Friday, June 10, 2011

Damned if I do, damned if I don't

For many people, this won't be new news. But for some folks who have had the cost of healthcare largely hidden from them through exceptional coverage provided by employers, it's hard to understand exactly what kind of crisis the rest of the nation is dealing with. I certainly didn't understand what the big deal was, anyway.

When I was pregnant with Everett, we were lucky enough to have the cost of that pregnancy obscured through coverage with Kaiser Permanente in California. We had no deductible, and no co-pay for office visits during my pregnancy. It was the magical kind of care I was fortunate enough to have through my childhood, and up until my graduation from college and marriage, then, with a $10 co-pay.

Living in the Colorado Springs area, pregnant with Lucy, we had health insurance with Guardian. It had a $200 deductible. Despite the enormous amount of complications I had during my pregnancy (polyhydramnios, then oligohydramnios, then hypertension, and partially abrupted placenta), and twice weekly visits to the maternal-fetal specialist from 20 weeks onward, the whole thing only cost us $200, that we could see. I kept all my Explanation of Benefits (EOB) forms from my pregnancy; they totaled just over $25,000 including delivery. It was certainly not the kind of cash we had laying around as young adults with a toddler, two car payments, a mortgage, and a financial setback from relocating to Colorado. No, sir. At least with this company, I was receiving statements, so rather than the cost being thoroughly invisible to me, I had an idea of what the initial and negotiated charges were.

When we moved to Northern Colorado, Erick's new employer offered several different healthcare options, through United Healthcare. One plan would cost us a significant amount of money every month, but would have a low deductible. Another plan cost less each month, but the deductible was $2000, and the company would contribute a significant amount to a Health Savings Account each year. Little did I know, when we chose the higher deductible plan, the extent to which it would change our view of healthcare in the United States.

Even before that time, I had seen a physician who dealt with kids on the Autism Spectrum for Everett and I. I wanted to know if these food intolerance issues we had (we were having significant issues with gluten, casein, soy, corn and egg, and they were very real) were reversible, and I was hoping to find a physician who would help us figure it all out.

I did find one, an M.D., who was covered by our insurance! Happy day!! No, wait. Only office visits were covered, because guess what? There is no such thing as food intolerance, according to insurance companies. In fact, I would discover through networking with other families dealing with Autism Spectrum Disorders (ASD), that very few lab tests, vitamins, pharmaceuticals or even therapies helpful to those afflicted with ASD are covered by insurance. Practically none, in fact.

But that was just the tip of the iceberg. When we moved to Northern Colorado, it was a sudden and distressful move -- not a move by choice, at all. Erick had been laid off suddenly (as was the custom with this particular employer, and they were laying people off in that fashion for about 18 months before it was his turn, and shortly thereafter, the office was closed), so we had to quickly find other employment, put our house up for sale, and move. Nevermind that this was actually his second position in Colorado; the previous one had been for a very small company with a very high turnover rate, which he had left seeking security.

I had grown up in the very house my parents purchased in 1969. They still live in that house. Everything was very secure. We didn't live a particularly glamorous or shiny life there, but it was secure. My parents only purchased what they could pay for with cash, and they're still pretty much like that to this day. Maybe they sheltered me from any economic stressors they may have encountered, but I'm under the impression that economically, raising kids in the Reagan era and having government jobs, they didn't worry how they were going to pay the mortgage if one of them lost their job. I don't think they ever had to worry about losing a job, in fact.

So, upon moving here, I freaked out a bit. Okay, I freaked out a lot. While we were trying to sell our house, we attempted to live apart for a month. At the time, Everett was 4.5 years old, and Lucy was 16 months old. House showings were a nightmare; and keeping the house clean -- fergeddaboudit! So, we got the cheapest, smallest apartment we could find in Northern Colorado, in order to reunite our family, and keep our home in show-quality condition around the clock. As I stayed in that apartment, though, my mood sank. All my friends were in Monument and Colorado Springs. There were many friendly people reaching out to me up here, but my mom had told me that I would make my best and life-long friends through my kids when they were babies. Would I ever live somewhere long enough to have true friends who would really understand me?

I turned to the internet and became fascinated with alternative medicine. The only place I had space for a computer in the apartment was in the galley-style kitchen, so I would stand in the kitchen while the kids watched TV and played in the living room, the other side of which was only 8 feet from my computer in the kitchen. I kept a food diary and religiously avoided all my problem foods -- so I was eating tapioca bread, nut butters, jelly, chocolate chips, and green energy bars most of the day, all while nursing my toddler. I lost so much weight that I got down to a size 6 -- even in high school I was a size 10.

I sank into a deep depression, crying much of the time. I felt dizzy a lot, and I was having trouble remembering simple things like to pay the bills, or even my name. I had no patience for my kids, and I was constantly worried. The internet wasn't helping me figure out what was wrong. So, I found myself a therapist.

So, do you think our insurance plan covered mental health care? Bzzz. Nope. But with the state of my mental health at the time, $100 a week seemed necessary, so I went.

Around the same time, the physician I was seeing recommended an environmental toxin screen for me. It came back from the Mayo Clinic showing extreme levels of organophosphate -- yep, like the pesticide -- and barium. I was pretty much eating all organic, so I couldn't figure out why my levels would be high. My sister the doctor said that if they saw a patient come into the ER with organophosphate levels as high as mine were, they would be concerned for the patient's *life.* With all the weight I had lost recently, I became certain that I was detoxifying a life-long burden of pesticide, and I began taking fistfuls of vitamins to aid my detoxification every day.

I began seeing a local physician (an M.D.) who was also covered by my insurance, but who practiced holistic medicine. I decided with the abnormal test results I had, and my frightening symptoms, I needed to be under the care of a local doctor. I felt that I was having symptoms of stroke (loss of memory, inability to speak, dizziness and flashing lights). He diagnosed me with visual migraines, but ran some ordinary tests (which, at the time, were covered by my insurance). I found out that I had very low cholesterol, which is interesting for two reasons: low cholesterol is a predisposing factor for hemorrhagic stroke, and women with visual migraines are more likely to have a strokeIronically, my cholesterol level and weight at the time would make the insurance company overjoyed, despite the fact I had never been that sick in my entire life.

Fortunately, we lived in the apartment for about five months, and as soon as we moved into our house, things started to get better. I started incorporating more animal fat into my diet to raise my cholesterol and protect me from the risk of hemorrhagic stroke. While moving out of the apartment, we found that the dryer vent was not vented to the outside -- it was venting into the apartment all winter. I would find very soon after moving into our new house that I would only have migraines when running the dishwasher, doing the laundry, or being exposed to certain chemicals, and after switching to environmentally-friendly detergents (and doing some other nutritional interventions I will cover in other posts), I would never have another migraine, and my mood steadily improved.

It wasn't until last year, five years after all this happened, that I had an AHA! moment, and figured out that my organophosphate poisoning was probably from the Tide laundry detergent fumes we breathed for five months in that apartment. The Environmental Working Group would help clear it up for me.

And, that pretty much sealed the deal for me doctoring myself. I had a couple more failed attempts at getting help from physicians, but ultimately, I've had to do the work myself.

Nonetheless, the issue of insurance was still an issue. And, in 2009 when Erick's job in Northern Colorado would become defunct through closure of his division and sale of the intellectual property he had helped to develop to a Malaysian company, it would become a huge issue for us.

In 2008, when Lucy was going on four years old, and my health had mostly recovered, I became obsessed with the idea of having another baby. Obsessed enough that we would get an SUV in case my hormones got the best of me. With my first-dog-baby aging, I decided to see if a puppy would quench the desire for a baby. He did.

I had more than just a $2000 deductible to worry about when it came to the possibility of pregnancy. Erick's company had been downsizing in a significant fashion, even before he was hired. The speed at which it was happening made us unsure if they would even continue to have a facility in our town in 18 months. (They're still here, but not in much of a glitzy economically-stimulating manner). And, after all the complications I had during my pregnancy with Lucy, I found out that my hypertension had not been due to preeclampsia. I had never dumped protein in my urine (a hallmark of preeclampsia). What was discovered through ultrasound and confirmation by dye contrast CT is that I have a small right kidney. After ruling out various causes for my kidney to be so small, it was determined that it was damaged by an old infection. So, the likelihood of my super-duper nutrient-dense clean and healthy diet allowing me to have a non-life threatening pregnancy was, um, small at best.

Compounding the health-related financial woes was an incident in which my dear sweet Lucy put a bead in her nose on her brother's birthday. We took her to Urgent Care, where we were told they would be unable to remove the object ("And anyway, we have a three-hour wait. Take her to the emergency room."). While the emergency room here in Northern Colorado is uber-fast and friendly, with excellent service, a one-minute foreign-body removal from the nasal passage of a three year old costs $1200. According to a physician I know, I could have removed it myself by covering Lucy's empty nostril and blowing into her mouth. Apparently we had done this when she had put an eraser from a mechanical pencil into her nose the year before. Why didn't the people at Urgent Care know this?

Fortunately for us, the closure of Erick's division did not require another move. It did require a new adventure, though! We are self-employed, and have the luxury of learning about health insurance for the self-employed. Yep, here's where all that "pre-existing condition" stuff really matters. We have a new deductible -- much higher, at $5800. Basically, it matches the amount we can legally add to our Health Savings Account annually. And, it does not cover pregnancy. In the state of Colorado, legally, insurance companies only have to cover complications due to pregnancy; however, when my policy was issued, it contained a rider EXCLUDING any pregnancy complications I might have related in any way to hypertension.

And so, we decided our family was complete. Or at least, the insurance company did. A minor outpatient procedure finalized the decision.

Lucy would, shortly after our policy was issued, slip on the floor in the breakfast area and get a concussion, so we learned that an emergency room visit and CT scan cost $2400. I also learned that the leading cause of emergency room visits in children under the age of 18 are falls. A trip to Urgent Care to ensure that a sprained ankle is just a sprained ankle is $500 (that one's on me). And, most insurance is not covering orthopedic supplies these days (they make me sign a waiver at Urgent Care). And, because neither the doctor's office nor Urgent Care casts broken arms, we still spent $1000 bouncing back and forth between Urgent Care, the family physician and the Orthopedic Center trying to avoid the emergency room.

These things wouldn't seem so expensive if we weren't already paying $6000 per year for the insurance that isn't really covering these events.

Last year I found out that if I tried a low-carb diet (getting into the health insurance company's elite weight range), and it leaves me feeling yucky, I could spend $600 to have my B-12, Thyroid and Vitamin D levels checked. I didn't forget the important stuff -- you know, the cholesterol levels -- for another $155. Because the doctor was trying to be helpful, some other B-vitamin tests were recommended -- and yes, those did prove helpful -- but they were another $250. I was thinking maybe these were part of the "Preventative Health and Laboratory costs" that would be covered under our insurance plan, but eleven months after they were all run, right before tax-time, to boot, I got the $1005 bill from the laboratory!

So naturally, I'm not sure whether or not to be happy that I can afford my terrible health insurance. I have multiple close friends whose children qualify for government medical programs, and who themselves have no healthcare coverage, and, even with the government assistance, that is a terrible position to be in. Still, it feels like when it comes to health insurance and my pocketbook, I'm damned if I do, and damned if I don't.

In seeming celebration of my decision to doctor myself and save the doctors for emergencies, this April, United Health Care sent me a letter notifying me that by law, now, in the state of Colorado, they must cover pregnancy. Thanks.