A Healthy Dose of Thanks

This month I finally paid off my medical bills, and for that I’d like to thank you.

See, I do have insurance. Relatively good insurance. It’s the biggest reason why I have not become a full-time blogger. I know the value and cost of healthcare; my father was in and out of hospitals from when I was in 4th grade until he passed in 1998. If my family didn’t have quality health insurance, I can’t imagine what would have happened. As it was, we still struggled financially to cover the copays, refinancing our home, and depleting me and my sister’s college funds.  I remember when Karl had cancer; with his great work insurance he didn't pay a dime out of pocket and was able to see highly-rated specialists and try any treatment recommended to him.

When I accepted my current job eight years ago, a big deciding factor why I chose it over another company was the insurance. My current job's insurance required me to go to health clinics and I’d spend hours just waiting to see a health professional who was often overworked, overtired, and not really interested in me as a human. We were thinking of starting a family, and I wanted to be able to get the care I wanted, not was forced into. This job had a PPO with the insurance I grew up with. Not the cheapest, but I knew it to be worth the money.

And it was. I didn’t pay a single dollar out of pocket for my prenatal care or delivery of Emerson, even though I chose midwives and a birthing center, even though last minute I was admitted to a hospital, even though I was in that hospital for four days before even giving birth. Outside of childbirth, I went to the dermatologist when I had a funny looking mole, the doctor when I had a cough, the orthopedist when I sprained my ankle and made all these appointments with doctors I knew or were highly rated by those in my community. I could find doctors near my office or near my home, I could afford my prescriptions.

And then my company decided to save money and “help us make better choices” and changed to a patient-managed healthcare plan with a high deductible. It didn’t seem like a big deal at first; I saved up money in my HSA which rolled over from year to year, Emerson’s wellness visits and vaccines were 100% covered, I was taking home more of my paycheck and according to all the insurance paperwork, I should be fine if God forbid something terrible happened to one of us. Once I met my deductible, everything would be covered, and I saved enough to cover that very high deductible.

Then my arm broke in February 2014. I went to the emergency room at the hospital closest to my home (in-network), was assigned the orthopedist on duty (also in-network), he performed my surgery at that same hospital, and then performed my after care. Even so, I met my deductible by April 1st. Sweet, it’s all free for the rest of the year, right?

Nope. I learned this pretty quickly when my arm rebroke in May.  Because it became a complicated situation, I knew it was best to choose a wrist and arm specialist.  I searched around and while many took my insurance, they weren’t in-network or as cheap as my general all-body orthopedist. They also performed surgery at hospitals and surgery centers that weren't in-network.  I decided a right arm isn’t a place to be frugal and decided it was worth the cost. But this cost money. A lot of money. But I made this choice, and I felt my arm was a worthy investment.

Through this process I learned that insurance can decide what they think is necessary and what is not, whether or not your doctor agrees. Nerve block? Unnecessary. Anesthesia? Unnecessary. Bone stimulator implanted in my arm to help healing since my bone was dying from the second break? Unnecessary. A replacement cast each time they removed it to get clear X-rays? Unnecessary. All the pre-op appointments? Required to be admitted but not considered wellness checks so they cost out of pocket about $100 each. Let’s not even discuss the brace, the sling, the bandages and splint, the follow-up visits every few weeks for X-rays to check progress, all which were considered unnecessary.  As for prescriptions, they often were often too expensive to even fill.

Finally I was at a point where I could do physical therapy to gain back strength and dexterity. I called insurance before scheduling; they told me they covered 60 sessions a year, and the PT recommended by my doctor was in-network. Finally! I went 2-3 times a week and was seeing progress. Then 2015 started. I was continuing my therapy until I received a bill for over $1,000 for two weeks of appointments. I called my insurance. Yes, they do cover 60 sessions… after the deductible was met. Since I had wiped out my HSA in 2014, I had no back-up funds to cover these bills. And with the second surgery I had also depleted so much of our savings. And I still had a third surgery scheduled for later in the year (considered unnecessary since it was to remove that unnecessary bone stimulator). I stopped my physical therapy months before I was supposed to because I couldn’t afford it; I never gained back all the flexibility of my right wrist and hand and I have no idea how this could negatively affect me as I get older.

This blog is the only reason my family was able to make it this past year. While I make a fine living at my day job and Karl brings in money from photography and yoga, the blog is how we were able to pay the bills relatively on time (and at least pay monthly on medical bills that let us do a payment plan). We cut costs every way possible, sold a lot on eBay, Poshmark, and Craigslist; made do with a lot less. I made changes with how I monetized this blog in hopes I could bring in more income without completely selling my soul or losing your trust.

And so this month, thanks to the blog, I finally paid off my medical bills. But I worry about those who don’t have a second income to help them get by, don’t have a couple years to build up an HSA before a tragedy, and those who don’t have insurance at all. The ACA still costs hundreds a month and doesn’t cover everything. I don’t like to get political on this blog (and am not encouraging a political pro or anti Obamacare debate in the comments), but it’s really concerning how expensive it is just for preventative and emergency healthcare in the US and how much time and research is now required to find affordable care, even if you have insurance.

For all the time I spent on the phone with insurance, meeting with HR, haggling prices with medical professionals, researching prices for everything from a pre-op appointment to which treatments to accept during a surgery, educating myself on the side effects of cheaper generic prescriptions, calling doctors and asking for quotes before they even saw me, I could have earned a college degree.  And with the amount of time needed to be able to be on a computer, to make phone calls during business hours… it seems patient-managed healthcare is only for those who have a secondary education, free time between 9-5, and internet access.

For those who have quality healthcare, don’t take it for granted. I did. I figured my family and I were in good health, but accidents and illnesses happen to all kinds of people in all conditions of health. And even those who have good jobs and “their act together” can get into a serious financial predicament because of insurance and/or a health issue. Whether you’re looking for a way to donate a bit more money for a better tax return or you wish to make a difference this holiday season, consider giving to organizations like The Health Wagon (I featured them last year for #GivingTuesday) and NAFC – The National Association of Free & Charitable Clinics. Accessible healthcare for all benefits all of us.

13 Comments

  1. Anna Wagner
    February 21, 2016 / 12:23 am

    This is so important. I hear a lot of talk about how high premiums are, but not much about how much insurance (and health care) can be just awful otherwise as well.

    I was just laid off and luckily am covered on my parent’s plan again until I turn 26 in July, but my health insurance at my previous job was not great and our health care system overall isn’t either. It was fine when I started working there, but then they switched to the self-funded, high deductible plan with an HSA. So far my HSA has covered everything insurance hasn’t (which, turns out is a lot, including apparently a physical during which the doctor updated my asthma inhaler prescription – necessary in my mind) but it wouldn’t be a pretty situation if something unexpected happened.

  2. January 7, 2016 / 4:33 pm

    Great post, thanks for sharing some of the reality of living in the US. To those of us in most of the rest of the world, the idea that you have to pay when you get sick or give birth (and if you can’t pay, you don’t get care) is astonishing (and very short-sighted as not dealing with health issues costs the country far more in the long-term). I do hope that sense can prevail and this crazy, overpriced system can be improved…

  3. hope
    December 29, 2015 / 4:34 pm

    I am so glad that you were able to pay off your bills. And it is most definitely not a good situation to be in. Right to health is a basic human right and I am sad to see US does not take care of its citizens health. Soo very thankful that I live in Canada.

  4. Karen Combs
    December 29, 2015 / 3:58 pm

    I’m in the same boat– thank goodness we have the means but 9K for a CT that cost 1K two years ago? Insane!~

  5. Mallory
    December 29, 2015 / 1:56 pm

    The idea that you can’t just go to any old hospital and have a baby or just see a doctor because you are sick is so weird to me ….so yes, definitely appreciate socialized health care (and to be honest I do NOT understand how people can argue against basic medical care for everyone, I mean, I pay beacoup de taxes, but whatever, priorities).
    Glad you are on the other side of it now.

  6. MJ
    December 29, 2015 / 1:41 am

    J’s mom passed away from cancer in October. She was diagnosed in May with stage iv uterine cancer. It was caught late, after it had already spread to her cervix, lymph nodes, spine, and stomach. She did chemo, which had the unfortunate effect of making her sicker. She ended up in the hospital for almost two weeks before coming back on hospice. All of this is to say, after she passed the medical bills kept coming. (She had moved in with us in August.) I almost had a break down when the bills arrived. I am so so thankful she had Tricare, military insurance, from when she and J’s father were married. The last bill I saw was over $200,000 but she only owed around $36. It breaks my heart and honestly scares the crap out of me to think about what we would do if this had been J or me. We have decent insurance, but I know we would have been looking at massive bills if the circumstances had been different. Long personal anecdote….I am glad you have come out the other side of this!

  7. Ginger
    December 28, 2015 / 4:46 pm

    When an employer starts talking about benefits and helping employees to make better choices, it’s time to hang onto your wallet! Mine is mouthing those phrases about PTO, they’ll help us “manage” it better by cutting what we earn. Thanks a lot.

    I’m glad your arm is better and that you were able to use your talents to earn some extra cash. Keep at it with your at-home PT.

  8. Diane Hance
    December 28, 2015 / 4:11 am

    I am so sorry for all your frustration in dealing with the insurance industry, but huge hugs and pats on the back for you in having completed an admirable task in getting the bills paid off. I am just beginning the fight to get the health care I need. I don’t know why, as Americans, we have been in the dark for so long. Doctors and patients no longer make our health care decisions. The insurance industry makes those decisions and has been for quite some time (long before Obama care). It is such a conflict of interest since their only goal is their bottom line not your health. I don’t know how to make it happen, but we all need to stand up to the insurance industry and demand better health coverage for the huge amount of premiums we pay. Perhaps the only way it can happen is with universal health care? Thanks for letting me rant a bit–I will step off the podium now! So glad you made the choice to get the care you needed, you are worth it!

  9. J9
    December 27, 2015 / 6:30 pm

    Your post made me realize that as a Canadian I am very, very lucky to enjoy universal health care. It is by no means perfect, but I cannot imagine having to shop around for specialists or forego physiotherapy or be told anesthesia is unnecessary! Good for you for making it thru this challenging time in your life. I enjoy your blog, keep up the good work!

  10. December 27, 2015 / 1:41 pm

    It is a frustrating battle…one I learned early as a dental professional. As a patient, we seem to think that health insurance is there to help us. And you could say that it is….but the reality of the situation is it is also a multi million dollar business, who’s true goal is to make money—not that that’s a bad thing—just sometimes, the health of the patient gets pushed to the wayside. I think the learning for all of us, should be that our health is truly important and quite an investment. For those people who are healthy—yippee! For those who aren’t—it can be such a struggle.
    I do try to appreciate having insurance, but I also feel annoyed when the “rules” seem disjointed. jodie
    http://www.jtouchofstyle.com

  11. Amanda
    December 27, 2015 / 1:35 pm

    I am so proud of you and your family for working hard to pay off your medical bills, not to mention being so well informed about your health care. I read your post just after spending 45 minutes on the phone with Humana asking many questions about our health insurance plan that we pay $1000 a month for- and that has a $5000 per person deductible. My husband is a self employed cancer survivor and we don’t qualify for any subsidies through the Affordable Care Act, so I am reminded very often how broken and NOT affordable the health care system is in America. If anyone knows of ways to get involved in helping to make a positive change in the US health care system, I would love to be a part of it. I know we can do better.

  12. Jane
    December 27, 2015 / 1:28 pm

    I’m so sorry you’ve gone through all of that. If a procedure or test ordered by your doctor is disallowed by your insurance company, you have the right to request a third-party medical review if your doctor files an appeal with your provider. About thirty percent of appealed decisions are reversed upon medical review. Here’s to a healthy and prosperous New Year!

  13. Bridget Wall
    December 27, 2015 / 12:04 pm

    Oh goodness, medical bills. So tough. I’m glad you’re finally on the other side of that struggle.

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