Birthday Presents (II)

On the morning of my birthday, I checked on my medical claim for the Face-Hugger Cat Incident (q.v.) and discovered that I had been walking around for three weeks without medical insurance.

I think this could only happen in America. My Canadian and European readers may start shaking their heads now. Apparently my insurance plan did not conform to the recently implemented excuse for a national US health policy, the chimera of bureaucratic mazes and giveaways to insurance companies that is known as the Affordable Care Act.

I was, and am, in favor of the thing that this Act ought to be — a way of making sure that every American citizen can get medical care and do it without going broke. But after several rounds of legislative and judicial bitchery, what we have is a handful of welcome reforms (you can keep your kid on your policy till he’s able to earn enough to make rent never mind a premium; carriers can’t reject people for “pre-existing conditions” that have, famously, included acne medication) and an undertow towards the patchwork quilt that was the problem to begin with. Because some state governors and legislatures believe that it is better to die free than accept Federal tax money, and the courts have let them turn it down, people in the poorest states in the US still cannot get the medical care that is available to nearly everyone in nearly every First World nation. The political will to create a single-payer system didn’t exist, so we are back to being fed to the insurance companies, if we can afford it.

Me, I have had the same insurer for seventeen years — one of the largest in the country. During the last two or three I have: sat on hold repeatedly trying to get an erroneous street address purged from the system; spent about as long trying to find out why an automated payment I set up did not, would not ever work; gotten haphazard communication, some by paper mail, some by e-mail, some on parts of the website that won’t come up when I try to go there. Even their own IT people say it is a useless clusterfuck. I laugh when I hear people mock the government’s healthcare site for being difficult.

There at the top of the page, with no explanation, were the words “Terminated 10/31/2014.”

WTF? Half an hour on the phone with three people, none of whom  could actually seem to agree with the other two, revealed that it was this ACA compatibility thing. One said I could renew retroactively because I had received no notice, the next said that was absolutely impossible. “Didn’t you get an e-mail?” Noooo, hon, I did not. “Well maybe you were in a group that got a paper letter.” Nope, though I get all the snail-mail promotions about signing up for my free counseling about diet and exercise. “Well you can sign up again on Dec 1 outside the open enrollment, but you have to include your letter of termination with your application.” I. Don’t. Have. It. Can you e-mail it to me again? “Oh no, we can’t send e-mail from here. I can send a paper copy and you will have it in 7 to 14 business days.” Well that does not help a lot with December first, now does it?

By now it’s 1 pm on my birthday and I dearly want to get to the gym because I have made my own massage appointment for later, and now I really need one.

I call up the broker who sold me my policy in 1997 and explain. He has the same assistant he had 17 years ago. She hears the panic in my voice. “He’ll call you when he’s out of class this evening,” she says. “You’re not home till six? Fine, he’ll call you then. Relax. We’re going to take care of you.”

This agency does not get a penny out of my pocket, by the way; their cash stream comes in small emoluments from the insurers for each policy they match with a customer. I go work out, I get my massage, fighting down a sick panic that people outside the US probably cannot imagine. The broker leaves a voicemail with the number where I can reach him after six.

“Well happy freakin’ birthday!” he says. “Hey, look on the website. You got my website up there? Click on Temporary Insurance. You can buy coverage till January first, pick the one that works for you, it’ll be effective tomorrow, just use a credit card. That gives us time to go over what’s available now. I got you right here in the system from before, I can see your old premium amount [note: I have not spoken to this man since 1997]. You must have changed something about your plan since 2010 or you would be grandfathered in.”

“I raised the deductible so I could afford it,” I explained.

“Well wait till you see the premiums now! And the coverage sucks. But we’ll see what we can get for you.”

After the polite runaround from my insurer’s “Customer Care Specialists” — “we’re so sorry, but you are screwed” — I can’t tell you how refreshing this was. The next morning I had a link to a sort of plan spread sheet — and, yes, the premiums are about double what I had been paying, not least because I am now sixty and therefore, in the actuarial eye, a tottering edifice probably riddled with cholesterol plaque, osteoporosis and incipient arthritis. If I ever meet an actuary I may swing him  around my head leisurely, like a yo-yo, and then make him pace me on kettlebell swings until he turns a faint, tasteful dove-grey color, before restoring him to life with a glass of fresh celery and spinach juice, just to make a point.

I shot off the application yesterday. Must check up on that after the holiday.

At least the cat in the face thing was covered. Oh, that ER visit cost more than my last mortgage payment, for having my face washed twice and bandaged, some tincture of benzoin, a loading dose of antibiotic until I could get to a drugstore with a script, and a tetanus shot — and, of course, the ubiquitous nurse taking your blood pressure and tch-tching because it is soaring, not surprisingly when four fangs and half a dozen claws have just plowed up your face. My now-dead policy covered a little over half. I’m glad that Tch-Tch Nurse wasn’t around with her goddam cuff when I was on the phone with the insurance company.

There are people who say this is freedom and it’s better than the slavery of having a national health plan. Because, God forbid, people might get jerked around.

I guess the Cute Engineer was prescient and knew what would be called for before the day was over. He gave me a bottle of Bunnahabhain.



14 thoughts on “Birthday Presents (II)

    • I don’t know what part of this Americans (or enough of them to mess things up, anyway) don’t understand. They may not actually be able to conceive of a system that doesn’t make medical care into a gotcha game.

  1. My HMO is pretty good, no complaints. But they used to be awful and have apparently inculcated a culture of trying harder. This is good, but then, I’m in good health and not yet sixty and subject to (as many) arbitrary prejudices. Meanwhile, though I was once something of a pseudo-Objectivist, I just don’t get that sink-or-swim individuality anymore. I’d much rather be part of a system that takes care of everybody, than in a system that takes good care of me while others get no care at all. And by others I mean others in my community. And by my community I mean my city, state, country, planet, because those whom we don’t help to hold up, may sink and pull us all down. Which is the economics of it but there’s also this thing called compassion that the atheists in my life are a lot keener on than the religionists by and large.

    • Bingo. Because alas, most religions, certainly the Mosaic ones, seem to conceive of the world as a big karma engine where if you suffer, you musta done something to deserve it.

      By me, anything that can conceivably become too expensive for a person with full-time work to afford — of which medical care is the premium example — has to become the responsibility of the community, at least to the extent that everyone has access to it. Whereas some of the “individual responsibility” types make it sound as if it’s your responsibility to pave the street that fronts on your own lot and your neighbor’s to pave his, and so on.

  2. Oh, man. So sorry. I know exactly what this is like, also being self-employed. I am very, very lucky that Oregon is one of the states that overrode the ACA to allow “non-compliant” policies to remain in effect, as the ACA-compliant policies for the self-employed are, as you know, exorbitantly expensive and offer less coverage. What a clusterfuck. I know a lot of lower-income people who have benefited from the ACA, and I’m thrilled that the elimination of the pre-existing condition prejudice allows people not to have their insurance tied to a job or a spouse. But as for me personally… I’ll cling to my sub-standard policy as long as I can.

  3. That whiskey looks lovely. I also like that they didn’t force me to enter my DOB just to look at their website, they took my word for it.

    Happy belated birthday. If you ever sling around an insurance man like raw pizza dough – please, please film it.

  4. Kafka couldn’t make this stuff up! I’m glad your agent could sort things out. You’re lucky they aren’t making you get a medical and then excluding pre-existing conditions!

  5. Fortunately, that’s one thing the ACA takes out of the mix. If I had to be poked and candled in a medical fishing expedition at this point, I would simply and sordidly rampage like the Incredible Hulk. And probably burst their blood pressure cuff. After the last round I had in one our most venerable local hospitals, being literally forgotten behind a duck curtain by a nursing staff that was too busy to pull tubes and things out of me and give me something to eat, I go into fight or flight at the sight of a clinical environment or even a medical device. In fact, just telling you this, I’m starting to hum all over like an old car with vibration in the body work and breathe on the top half inch of my lungs. And they don’t GET IT.

  6. I don’t even know what a medical insurance is, what it covers, how much it costs, let alone how it works (I had to figure some of your words from context, I definitely know nothing about it). I never seen a bill from an hospital, I never saw a cash register in an hospital. From the day I was born, I was covered for anything that would ever happen to me. Except for purely aesthetic things (that is, if I’m fixed for something that wasn’t a problem in my life except for the fact that I didn’t like it), I’m covered for everything. If I get cancer and it costs $5M to get back on my feet, I will get fixed and will never see a bill and nobody will check if I paid my phone bill or electricity bill on time over the last few years.

    The downside to it, is that if I need to provide a blood sample, I need to wait 3 weeks for an appointment. If my life depends on it, they might find a slot which they keep for emergency… in 2 weeks. And 25% of my income is deduced before the money reaches my bank account.

    Doesn’t have to be like that though. I was told in Alberta they will get to the hospital for a simple cold and will wait only a few minutes to see a doctor. And they don’t even have a sales tax, they don’t need it. Something got totally wrong over here.

    Yes, medical cares should be available to everyone. Dying at home from a simple illness because you couldn’t afford to pay a visit at a doctor is simply not something any human being should know, no matter where they live. First world, huh?

    But don’t despair, dear friend. Your army can beat any other army in the world.

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