Monday, February 27, 2012

Putting a price tag on health...

In 2006, we uprooted the family and moved to Tennessee for what was supposed to be a dream job. One small glitch was that this dream job came without health insurance. We didn't think much of that small fact at the time. We were all healthy for the most part. Even my son who has asthma was not needing much in the way of support and we figured we'd just buy our own health insurance and be done with it. My husband took the job and we moved from Arizona to Tennessee.

Alex in 2006
I had no idea what a debacle the individual private health plan application process is. My son and I were denied coverage by our first attempt through Blue Cross. They cited his asthma. They cited my "body build" which was humiliating to say the least. We worked with an agent after that to acquire insurance through a company I'd never heard of (and for good reason as it would come to pass). For the sum of $600 a month we had some health coverage with a few "riders" in place - no coverage for my son for ANY respiratory issue for 2 years and no coverage for ear tubes for my daughter ever (she had ear tube 3 times as an infant/toddler).

I think we had the plan for about 6 months when my daughter started complaining about her ear. We took her to an ENT and eventually they scheduled exploratory surgery because there was something blocking her ear canal. While in post-op, we found out a) she actually had a small pebble in her ear (apparently from the preschool playground) and beyond that they believed she had something called "cholesteatoma". This was a scary sounding thing to us because it involved a "benign" tumor.

Here was the pebble found in her ear. On the left, was her ear tube taken out as well.
I put a dime in the photo to guage the size.
 While sitting in the hospital taking in this news, we received notification from our insurance company that they were in fact cancelling our policy on Alex altogether. They claimed we lied about her health. You see, we marked on the application that she had ear tubes 2 times. I forgot about a third time in the myriads of paperwork. You'd think if I had been trying to cover something up, I would have lied about her having ear tubes at all. The simple truth is I'm a mom and I have ADD and I omitted a date. But they used that to accuse us of fraud and cancelled our policy and refused to cover the surgery Alex just had.

I realized much too late how critical it is to have good health insurance. A dream job means nothing if you have no health care coverage these days.

We applied to buy into the state health insurance plan for children in Tennessee. We made more than the income limit for free coverage. But TN had a great plan to allow for people like us to buy into the plan and they couldn't deny pre-existing conditions. The irony was they won't allow you to do this if you have existing coverage. You have to be without coverage for 3 entire months before applying. Because Alex had coverage from that crappy company, we had to wait 3 months.

I took a photo of all the paperwork we had to deal with during my fight with the insurance company.
I learned to keep copies of everything from that experience.
Unfortunately, ear tumors won't wait 3 months to be addressed. So we ended up in a enormous amount of debt over the whole mess. And we learned that any other job opportunities would have to offer a health plan. Private health insurance is a joke.

Fortunately, Alex's ear tumor was caught very early before it even reached a stage of needing removal by surgical means. We learned she had terrible allergies (all trees/weeds/grasss) and that created inverted pressure in her ears that caused pockets to form. The pockets were not full of hardened materials that form the tumor. So we had to address her allergies and use a variety of methods to reverse the pockets by reversing the pressure in her ears. She started getting allergy shots and we did everything we were told and she was free of the mess within about 6 months. And, we had state insurance for the kids for about $500 a month.

A few months after Alex was diagnosed with the ear problems, Memphis was besieged by a series of tornadoes. I remember taking cover in the closet in our house wondering why we were crazy enough to move from Arizona to this stormy place.

Crazy tornado night - 2/08
And then we found out my husband's employer was hit by the tornado. They lost everything as the facility took a direct hit.

Destruction of the company - notice the overturned semi-truck - one of several!
And a few days later, the place caught fire while crews were trying to shore up what remained of the building.

Adding insult to injury...
The company was grossly under insured. While they tried to recover, inevitably, they went under and my husband was about to be unemployed. Fortunately, he is very intelligent and highly skilled in what he does and every employer he has gone to work for has fallen in love with him so he quickly was able to get another job. and it came with health insurance. Even though it was a good job, we also began to question our long term goals. We wanted to go home to Arizona. We missed our family and I missed the desert. But we knew we couldn't be without health coverage so when Joe found a job here in Arizona, it had to have health coverage.

We came home to Arizona in September 2010 and Joe found a job here with health insurance. I'm grateful for it. But I have also learned that a 70/30 plan can be crushing even still when your child is in the hospital for 6 days, and 2 of those days are in the PICU. The, factor in doctor visits every week with $50 copays, prescriptions with $40 copays, and lab fees and so on and so on. In fact I just got yet another bill for $950 to cover the doctor visits during the hospital stay. That's separate from the hospital stay itself which I won't even type the amount here.

The stress of diabetes itself is crushing. The stress of facing hospital and other medical bills is like hitting someone when they are down and out. We'll get it worked out but what hurts more is it will be at the cost of buckling down pretty hard for a while on any expenses that aren't necessary.

The worst part so far for me has been talking to my son this week and letting him know he needed to take a break from figure skating. We simply can't afford the hundreds of dollars in lessons, ice time, classes, etc. while taking on this medical debt. He has been ignored so much more than normal in the past 8 weeks while we have worked to get Alex well. And now, I have to take away ice skating, something he does 5 days a week and I am sure helps him get his mind off the stress at home.

Ben's spiral
But there is no choice right now. I'm hopeful though because without the expense of skating and the expenses of some other items we cut, we should be okay because we had that 70/30 plan. I shudder to think what might have been if Alex had been diagnosed a few years ago.

2 comments:

  1. It is terrifying.

    After my daughter was dx, we didn't have childcare for our 2 year old newly diabetic toddler. I was 20 weeks preggo. I had to use all my FMLA, and then my husband used all of his leave...except for one small problem. That left me without a maternity leave -- which meant we'd lose our health insurance on the first of the month, after I went into labor.

    So Jason looked high and low...he interviewed for his position in AZ in October, got the final offer on 12/14, and I went into labor about 2 hours later. We had to leave everything behind, take a 50% paycut, and start building a new life as the market fell apart -- just to maintain access to health insurance.

    My girls have never taken a dance class, gymnastics class or played a sport. They only wear hand-me-down clothing, receive garage sale toys for Christmas, and the Tooth Fairy gives them a quarter.

    But we have diabetes supplies.

    And each other.

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    Replies
    1. It's funny how things work out sometimes! How amazing that he got the job right before you went into labor. I'm sure the paperwork and getting the coverage was fun as you were admitted!

      I'm glad we bought a house with a pool this summer...free family fun when the weather gets warm ;-)

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