Wednesday, February 21, 2007

Healthcare/Health insurance

I'm going to "go there" because it is on my mind constantly.

I never gave healthcare/insurance a second thought, until our baby almost "ran out" of health insurance. By the time Matthew was 10 months old, 1.9 million of his 2 million dollar "lifetime cap" had been met.

Lifetime cap?? Oh.My.God. I had never heard of a "lifetime cap" in my entire life! I had raised a 22 year old without ever reaching the deductibles and I have always been very very healthy. You just think ... when you have insurance ... you have insurance, until you lose your job or discontinue your coverage. You think you are safe.

NOT always true. You should go check your policies. If you have a one million or two million cap... trust me... it's not enough if you have a major medical event. Also, they can have clauses in there that you don't know about. For three months at Stanford, we were told we were OUT of insurance b/c heart transplants had a $250,000 maximum payment... even though he didn't have a heart transplant... but a graft... the re~insurer tried to cut us off.

I think it is disgusting that in this rich country of ours ~ the middle class and above get screwed.
We middle class pay the taxes that pays for Medicaid. BUT, if we middle class "run out" of health insurance w/no options ... WE are not protected. At least if you live in Nevada. Yes, we supposedly have HIPAA to protect us... but from our experience ... the insurance companies find every single loophole possible to get out of it.

We were "not eligible" to purchase private insurance for Matthew... we fell thru every loophole the HIPAA protection had. Because we earn over the poverty level we (Matthew) didn't qualify for straight up Medicaid. "No health insurance" would be a death sentence for this boy who will need a lifetime of heart surgeries and care.

We were facing horrible and outrageous options ... such as: DIVORCE (so I could be a single, poor mother), moving out of state to another state that has a "high risk pool", giving Matthew up for adoption to a family member (saying we were unable to care for our baby), or my husband quitting the job he loves in hopes of getting more insurance at another municipality ...

WHAT IS THAT???? How crazy is that??? Makes me spit firing mad every time I think of it.

It was 18 months of a living hell (that I could never relive) ... not only worrying about the life of our medically fragile baby... but then to worry about the financial end of it at the same time... it's almost unbearable.

Luckily for us, my husband's employer raised the lifetime cap this past November. Just in the nick of time, I might add.
This was a livesaver for our family and Matthew ... I am still thrilled beyond words and thank God every chance I get.

But... this doesn't change the fact that this type of thing is happening all over this country!!

You are safe in this country if you are poor... at or below poverty level ... then you will get all the medical care you need. Medicaid pays for it all. We have seen "illegal" mothers get free healthcare for their babies and other families that went home to care for their baby with a Medicaid card. No worries for them. But, not us....forget it...."we make too much money". HA!! Anything over the federal poverty level means you make too much money. I sure don't know anyone in my life that can afford Matthews care without health coverage.

My husband and I call this "reverse distribution".

Healthcare prices are so outrageous now... no one can afford it without insurance. Holy Cow, even with insurance, these cardiac kiddo's are VERY VERY EXPENSIVE and can be quite a financial drain. It's no wonder we almost "ran out"~ because of the horrible prices our insurance paid out. Everyone should treat their health insurance as if it's a savings plan and watch every penny spent. FYI, one hospital overbilled by $130,000.

That is why we are continuing our fight to the State of Nevada. We are going to testify to our legislators soon. We testified in August of last year and persuaded Senator Joe Heck(R) to draft and submit a "Medicaid buy~in " bill... unfortunately there is an income cap ... so we would not qualify. This bill will help 40+ Nevada families, I hope it passes.

We need something to protect the middle class families.

We need changes in our healthcare system. No one should ever face what we faced.

Here is an eye opening link:
http://www.washingtonpost.com/wp-dyn/articles/A9447-2005Feb8.html?sub=AR
Article written by Elizabeth Warren, a Harvard law professor called...Sick and Broke.

34 comments:

Multi-tasking Mommy said...

Wow! That is so scary. I cannot even imagine having to go through what you have... You must be one VERY strong woman :)
Thanks for the eye opening post.

Queen of the Mayhem said...

Terri,
You KNOW how I feel about this tragedy! Was Paige able to sell this story to one of her editors? Every time I think about this....my blood boils!

david santos said...

Hello!
All very good
Thank you

Terri said...

I didn't feel so strong at the time! I cried A LOT and worried myself sick. But I did fight... I didn't just sit back and take it...
I was fighting for Matthew's life.

I look back and wonder HOW I didn't fall apart.

Hence, the name of my blog :-)
I don't know how I coped...

I think it was a lot of chocolate!

Burg said...

I know EXACTLY what you mean.. I never cared much about insurance until I had children, and mine are healthy, but then when we didn't have it it was a real eye opener.

Unfortunately, the middle class screwing doesn't really stop with just healthcare. Total dependence seems to be favored by the vocal majority in this country even though they'd never admit it. The illegal/jobless/lazy get fancy terms like "poor" and "needy." The truly helpless get overlooked. It's like your punished for having a job and heaven forbid, raising your own kids.

Gee.. I could go on and on, but I won't.. And I'm sorry if I sound harsh.. Praise God that things turned around for you and little Matthew, who I learned a bit more about after poking around on your other blog a couple nights ago. What a handsome little man!

Your in my prayers... Stay strong!

Dan said...

I still cannot get my head around the American health insurance stuff... Over here, granted, our Casualty department (ER to you non-brits) CAN keep you waiting for a few hours to get stitches, a plaster-cast, whatever - but the emergencies are dealt with ASAP. Some of the hospital wards are full, understaffed and underpaid, but then, you only read about the bad stuff in the press.

I would happily know that while I am sitting for 4 hours waiting to get my leg xrayed, a kid somewhere else in the hospital was receiving the very best treatment, then so be it.

Terri said...

Burg,
I COULDNT' AGREE MORE!!!

"The illegal/jobless/lazy get fancy terms like "poor" and "needy." The truly helpless get overlooked. It's like your punished for having a job and heaven forbid, raising your own kids"

Terri said...

Dan,

OMG... I have thought to myself hundreds of times...

"if I lived in the UK,Canada,Austrailia,Singapore we wouldn't be worried about this stuff".

I'm all for Universal Health Care now, but my husband is very much against it.

weatherchazer said...

I've got to weigh in on this one. I work for the State of North Carolina in their Medicaid division. I hate it. My primary job is with the elderly in need of Nursing Care or Assistance at home. They are screwed just like the middle class. They have worked so hard all of their lives to make something of themselves and to give to their children. Then when they are sick and can no longer care for themselves, they're punished for trying to live with pride by working hard and EARNING what little they have. I hate what I see everyday with kids coming in pregnant and no idea what they are in for. It's a big game. They pop out five and the state pays for them all. Then the kid is on assistance for a lifetime because the father was not there, the mother didn't try; the child sees this and the cycle perpetuates itself. And I don't even want to start on the immigrants! They get better help than people who were born and raised here!

As for private insurance- I am lucky enough to have insurance through my job, as does my husband. It's not great, but we are both in relatively good health. My children on the other hand had to have private insurance because for us to purchase through our jobs was 3 times more expensive- and it would not even be as good as the policies they have now. Terri, I feel for you girl, I really do. My daughter had some complications at birth, but not to the extent of Matthew's. You and your family will always be in my prayers for good health and long, happy lives.

Dan said...

Terri, you got my blood boiling with this post ... now I have to go to the doctor but I can't because it's too expensive!! :)

But seriously, I'm with you on this. I don't know what the solution is, nor will I even venture to figure one out. But I don't think there is an ideal system anywhere in the world to turn to. Or even one that comes close, that we can make better.

I often wish that we can go back to an earlier day when people were living nearly as long and where things were so much simple. Why has modern life become so freaking complicated??

The extra few years we have added to our expected lifespan through modern medicine just doesn't seem worth it!

Terri said...

Weatherchazer,
I am totally with you on that one too!! I met a wonderful senior citizen who was in his 70's... he lost his home, everything except a piano and a bed b/c his wife of 50 years got cancer in her spine .... he cried his eyes out to me... that was about 20 years ago.. and I could never forget his face and his story...

I met another family years ago that had to divorce so that the husband could get care... they too had been married almost 50 year...

It scares the crap out of me!

What good does it do to save your whole live...
only to have it snatched away b/c of an illness...

Everyone needs to pester their Senators to help come up w/ something..

My husband has ideas but it's too long to explain...

But I know our insurance PAID OUT $14,500 to $21,360 a day for room and board at Stanford during our first 2 1/2 months...and that was with a 40% discoun.
That did not include doctors, surgeons, asst. surgeons, xrays, labs...

It was on the news that healthcare is going to continue to climb...
one out of every 5 dollars will soon go to healthcare.

But.. if you are illegal or "poor" you are jusssst fine!

Terri said...

Dan, we think a lot of the problem is

the lawsuits.....

we are paying for those who don't have insurance (poor, illegal)in a round about way...
and oh yes...

greed!

Terri said...

Dan.. I meant to say...

had Matthew been born as little as 10 years ago...
he would not be here today...
the type surgery he had is fairly new...
so we are forever grateful for technology and advances...
but...

once they save your kid...
the insurance is wiped out...

I am friends with two other families of cardiac babies here in LV that ran out and they are in a mess right now....


Excuse the words spelled wrong...
I'm typing fast and furiously!

Nancy said...

Terri,
Have you heard anything about Lincoln or Mason? I worry so much when we go so long without getting an update.

Sending hugs to them.

Nancy said...

I am so proud of you for fighting for the rest of us even though you were able to get your own insurance troubles taken care of.

Nancy said...

And Dan (the odd one),
I have spent 6 hours and more in the ER trying to get them to take care of my heart kid - who was having difficulty breathing - whose O2 sats were in the 60's or lower!

Our Emergency rooms are filled with people who don't need to be there. They either don't have primary care doctors (for various reasons - some being that they are uninsured and only go to the ER when they get sick - or the primary card doctors are so over-booked that they can't see their patients and send them to the ER) or these people don't want to take the day off of work to take their sick kids to the doctor during the day so they take them to the ER during the odd hours...

Don't even get me started on the families who feel the need to bring everyone and their grandma to sit in our waiting rooms - spreading more germs for those who are REALLY ill and whose immune systems are already fragile. Many of these people are allowing their young children to run wild, spilling water and ice on the floor, laughing or fighting and causing mayhem (no offense, queen of mayhem).

I have had to sit through all this while trying to keep my heart child away from all the other germs all the while wondering what is considered an emergency. Last February Jessica was throwing up blood and had bloody stools - her O2 sats plummeted and she couldn't even sit up she was so weak - her breathing was very labored and it still took us over an hour to get past the registration desk and into a room! It then took us 4 - 5 hours to get an IV started and admitted into a room on the ward.

There are soooooo many things wrong with the way we practice medicine and pay for it in this country.

Sorry for my rant but hey, I wanted to fit in. ;-)

Burg said...

I think you hit the hot button Terri!! LOL

I'm with you on the lawsuits and more importantly, the greed. I don't feel like hospitals should be conducted as a profit making business and I can't help but wonder if that's what happens when my bill contains a charge of $18.50 for a couple Tylenol. The health insurance industry is the only type of insurance with no real regulation. I think there needs to be a crackdown on whatever's going on there..

I tend to disagree with the thought of socialized medicine. It sounds like a great idea until you have to experience it. I haven't had near as much as a friend of mine who has lived overseas, but the little bit I have had was a craptastic experience to say the least. What scared me most about it is that the doctors seemed to care less for the patients. The last person I come into contact with that I want to experience burn-out syndrome is my doctor! Oh, and maybe the counter worker at Taco Bell.. I don't like spit very much..

Terri said...

I know... I know re: the universal or socialized medicine...
My hubbie keeps telling me that ... and he explains why....
he did say that Singapore has a good plan... but I can't remember what it was...

I was listening to Rush Limbaugh the other day and they spent 1/2 hour talking about the "wait times" for people to get in for MRI's and other tests in the UK and Canada... it was crazy!

Salty Sailor said...

I think the way you Americans deal with healthcare is atrocious. It shouldn't be optional, everyone should pay a small amount out of their income every month like us Brits. That way you don't have to worry about it and you can go see a doctor anytime you want.

Oh, and well done for fighting back - I totally hate insurance companies.

Queen of the Mayhem said...

You should try being in LA and need to go to the emergency room! We are still so overwraught with displaced Katrina victims that it is absurd!

Luckily for us, both of my children have been relatively healthy. But, the few times we have made the trek to the emergency room, it was terrible! I sat in awe of these people who were there.....for SINUS infections! WTF? And I was doubting myself for bringing my kids for SERIOUS injuries! I guess when someone else is paying for it....you can SPLURGE! UGH!

Dan said...

The wait times over here are often dodgy, BUT it depends what it's for (mostly). When I had been off for a year, the bone-doc wanted to check my back, and booked and MRI for me - I had to wait about 10 days, no biggie. A friend of mine has something odd going on with her plumbing, and no one is worried, and she had to wait 4 weeks.

By the same token, the "important" stuff is usually dealt with fast - cancer, heart issues, emergency stuff - but the stuff that can wait - tonsils out, joint replacements and so on - they tend to have more people needing them, thus a longer queue.

Don't get me wrong, I have horror-stories aplenty - it may come as a shock to some, but as much as I am an accident prone klutz now, when I was a kid, my mum was watched by child services, I was in and out of hospital so often. But for every horror story, I have a positive one to off-set it. As I've said before, the press only publish the bad stuff, no one would read headlines that said "Everything's Fine, Have a Beer!"

Liam's Mom - Gina said...

What misery you've been through.

I can't imagine the anxiety of having a child battling the odds and having to fight HUGE financial burdens at the same time. What a true nightmare! And to think that breaking treasured vows and splitting a family is the answer to a financial burden like that, just astounds me.

matty said...

That is horrific!

You know, we have almost reached the point where one either has to be VERY rich, dirt poor or in the armed service to be able to live.

It is getting so crazy!

Dan said...

Terri, well I'm sure glad he's here! That's a good thing for sure.

I agree with you about the lawsuits. So many malpractice suits and the insurance is astronomical. And yeah, those who make less get if for less.

Hugs and kisses my friend.

Kevin Charnas said...

RIGHT ON!!! YEAHHH!! WHAT TERRI SAID!!

Terri, I'm so proud of you for many reasons, but fighting to change this is one of them. Our health care system needs MAJOR attention and should be labeled a right to all citizens, without anything so absurd as a "cap". It should be a service to our citizens, not big business. The whole notion of how our health care system works makes me sick.

And "Oh, you've reached your cap, sorry."

WHAT??????

I would be out-of-control, forcing down pepper-spray drinks all over the place. It wouldn't be pretty.

Mary said...

Terri,

I've been reading Matthew's blog and didn't realize until I saw your picture on both blogs that you were that Terri! I hope you get your cbox soon!

The Special Zipper said...

I guess we tale take things for granted. In Australia we are like the Brits and pay 1.25% of our gross wage to Medicare (the Commonwealth Health System). Now obviously that still means it is still not a balanced ledger as that means some people do not pay at all and others pay through the nose as the higher income you earn the higher levy you pay.

OK .. so that is the base system. Then there is private health insurance on top of that for those that choose to purchase that. It is strongly encouraged by the Government to take some pressure of Medicare ... however Medicare is for every Australian .. not income assessed. Private Health allows you to choose hospitals, choose doctors, surgeons, specialists etc however is still frustrating in that often you can still pay considerable gaps between the fee the insurer is allowed to pay and the actual fee charged. In the cardiac world I must say this is almost non existent. We have world class surgeons in Melbourne that do not lump on exorbitant gaps.

So whilst Australia has got issues with elective surgery waiting lists .. (elective surgery is not as it sounds ie a knee reconstruction where you could be in immense pain is classified as elective surgery).

Anyway, great work Terri on the blog. Here I have been blogging for almost a year, and I have never got 26 comments. Mind you a good bit or "response commenting" as I call it, as opposed to Dan who has accused me of "comment spamming my own blog" when I have done similar, does help to build the numbers a bit. Still .. I am jealous. I going to have to do a Jenny and see if I can set a comment goal.

BTW ... have added your new blog to friends of The Special Zipper Now is all you need to do is link from Magoo to Steel Magnolia and back.

Dan said...

Don't worry Mr Tim, I'm taking to the idea of conversations via comments... I've never had this many either!

Terri said...

You know... if our politicians ever had to worry about this kind of thing ... things would be different ... but they are protected from what I hear ....I hear that they have a lifetime of health coverage after serving only one term..

You should have seen the email I got from Senator Harry Reid...our Senator...

it was blah blah blah...
"we're sorry that this is happening to you..."

basically... too bad so sad....he could care less... one: because he's a millionaire himself...
two: he's just a stinkin politician that only cares about "what's in it for him".

I can't tell you guys how many nurses,respiratory therapists and doctors that say that this kind of thing really upsets them...

they see this allllll the time in the hospitals and offices ....they see "certain people" get free healthcare ...

and then there are people like US ... that can get cut off with nowhere to turn... ticks me off!!

I am calling the general counsel to the Governor this week...he's expecting my call. We may get to meet w/ the Governor. I was supposed to meet w/ his Chief of Staff a couple weeks ago, but Matthew had a GI test so I couldn't go! :-(

I am lucky to have someone from the Fraternal Order of Police
lobbying for this cause now.
He's in Carson City now talking to the right folks.

Flawed & Disorderly said...

Dan's post DID crack me up! I'm over here to figure out the difference in the address of your steel magnolia blog and the one incorrectly linked to my blog....hmmmm

Flawed & Disorderly said...

I FINALLY figured it out!!! Your is wwwsteel....
and her is www.steel

There's a difference of a dot. Ironically I didn't have the w's in at all the first time, but it still linked to her blog. You two magnolias are the only ones who put the w's in your title...at least that's how it's written up on my blog. So weird that it still works!

Terri said...

F&D
that was the only way I could use "Steel Magnolia"..
Mike was was laughing at me!!

Welllllll!! You do what you gotta do to get what you want!

Dan said...

how about
steel-magnolia
steel-magnolia-LV
rusty-old-magnolia

hehe I'm tired and i've got NOTHING! Or nothin' as you lot say.

Melissa R. Garrett said...

I hear you loud and clear on this one, and I agree with the reader who said it doesn't stop with just healthcare. On paper, my husband earns above the national average yet in real life, we're living paycheck to paycheck (thanks, in part, to some really idiotic spending decisions. Our biggest hurdle has been affordable preschool. No child gets left behind? Yeah, right. Those at poverty level get all-day preschool paid for by the state of NY, and we're struggling to send my son to preschool a few hours a week. And I feel our medical bills have only just begun with my son's recent diagnosis of ADD/borderline autism. I know it's nowhere near the expense or trauma you've experienced, but it's a lot for us now and will continue to be a lot for us.

ARG! I guess my blood boils too!

Thanks for stopping by my blog Terri, and I hope you come back. You have a BEAUTIFUL family :-)