two full time jobs, and I could have coverage through my part time job (my part time job kind of rocks).

However, thanks to my particular insurance history, I don't have a general practitioner, I've only ever been to a single specialist, and I'm way, way behind on any preemptive wellness programs.

I don't know how it worked when I was very small -- I have vague memories of a pediatrician who was possibly named Dr. Lips -- but my family has, as far as I can tell, never been properly insured. My father's job has never been terribly secure -- satellite communications can pay well, but he was almost always a contractor rather than a salaried employee, and as my mother didn't have a college degree until I was at least six years old (my oldest sibling twelve and my youngest five) and four kids to raise, it took awhile before she found steady, full time employment.

When I nearly bit my tongue off in second grade, my father first took me to a walk-in discount clinic, but it was closed. We ended up in the emergency room and I have no idea how my parents may have paid for that. When I broke my wrist in third grade, we went back to the walk-in, this time open, and they were the ones who took care of it.

Sometime around when I was ten or so, my family ended up under a Kaiser HMO.

At the time (and, as far as I can tell, still), Kaiser did not assign general practitioners. There was no single person who you would regularly see when you went in for a check up. It was always always a stranger, and often times in a strange location. There was no trust formed between patient and doctor. My younger brother once nearly broke his nose at summer camp and had a panic attack, resulting in an ambulance ride to the nearest emergency room. What I remember most about that event was sitting in the hallway while my mom was on the phone to Kaiser. It seemed that since my little brother's nose wasn't actually broken and he only thought he couldn't breathe, it didn't constitute an emergency and they refused to cover the ambulance and ER visit.

[bellatemple]

My mom finally got a good full time job sometime when I was in middle school. I think we were still with Kaiser when that happened, and my mother hated it. Around this time, my sister was no longer a dependent, my father had a decent full time position as well as my mother, and so Mom started going to off-coverage specialists for things -- chiropractors for her arthritis and spinal issues (she had scoliosis as a child), Dad's back (he threw it out several years before; the lesson to which was "don't swing a sledgehammer like a golf club"), and my ankle (which I've had issues with since I was wee, but never got properly checked out or worked on because, well, we never had a good, regular doctor), massage therapists, more recently, accupuncture. All of which was paid for out of pocket by my parents.

By the time I got to college I was on Blue Cross Blue Shield. And also so used to growing up with no access to regular doctors that unless I had a very specific, consistent ailment (two sinus infections, one spot of pneumonia on my lung), I followed the mother-ordered regime of "take a pain killer, take a shower, take a nap." Only, having taken so much advil for my ankle growing up, I'd become averse to taking medications, so I usually adjusted that to "drink tea, take a shower, take a nap" and hope it all goes away. When I spent a semester in London, I was covered under the NHS. During this time, my mom switched jobs, and I got dropped from her insurance. And I spent the next two years or so completely uninsured.

To this day, I've kept up with the same system I grew up with: Take a pill (aleve or sudafed, usually), take a shower, take a nap, occasionally interspersed with cold compresses, over the counter nasal sprays and ear syringes, and heating pads. I'll go to the doctor if one of my coworkers yells at me enough to do so, or if whatever I'm having an issue with gets so bad I just can't take it any more -- and then doesn't go away within a day or so. I use a discount walk-in clinic -- where they constantly point out that I should maybe see my regular doctor, which I don't have.

I have insurance. Pretty good insurance, too, which is covered in full by my employer. But a lifetime of living without insurance means I have no idea how to use the insurance I have. The local doctors who take my insurance are seldom if ever taking new patients, I have no way of getting word of mouth advice on which doctors are trustworthy since all of my friends are on different insurance plans that are only taken by different doctors, and the insurance system is complicated enough that I'm never entirely sure what I can do or can't do and still be covered.

I have been very, very, very lucky healthwise, as has the rest of my family. I don't think any one of the six of us would really know what to do if we ever had a truly life-threatening and expensive medical emergency on our hands.

[(Anonymous)]

/bemusedoutsider here/

I recently got in to Medicare. At first it seemed too limited: the natural sort of doctors I like didn't take it, so I had to settle for a straight doctor who is at least reasonable to talk to. He was generous with ultrasound and offered MRI.

Then I fell and broke some bones including a hip. Local county ER, complete hip replacement surgery at the local hospital, 4 weeks in the local totally charming rest home. Medicare took care of almost all of it, no hassle. They've already paid most of the bills so the providers aren't having to fight for it.

Yes the co-pays add up to about $3,000 so far. My only complaint there is that after 20 days in the rest home I had to pay $133 a day for a few more days, Medicare's 100% for 20 days was too short. Now I'm working on a MedicAID application to pay some or all of the $3,000. Can't report on that yet but the MedicAID worker is very nice and trying to help. If I can't ever pay it, the providers will lose, but no one made me wait for treatment or shorted me.

Also Medicare has sent nurses and physical therapists to my home (30 miles out of town) ever since.

So -- kudos to Medicare for the BIG things.

[spiritdancer]

Up front: I currently have insurance coverage.

I grew up covered by insurance - my father had coverage thru work that covered the family. I went off to college, and veterinary college, and after graduating, got coverage thru my professional organization (AVMA). Individual coverage, several levels available, good coverage, open enrollment, including for my husband when we married.

After several years, I bought my own practice. By this time, the employee coverage that the AVMA program once offered was no longer available. My employees got coverage thru a spouse, or went without - there was no money available initially to offer coverage to them. I investigated getting a small group policy, and having them pay a portion of the cost as a payroll deduction.

We were looking at a group that would include 6 women (7, if I went with the same plan), with an age range of 20 to 57. I had everything lined up, and pretty much ready to sign us up when one employee came in to say "Well, I'm pregnant and need to go to the doctor. Where's my coverage?"

That one sentence roughly tripled the cost per person on the proposed coverage - and it wouldn't go down even if she didn't get coverage thru my office. I couldn't afford it, and neither could they, so we didn't get coverage.

Meanwhile my group coverage? Well, the cost went up significantly - we're talking $6000+ for 6 months at the point where we couldn't take the increases any more. By this point, my husbans was working a contract job that offered health insurance, so we dropped him from my coverage so we could afford to maintain any coverage. About 3 months later, the job went away, but hey! he qualified for COBRA coverage. Except we couldn't get anything from the insurance company as to cost, how to pay, and necessary forms. Then they dropped him for non-payment of the fees. Wonderful catch-22, that. Just wait long enough, and you can just get rid of the problem.

We have coverage now thru my husband's employer. It's a rather large company, and the coverage is decent, for what it is: HSA qualified plan, $5K deductible, you have to go to their pharmacy or pay thru the nose, etc, etc.

If he loses his job, we will not have coverage. He will not be able to get coverage privately, since he has pre-existing conditions: narcolepsy, high cholesterol, and high blood pressure. All of which do well with medication, but some of the meds are expensive, with not much in the way of generics available. Even with our coverage, trying to get one of the meds filled last year before the deductible was met? Our cost was $1500, for what was supposed to be a 2 month prescription as written. It's a daily fact of life that he doesn't use the prescribed dose, so the meds will last longer. He walks a fine line between being functional at work, and saving up meds.

The idea of not having coverage terrifies me - one major medical issue, and we'd lose our home. And this with two kids under 4.

[lilacsigil.livejournal.com]

I'd often wondered how small-to-medium businesses cope with providing health insurance in the US. Thanks for the (horrific) details.

[herald-mari.livejournal.com]

My father died because he had no health insurance. If he had, maybe they'd done the whole battery of GI tests sooner. Maybe they would have caught his esophogeal cancer (a very hard form to fight anyway) early enough so he could have had a chance. And then, maybe, his six months wouldn't have been three. (Granted, he still could have passed away, but if they'd caught it earlier maybe they could have stopped it before it had spread to his liver).

My mother is diabetic, with heart disease and other issues. Because she has "preexisting conditions" she pays for insurance that refuses to cover any of her costs.

My very good insurance plan refused to cover at a rate to where I wouldn't have to scrimp to afford them, the medications that control my sinus issues and actually allow me to LIVE when the temperature isn't below freezing outside. Luckily, both pharmacuetical companies have rebates/cards that are filling in the gaps. They're good until the end of the year, and I fear for next year...

One parent dead. One parent teetering on the brink dependant on whether we can afford her medicines or not (PPA only covers a few and she doesn't qualify for any assistance), and my quality of life and sanity hanging in the balance...that's what it's like for this American. Apparently in this country, only the rich have the right to breathe...or to live.

[(Anonymous)]

I don't have the money for insurance. If anything happens to me, my parents, who aren't exactly rich or they'd be buying me insurance, would have to pay for it. I think it's stupid to talk about how public health care in other countries is so minimal, because even if it is, a little bit of health care is obviously better than none.

I don't keep up with these things, but I heard something on the news a while back about a law that either passed or was about to pass saying that mental health conditions have to be considered just like physical ones by insurance providers. I didn't handle elementary school well, for reasons that have nothing to do with mental health. But my parents, out of exasperation, had me diagnosed with some disorder so that they could try putting me on prozac. It had no effect, of course. But if that law passed, I have a preexisting condition which would make it harder and more expensive to find coverage.

Near and dear to my heart

[adpfromga.livejournal.com]

My husband got corporately reorganized (sold like a whore from one pimp to another) into a company that does not value employee benefits from a company that did.

We went from a fairly generous 80/20 out of network, teeny co-pay in network PPO, that we were happy to pay 300 a month for for him, myself and my son in college to coverage that costs 100 a month and the following restrictions:

They won't cover my college age son.
I get two visits, covered at 100% - well woman and a physical - a year
He gets one visit, covered at 100% a year
No drug coverage
2400 per family deductible
After the deductible is met, the coverage is 80% of reasonable and customary, PERIOD.

I found after my physical that much of my yearly (and thats really neglecting it) lab work is not covered by my policy. Simply not part of a "physical" as defined by my coverage. I am both diabetic and I've got a non functioning thyroid gland. Very basic tests were covered, the rest, which dig a little deeper into my overall health, out of my pocket. I'm supposed to be doing this every 6 months. I'm not.

Last year I had a 40K surgery. My cost for the hospital visit after all the negotiating between the insurance company and the hospital was done, was about 400.00. I paid my copay and for some stuff the insurance didn't cover in some of the pre surgery visits, but my total health care costs above and beyond the premium for 2008 was less than 3K.

And I could go to my wonderful doctor, who is in my PPO, ANY TIME I needed to. Now (he is really cool) we just talk on the phone. That 120.00 office visit is mine to pay for.

Oh, prescriptions - I take 5 medications at present, plus test strips and lancets, once had significant coverage, now all my cost.

So while my husband points out that the 200.00 a month is our deductible over a year, I point out his routine colonoscopy, which never cost us more than 100.00 on the old insurance is pretty much our financial responsibility with this coverage. So he hasn't gotten one.

But what really, really scares us is what happens if we have to buy our own insurance. He will have no coverage on his knees or his colon, my remaining reproductive tract and entire endocrine system is a "pre-existing condition" as well.

So I don't know what the answer is. But it isn't this.

[secondalto.livejournal.com]

My family is on Medicaid (my husband is also supplemented by Medicare because he receives disability). We've been covered for about 11 years with a brief 2 year period when I was working and made too much to qualify for Medicaid (but not enough to afford insurance through my employer, that was at $9.25 an hour).

Though I'm grateful that I am covered, I know how broken the system is because only so many doctors/pharmacies will take Medicaid. I have swelling in my legs and the doctor prescribed these stocking (that would have to be fitted) for me. Every place around here that accepts Medicaid didn't have them in stock and wouldn't order them because I was the only person who needed them. The one place that did carry them, doesn't take Medicaid and would charge $80 PER LEG out of pocket. Needless to say I haven't gotten the stockings. I'm limited to what doctors/specialists I can see because of the type of insurance I have. And that would mean sometimes I'd have to go several miles out of my way if I really needed to see that person which means more gas and time away from work.

I am glad to have the coverage for my kids and for when I was pregnant with them. My son was born early and ended up in the children's hospital for the first two months of his life. I don't know how we would have survived without the insurance. My daughter had to spend an extra two days in the hospital because of jaundice (and luckily the insurance covered me for a max of 48 hours after her birth so I could stay with her).

In conclusion, I am glad that I am covered, but what I do have isn't all that great and I know the system needs to be fixed.

[(Anonymous)]

Sometimes I have insurance, and sometimes I don't. It varies. Right now I'm back in college and have the university's plan, which is comparatively inexpensive since the vast majority of its users are in their late teens, early twenties. Since I'm 38, I know I'd be paying a buttload more if I had to find insurance for myself. My last Serious Full-Time Job didn't even offer insurance, or pay me enough to get it and still make a decent living wage.

I have pre-existing conditions that make it problematic for me to seek out individual coverage, too. I'm a chronic clinical depressive, and while generic prozac ($4 per bottle at Target) is all I need, it's amazing what a massive hurdle that alone puts in my way in terms of coverage. Then add in the lactose intolerance (formerly treated with about $50 in Lactaid per month because it's severe; now only needs $9 in Ganeden Digestive Advantage, so that's something!), the probable Celiac disease, the psoriasis, psoriatic arthritis, chronic migraines, and your basic allergies... and I have enough things wrong with me that my rates are going to be jacked up way high.

While I have insurance, I try to remember to get myself well-care, but even that is very difficult. There are few to no clinics in the US where you can just walk in and get something done, so if I have an arthritis flare-up, it's generally over before they can fit me in and see me. How helpful is that? Not at all. Emergency care is available but it's generally so expensive that it's not worth it. I remember, as a teenager, when I slammed my hand in a steel door, I was able to be taken by my mother to an emergency care clinic and it didn't cost me all that much. And even eight years ago when I fell down some stairs and my elbow was sliced open, there was an emergency clinic I could go to nearby, that patched me up and didn't require my firstborn. Places like that don't seem to exist anywhere near where I live now, though.

Mostly, I rely on cheap services where I can find them, particularly ones that don't necessarily feel obligated to report whatever they're treating to my insurers because every report is another nail in your insurance coffin, another excuse to jack up the rates, even when it's something that the company isn't paying for and won't. It means that even though right now I'm covered by insurance, I'm a little afraid to utilize the services I've paid for because there are long-term consequences (in terms of insurability) for going to the doctor at all, for anything. (I know this because my last full-time job was working as clerical staff for a bunch of insurance salesmen and saleswomen, and I got to see exactly which conditions jacked up their clients' rates and by how much.) I try to rely on OTC medicines and inexpensive generic prescriptions to treat my conditions. And I hope that nothing major happens. Because my health has already forced me to declare bankruptcy once. I never want that to happen again, but I'm well aware that it might not take much to put me back into that position again.

Plus anything that'll let GPs stop treating their patients like McPatients, who have to be processed within a certain period of time regardless of the nature of their ailment, would delight me. (That doesn't happen to me at the University clinic, and every time I go in there it amazes me all over again that there are still places where the doctors have time to notice you're human.)

[wesleysgirl.livejournal.com]

We're underinsured (in my estimation). We pay $500 per month for what basically amounts to catastrophic insurance -- the only things covered until we hit a $2000 deductible per year is discounted medications and a once-per-year check-up. NO lab tests or diagnostic tests of any kind are covered until we hit the deductible. So when our son broke his wrist last year, the only thing that was covered was the actual cast -- we had to pay for the x-rays, the reading of the x-rays, and the $25 co-pay for every office we walked into (a total of 6 by the time it was over). When I went to the doctor for my yearly check-up, I had to pay for all my bloodwork. Every time my son gets a sore throat during the school year and the school nurse insists that he be checked for strep, it costs us $75 -- $25 co-pay, $25 for the rapid strep test in the office, $25 for the throat culture at the lab (except for the two out of 12 times that he actually had strep, because one of those times the rapid strep test was positive, so we didn't have to get the second cultured test).

We do save a significant percentage on asthma inhalers, but I buy my SSRI meds sans-insurance because they're cheaper that way (I get the generic from the Stop-n-Shop pharmacy).

I believe that my father died in part because his medical insurance refused to pay for him to go to a proper rehab. He was alcoholic who went into liver failure. He was severely jaundiced and he realized he was very ill and freaked out and called the insurance to see if he could go to rehab to get dried out under proper supervision, but the insurance co asked if he'd stopped drinking and he said "yes" and they said if he was able to stop on his own, he didn't need rehab. He hadn't had a drink for 24 hours at that point, and he was shaking like crazy. A day later his regular doc admitted him to the hospital, where he later died, but I'll always wonder if that day could have made a difference.

[spiralleds.livejournal.com]

It breaks my heart to hear about your dad. To me it brings home the fact we do have 'death squads' deciding who lives and dies, except we call them insurance companies.

[harmonyfb.livejournal.com]

I am insured on an hmo, with a $7,500 family deductible for a long list of procedures.

CT scans? No, not until I meet the deductible. Ultrasounds? Ditto. (And when my husband hurt his back and had to have an ultrasound, the charge was $800. When I called the hospital to set up a payment plan - $800 is nearly my entire monthly income - I was told that it was 'wasn't a big amount' and that they didn't do payment plans on such piddly amounts.)

My mother just finished having a biopsy because of suspicious issues with her breast. Her insurance would not pay for an MRI, but they did pay for a biopsy. So she stayed overnight in the hospital and got cut open because the insurance wouldn't pay for the less invasive option.

And you know what? We have pretty good insurance. I live in fear that we might someday not have any at all (my husband is diabetic. Health insurance that would cover him? More than we make a month, I'm sure.)

My friend Tom died in 1998 at the age of 32 because he didn't have health insurance. So when he started having trouble breathing, there were no tests performed - not even an X-ray. He was told 'oh, it's probably asthma' and given a generic inhaler. An X-ray might have shown the blood clot that killed him. :(

[cruelhaven.livejournal.com]

At the moment I have great coverage -- but that could change at any time. I work for a tiny company (where, among other things, I do the books) and the insurance premiums are killing us. And the rates are going up again next month, to $617.18/month for a single person or $1666.38/month for employees with family coverage. I don't know how much longer the company will be able to pay the cost of health care for its employees. We have looked into less expensive policies but so far have stuck with the "good" one. And even then it isn't great -- I end up paying about $2,000/year out-of-pocket on dental plus $400 or so on eye care. Add to this that I'm on allergy injections ($28/week plus $420/bottle), three prescription medicines (only one of which is a generic), and my husband is a diabetic
with high blood pressure and also needs a handful of non-generic meds) and we'd be paying more than we could afford on medicine alone -- the heck with doctors visits, routine medical tests, or heaven forfend, emergency services.

Canadian in US

[(Anonymous)]

I was born in Canada, lived in Israel for eleven years and have lived in the US for eight years since age 29. I've been insured all those years through school and work. Still, I miss my OHIP. I'll tell my Canadian stories in the other post, but here are some of my stories from here:

1. For my first two years here I was covered through my university health insurance plan. It worked fine, I just went to the clinic whenever I needed anything. No complaints, really.

2. In my third year of graduate school my ENTIRE SCHOOL was dropped by the insurance provider because our average student age was too high. The school scrambled and found two emergency insurance options for their students. One cost in the range of $300/month. The other had a maximum lifetime benefit of $50,000. Yeah.

3. The next year the school arranged health insurance for all of us through Kaiser. I loved it, the clinics were open decent hours and had everything I needed, and I didn't need to carry referrals from place to place. It was just like the clinic I used to go to in Israel.

4. The next year I began working and was supposed to get health insurance through my employer. It took four months for my employer to arrange coverage for me, despite frequent frantic phone calls. I was lucky, I didn't get sick in those months.

5. Since then I've been working and have been on Blue Cross/Blue Shield, the best (and most expensive) insurance available in my area. (Kaiser doesn't have clinics in my state, alas.) I don't like it. It's been hard finding doctors who take it and I've had waits of up to six weeks for needed appointments.

In general, my sense is that the medical care here is no worse than what I've had elsewhere, but I also feel not qualified to tell. The main difference is how much doctors push pain medications and antidepressants for even mild discomfort even when I don't feel they are necessary. Also, the hospitals here look much prettier.

Re: Canadian in US

[caitlin.livejournal.com]

Yeah, Kaiser doesn't have clinics in the state I now work and live in as well.

I used to have them and loved it. I always knew where to go for care.

Wait times in the US

[mamculuna.livejournal.com]

This is a bit OT, because it's related to wait times, not the difference between insured and not insured. But I thought it was relevant:

I took someone to the hospital with a rupture appendix in the US two years ago. We waited 11 hours for him to have surgery--with no painkillers. I don't even think he saw a doctor for 7 hours.

I've gone in with minor injuries and the wait time in the ER is always at least 2 and often 3 or 4 four hours.

My husband needed surgery a few years ago (problems with parathyroid). He was diagnosed in early November and couldn't get surgery scheduled until early January--and they didn't know beforehand whether it was malignant or not.

I know this should go in the US section--will post it there also.

Re: Wait times in the US

[jennem.livejournal.com]

My sister-in-law went into the ER with horrible abdominal cramps. We waited for over 9 hours (in the freezing waiting room) to get through the doors of the ER. Once inside, it took them five minutes to figure out that she had a ruptured ovarian cyst and needed an immediate laparoscopy. She was in surgery ten minutes later.

But, we can't have a public option in the United States! NO ONE WOULD BE ABLE TO SEE THE DOCTOR! THE WORLD WOULD END.