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Sick, Deaf, and Uninsured: The Nightmare of American Healthcare

Published on August 28, 2018

4.7K views

uninsured nightmare of american healthcare

Lifelong Hearing Loss

At the age of nine years old, I was diagnosed with progressive sensorineural hearing loss. At that time, I already had a 60% loss in the high tones. No one knew I was deaf because I had adapted and learned to lipread. I suspect most people I encounter these days don’t realize how deaf I am. I have had hearing examinations where the audiologist thought something was wrong with their equipment because I am so deaf I don’t hear most of the tones. My speech comprehension goes down about 50% when the audiologist covers their face with a piece of paper. I was recently tested and my loss has progressed from the “Moderate to Severe” category to “Severe to Profound”. Without hearing aids the world is a very quiet place.

Unprepared to be Uninsured

For the whole of my adult life, healthcare and insurance were not things I worried about. My first husband was in the military, so on those rare occasions I needed a doctor, I saw whoever was on shift at the base clinic. When I was pregnant with both my children, an Ob/Gyn was assigned to me and then I saw whoever was on shift when it was time to give birth at a military hospital. When I went to work for a city government, I had health insurance and doctors were assigned to me sort of magically. For much of the time I had health insurance, I didn’t even make the deductible. I was completely ill-prepared to join the legions of the uninsured in 2010 when I had to take an early retirement from my civil service job.

Phone Impaired in the Age of Smart Phones

I was last able to use the telephone on a limited basis in 2009. Even though I had a special amplified handset on my work phone, I sometimes would get a call and be unable to understand anything the caller was saying. I had to hand the phone to a co-worker when that happened.

Now that I don’t have an amplified land line, I cannot use the phone at all. What calls get made, my husband has to make or take them for me. He has auditory processing disorder and is likely high functioning autistic as well as ADHD. So phone calls take a lot of energy on his part and I don’t ask him to make them unless it is absolutely necessary.

One of the things I think many people may not be aware of is that many, if not most, healthcare practices do not accept uninsured patients. This is especially true of specialist like GI and endocrinologists. I don’t blame them, I cannot pay medical bills unless they are given to me in a manner that I can plan for and afford while still paying upfront for ongoing health care, medications, and supplements. Not being able to use the telephone to call multiple practices to inquire about their patient acceptance practices and to get cost information upfront makes it nearly impossible for me to get services I need even if I have funds to pay for them.

The High Cost of Not Knowing

After retiring early without health insurance, I managed to get by for three years without any healthcare. When I started having chronic diarrhea, I looked around online to find help that I could afford. That information was not obtainable without a phone, so I wound up in the local university hospital ER with a blood pressure of 240/130. We owed no one when we walked in the hospital doors and now we had debt more than a small house would have cost. I remember lying in bed in a haze and crying because I felt I would never again own a home of my own.

Ironically, the event that I believe triggered my hypertension was related to an unscheduled “invasion” of our duplex by appraisers. One of the reasons I need a home of my own is that I don’t feel entirely safe in a rented home. It is a subjective thing and I have been at loss to explain it until I started learning about autism.

During the four day hospital stay, I filled out an application for financial assistance, but since I still had money in a retirement savings account, my application was denied. I did not feel I should take the money out of that account because I was saving to buy new hearing aids. The ones I was wearing were over 10 years old.

I considered trying to pay the hospital $20 or $30 dollars a month to preserve my tattered credit rating, but I received about a dozen bills, none I could afford. One was for $47,000 (that was already discounted 60%) from the hospital. Several were for $2,000-to 3,000 and numerous in the hundreds from various entities like labs, catering, and doctors. There were even separate bills for the emergency room. There was no way I could pay all of them even at $10 a month. We were living payday to payday with little remaining. Since I could not pay all of them, I did not pay any of them. I was used to paying my bills on time and so consciously deciding not to pay these bills caused me a lot of distress. I still had undiagnosed and complicated health problems that needed ongoing care. I had no idea how I was going to pay for that.

Hostage to the System

I was referred to a local health clinic and I paid for that out of my income tax refund, which I had decided to park in a savings account to pay each years’ ongoing medical expenses. When I was referred to a rural GI practice, my husband’s mother gave us several thousand dollars to help pay for it. This experience was another nightmare. The rural GI was treating thousands of low-income patients and he had, at most, 15 minutes of time with us. He spent most of that time entering data into a computer. This was a problem for me because I need people to face me in order to be able to lipread. I explained that repeatedly, but he either forgot or ignored my request.

I was having ongoing diarrhea, digestive issues, and malnutrition when I was referred to the GI. I did not feel it was safe to protest or be overly assertive with this doctor, as I desperately needed his services. His lack of accommodation for my deafness was only part of what made this experience so upsetting. He seemed to have no understanding or concern for our financial issues. Even though we explained our financial situation, he ordered a litany of expensive tests. I could not get anyone at the clinic to tell me how much things would cost upfront. Even his office visits were a problem. I asked about cost and explained I was uninsured at the time of the first office visit. I paid the $179 they requested up front, but then they would send me additional bills for $79 with no explanation. The total of all the tests including endoscopy and colonoscopy, CT scan, etc. was somewhere around $8,000-9,000. I think we paid 4 or 5 thousand up front from money my mother-in-law gave us. Again I didn’t get one billing entity, but a 1/2 dozen or so different bills. So that was yet another hit to my already miserable credit rating.

I continued to suffer digestive issues even on the prescription enzymes and PPI. Since the doctor declined to address several of my health concerns that he didn’t feel were GI related, I was disinclined to go see him again. It was only when we finally got two incomes that we were able to afford an allergist. I was diagnosed with 44 food allergies as well as multiple environmental ones. The allergies were the cause of the digestive problems that the GI refused to evaluate. That was another three years of my life needlessly lost to digestion related malnutrition.

New Type of Primary Care

I recently changed from the local corporate clinic to a new type of family practice two hours away. The family practice seemed like a good deal as they had lower costs for lab work and a monthly fee with $20 an office visit charge. They also had a patient portal which seemed ideal for me since I could write about my problems instead of trying to relay them via my husband over the phone. After two visits at $180 a piece, I had problems because they didn’t seem to want to hear about any of the problems other than the type 2 diabetes. When I managed to get them to understand the full range of my health problems, they unceremoniously dumped me via email. They referred me to a nutritionist who strung me along two weeks before declining to take me as a patient because I could not do consultations on the cell phone.

This dumping echoed a lot of childhood experiences of rejection so it was traumatic enough that it made me cry. It has been increasingly hard for me to put my trust in healthcare professionals since the death of my second husband to colon cancer. They were not the cause of his death but there was a lot of needless suffering along the way. This opened my eyes to problems in our healthcare system I was previously unaware of.

Fairly frequently in the past eight years, I have felt a sort of despair that is like being trapped in an emergency situation with no way to call out for help. Some of this stems from a lifetime trauma coping strategy of submission and some of it is due to poor communications skills on my part. I can never know how well I will be able to articulate the thoughts in my head. They seem so clear to me but somehow come out confused and garbled when I am stressed. I have to do a lot of meditation and exercise to calm down HPA activations just prior to a healthcare visits. I arrive at my appointments with as much written down as I can manage because stress causes me to lose even more communications abilities.

Direct Primary Care

I finally had a bit of luck when I found a Doctor of Internal Medicine who has a Direct Primary Care practice. I had almost disabling anxiety in the weeks up to my first visit because I was afraid if I told her too much about my problems she might refuse to take me as a patient. Fortunately, she was honest, blunt, and straightforward in a way that alleviated my anxiety. I focused on my official diagnosis and getting medications refilled on our first visit. On the second visit, I wanted to focus on the undiagnosed problems. Thanks to Chandler Marrs for editing and publishing my story here on Hormones Matter, I feel I have been heard and understood. As a result, I now have referrals to an endocrinologist, a GI, and a contact to get evaluated for High Functioning Autism (HFA).

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Insurance Liability and Medical Adverse Events

by Patti Ireland

Published on September 23, 2015

4.6K views

In reading a blog the other day, I was reminded how little many people understand about their health insurance (or any insurance), particularly how personal insurance works when injuries or damages are caused by a person or company with legal responsibility for those injuries or damages. Insurance is a subject that for most of us, causes great pain and consternation; we don’t get it, our eyes roll back in our heads and our brains go into explode mode if we have to read an insurance contract. More often than not, we just rely on the agent or claims person to explain to us. (I understand that- because that is how I felt before I actually went to work in the insurance industry.)

Who Pays What and When

Most of us think that if we get sick or injured, we go to the doctor or hospital, pay our co-pay or deductible, and are good to go. For your average illness, or accidental injury, that is the case. However, in certain circumstances, this does not hold true. For example, if you are injured as a result of your job, you may be covered under Workman’s Compensation, and your health insurance is not responsible for your medical care and bills. Or, if you are in an auto accident and if you did not cause the accident, then the auto insurance of the person who caused it is responsible for your medical expenses. Your health insurance is only responsible for any cost above the amount of the limits that driver’s insurance policy, and/or any amount that is paid under your own uninsured/underinsured motorist coverage on your own auto policy, if you have one.

Medical Adverse Events or Injury Claims

In the case of injury/damage from a medical device or a negligent physician, your personal health insurance is not responsible for the cost of your medical care that results from that damage. And that is the issue I’d like to discuss today- the medical/negligence issues. If you suffer from injuries that are the result of a faulty device, a reaction to a medication, a negligent doctor, etc., your insurance company will generally initially cover your bills, but if you go to court, and it is determined that another person or manufacturer are actually at fault in causing your injuries, and therefore legally responsible for what happened to you, then your health insurance policy is not responsible for any of your care that is a result.

So, how does it work? In most cases, the actual cause of the injury/damage is not known at the time you begin to seek medical treatment, and your insurance is covering those expenses. But once it has been determined in court that there is a party that is legally responsible for the injuries, then your health insurance company is not held responsible. Even though they did pay at first, the party that has been found responsible, whether a company or an individual, is now responsible for all of the medical costs associated with the cause of the injury/damage. As a result, the insurance company must be reimbursed for the payments they made on your behalf.

This is covered under the law by what is called “Double Indemnity”. This means that one cannot be recompensed twice for the same loss. So, for example, in a car accident, if you are not at fault, you can’t get payment of the cost to replace your car from both your insurance company and the insurance company of the other party. You can’t have the same medical bill paid by both your insurance and the other party’s insurance. You can’t purchase 2 insurance policies to cover the same item, or risk (such as health insurance). And in the case of product liability or negligence, you cannot be paid twice for the cost of your medical care. When settlement is paid, it includes the cost of the medical care. If you were the one who originally paid the full amount for the medical care, you keep the money.

If your insurance company paid for the medical care. You must pay them back.

Now in settling these cases, there may be multiple types of payment ordered to the injured party, which can include medical expenses, lost wages, cost of any home health or general care required as a result of the injury, and there can also be additional payments for pain and suffering, loss of companionship suffered by one’s spouse, loss of care to one’s children, etc. On top of that, depending on the individual case, there may be punitive damages that the party responsible must pay. (This is most frequent in a case against a corporation found to have been willfully negligent).

Usually, you will receive a check from the company/individual for the full amount of the settlement, and you are then responsible for reimbursing the insurance company from the settlement amount you received. In a few cases, the court may direct the responsible party to make payment directly to the insurance company for the portion of the award that covers those expenses, with the rest to the injured party, but most often, the injured party receives the entire sum and must reimburse the insurance companies themselves. Here is where it sometimes gets confusing for the injured party.

Class Actions are Different

Now, a caveat is in order here. The above describes what will generally happen in the case of an individual personal lawsuit. Levels of responsibility and damages awarded will vary in individual cases, but will generally address the actual expenses of the individual plaintiff, and settlements are awarded on that basis. There is, however, another type of case that many victims of medical malfeasance may become involved in, and that is the “Class Action Lawsuit”. Unfortunately, in a class action lawsuit, the amount of the award that goes to any individual plaintiff may not cover all of the individual’s medical expenses. In a class action suit, each individual agrees to accept a specific percentage of the aggregate award, after attorney’s fees are deducted from the award, regardless of their individual expenses.

An individual plaintiff’s award may not be enough to cover either real expenses or pain and suffering, yet due to the finding of liability on the part of the third party, the plaintiff may still be held responsible for reimbursement of the insurance company.

This is actually a subject for a more in-depth article in the future, but in the mean time, you should know that participating in class action suit may not yield a financial award sufficient to cover your medical expenses.

How Insurance Rates Are Determined

I would just like to add a note regarding the determination of the cost of individual health insurance policies and how rates are determined. (This actually applies to all catastrophic insurance policies as well, including auto and homeowner liability). Rates are set based on projections of how much an insurance company can be expected to pay for casualty losses of ALL their customers in a given time frame, and for losses that are not the result of negligence or intent by a third party. This is because of the liability laws that can hold a third party financially responsible for damage to another that is the result of negligence or malice. If the insurance companies were required to pay for losses to their customers that were caused by a third party, either intentionally or due to negligence, then rates would have to be factored to include those costs as well, and costs would skyrocket to the customer.

What This Means For You and Yours

The cause of illness or injury may not always be clear when it first occurs. And of course, the initial action taken should be to consult your physician, or in the case of emergency get to a hospital. Your personal health insurance will generally be the first source of payment. Should it turn out to be the potential liability of a third party, whether a person or a company, when consulting an attorney regarding a lawsuit, it is important to discuss with them the specific details regarding what sort of judgment is expected. Some basic questions to consider may include the following: Can you expect that all of your actual expenses (medical losses, loss of wages, any home health or household assistance, loss of future income if one is long-term or permanently disabled, etc.) will be covered? Can you ask for punitive damages? How will attorney fees and other legal fees be charged (Can the defendant be expected to pay, or will they deducted from your award)? This can help prevent surprises, and unexpected costs once the case is settled.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter.

Image by LEANDRO AGUILAR from Pixabay.

The Match Game of Healthcare That Works: Understanding Insurance

by Deb Andelt, JD

Published on March 4, 2015

4.9K views

Understand What Insurance Is and Is Not

Finding healthcare resources – people, treatments, care – is a match game. Your quest is to find resources to partner with you to feel better, heal and experience the life you want to live.

Reading “match game,” the vision that probably came to mind involves perusing a list of “providers” your insurance company included in a thick volume of paperwork. Or maybe you wish you at least had an opportunity to have access to such a list. You see lists organized by “specialty” (which you may or may not understand) and geography; and you hope you can find someone with solutions for your needs – someone to help you feel better – from this paltry information.

The Traditional Match Game: The Insurance Company Sets the Playing Field For “Health”

Health insurance is not healthcare. Insurance is business. Health insurance is a payment system.

In the framework of the traditional match game, the insurance company sets the rules with four basic things: 1) a list of “providers” – people who meet the company’s contractual requirements; 2) a list of acceptable services (your “benefits”) the providers can offer for certain ailments; 3) acceptable fees for such services; and finally 4) a means to parse the payment/cost burden. This is so familiar that perhaps we didn’t even question this until prices sky rocketed and services diminished.

Playing the well-being match game within this familiar framework puts the insurance corporation in a position of power. Playing the match game this way immediately puts a corporation, a payment system, in control of your well-being. Through their contractual relationships they determine what constitutes health, who is allowed to serve your needs, and what treatments or medications are acceptable. Insurance companies narrow the field of possibilities and choices for your path to well-being.

By engaging in this match game we’ve been attempting to attain well-being from a system in which the rules have been set by companies that are focused on payment and profit. Pause and think about that for a moment. We have been lulled into looking to a payment system as a means to experience vitality.

You may have had very good success with this structure. While this may work well for some, and may work some times; for many it is a challenge to find care that works. That challenge can take a further toll on health.

In this traditional match game it is very difficult to insert your personal needs, values, and beliefs about health and well-being into the framework of a payment system. It can be a challenge to find the right partner in healing, the right practitioner, who supports your personal journey to live your best life.

Time To Shift the Paradigm

If it doesn’t work for many, if not most, people to look to a payment system as a means to experience well-being, what do we do? It requires a change in the fundamental nature of the match game. In the next article we’ll explore this shift. It begins with identifying your personal concept of the essence of health, well-being and healing. This will vary for each person, and can vary over time. This shift puts each person back into control of their health.

About the author: Deb is co-owner of Experience In Motion, which equips organizations with tools to curate meaningful experiences for customers and employees. Deb’s personal journey from decay to well-being inspired an emphasis in improving healthcare experiences for patients and practitioners by focusing on experiences that heal and self-caring as a way of organizational being. www.experienceinmotion.net.

Note: This is part of an ongoing series to equip you with a process, a path, to identify and experience healthcare that works for you. Other articles in this series are:

The heart of healthcare that works: know your personal worldview of health

Find your Inner Chris Columbus

Health at the Nexus of Economics and Innovation

by Chandler Marrs, PhD

Published on July 23, 2012

4.1K views

Health innovation exists largely because of the promise of great profits. Whether it is new drugs, devices or even health insurance, the development of these products are firmly established capitalist endeavors. Health itself, however, like life, liberty or even the pursuit happiness exists on a different plane entirely, more closely aligning with the right of life than with a corollary product or commodity. Where it gets squishy is in determining who is responsible for paying for that right, especially when someone chooses to ignore the responsibility of good health, is genetically burdened with ill-health, faces poverty, or as is the case in modern industrial society, is sold ill-health by companies whose very existence depends upon products that cause illness.

Where do one’s right of life and presumably some quality of life or health end and the right to profits begin? Who shall pay for these rights? And are there innovation opportunities in defining or re-defining health as a right versus a product or a commodity?

Understanding Moral Hazard and Modern Health Care

In 2009, with the financial system in ruins, the phrase moral hazard burst into the daily lexicon. One could not listen to a news report without hearing how those responsible for the crisis pushed all of the risks of their highly profitable ventures on to everyone else – textbook moral hazard. And then, to make matters worse, we were being asked to bail out these giant institutions that crumbled our economy, while they continued to reap huge salaries and bonuses. The gall…

Many view health insurance and by association, healthcare, as an industry based upon moral hazard. Unlike the moral hazard of the current financial markets, however, where the chosen few distribute risk downward to the many, the moral hazard in health care presumes that the many distribute the risk back up to the few, those presumably responsible individuals, who are healthy. Indeed, the distribution of risk penalizes good health with the increased cost of bad health borne by all. “How dare we be asked to pay for our neighbor’s smoking or obesity?” The gall…

What is often missed in our moral outrage, is how being sick reduces the profitability for those at the top of the insurance industry. This is the crux of modern health care’s fatal flaw – a skewed version of moral hazard where health care is a commodity that few at the top of the food chain are willing to risk on those at the bottom.

Health Economics

Modern theories of health economics argue that the act of providing health care services to all and the distribution of those costs amongst everyone will reduce the total financial risks but also increase the need for care, and therefore reduce profits. The presumption is that when people are given low-cost health care will, they will choose to partake in more health care services in much the same way that lower prices encourage other product purchases.

Appendectomy anyone?

Despite the almost comical notion that people enjoy going to the doctor’s office and/or to the hospital in the same way they enjoy purchasing a new handbag, or that these services are like any other commodity driven purely by access and cost, this concept of moral hazard pervades the health care/insurance debate, with nary a question of its legitimacy or utility. What is more, this model likely reduces overall profitability of the industries that seek to reap the rewards from health while increasing the profits of those who benefit from illness or at least benefit from ignoring the illnesses their products cause.

Health Innovation

If health innovation (the products within the health care system, new drugs, devices, programs, vitamins etc.) are only developed on the promise of great profits, how does that square with the notion that individuals really don’t want to go to the doctors unless they have to? How do we reconcile the need for health innovation to maintain our economic and health vitality and the premise that health care isn’t a product in the traditional sense; that it isn’t needed or wanted until it is needed?

Marketing Health (or Illness)

The current healthcare business model answers that question with marketing. Make the consumer or the physician want or believe they need the products being sold. The pharmaceutical industry is quite successful marketing must-have medications and products and they do so by employing the same tactics and strategies used to market any other consumer product.

Indeed, the newer model products/drugs are akin to the designer versions of a handbag and yield the same ‘must-have’ response from the consumer (even the physician) who is willing to pay premium prices for the latest and greatest medication. Like the must-have handbags, newer drugs often have no more efficacy than older ones (sometimes are worse), often contain only single isomer changes (meaning molecularly they are almost entirely the same drug as the earlier, cheaper version e.g. Lexapro and Celexa) and more often rest the perceived utility solely on re-branding. A brilliant model if it wasn’t health or life and death that was for sale.

Another Way

What would happen if health was re-conceptualized as a right? If it were considered a right, then there would be a duty to protect it, legally. The current practice approving drugs and devices would look very different than it is today. From a market standpoint, the backlash from those who profit from illness would be swift and intense, but the potential for innovation and profits from other sectors could be equally strong, if the opportunity is recognized.

As it stands, we have big pharma, big agriculture (pesticide and herbicide use), big coal, big tobacco and other industries profiting wildly from their products, while distributing the health and economic risks downward to the masses in the classic model of moral hazard. These industries bear little to no responsibility for the true health costs of their products. Those risks are dispersed over time and over millions of people.

On the other side, we have the health care industry, straddled with the burden of caring for an ever less healthy populous while simultaneously having to answer to shareholders demand for profits. Their model of moral hazard proscribes increased profits for the top, increased cost for the healthy, and reduced services for everyone else. The health care industry pushes back on the individual, dis-enrolling, reducing access, but pays little attention to the purveyors of bad health. They buy hook-line-and-sinker the notion that the individual is solely responsible for his/her health. And while that is true in many cases, in today’s cesspool of environmental carcinogens, dangerous and eventually recalled (although not before the damage is done), pharmaceuticals and devices, endocrine disruptors, and generally unhealthy food supply, no individual alone can avoid all contact with the garbage that is in our environment and ultimately causes illness. And they shouldn’t have to. If the industries that currently lose money from illness (insurance, hospitals, employers), would step in and push back against those that profit from illness, we would see a radical change in disease rates, an enormous reduction in health care costs and an incredible increase in innovation.

If health were a right akin to the right of life, then products that affect health would be judged not just on the perceived profit margin, but on the actual cost/benefit ratio to health. The economics of health would switch from how do we distribute the cost of ill-health among the masses to how do we reduce ill-health of the masses. If a product causes more ill health and costs more than it benefits, perhaps it shouldn’t be on the market. Right now the debate is over how not to break the bank by including sick people on the insurance rolls or providing access to care for the poor, perhaps the math would work better if we looked how to prevent illness in the first place.

Healthy Behavior No Longer A Personal Choice

by Chandler Marrs, PhD

Published on November 8, 2011

5.2K views

It’s a strange state of affairs when the comedy channels break more important stories than the news shows. Just last week a report by Wyatt Cenac, from the John Stewart show set off a firestorm of discussion on the blogosphere. HR 3472, a bill proposed by former Congresswoman Kathy Dahlkemper, would have offered incentives (insurance discounts) for healthy behavior (not smoking, losing weight, controlling cholesterol) was defeated in committee not by partisan politics (both parties were in favor of the bill) but by intense lobbying efforts from the American Diabetes Association (ADA), the American Heart Association (AHA) and the American Cancer Society (ACS).

Why would the big three associations, which are supposedly for health and prevention, oppose legislation that rewards improved health? According their perfectly jumbled released statements:

ADA
“The impact of these provisions would have been to penalize people with pre-existing health conditions and certain health risks who could not meet these targets by charging them more for their health care. In addition, the legislation would have applied to health plans sold in the individual market, where people do not have the support of a formal workplace wellness program to help them achieve these goals.”

AHA
“This bill might open the door for discrimination of people with pre-existing conditions, and also those who are genetically predisposed to these conditions. Most importantly it would restrict access to healthcare to those who need it most and research has shown that this has a negative effect on health.”

ACS
“In fact, the bill would have enabled employers to reduce the health care premiums of people who met specific health targets (such as not smoking or maintaining low blood pressure), but also penalize people with pre-existing conditions who could not meet the targets by charging them more for their health coverage. The Society supports comprehensive wellness and health promotion programs that utilize incentives, such as discounted gym memberships, for employees. But we oppose restricting access to health care for those who need it most.”

If their stated opposition is understood correctly, it boils down to, unless everyone benefits from these discounts, no one can benefit. Aside from the absurdity of this argument for the essentially capitalist endeavor that is our insurance industry, in what strange twist of reality did smoking and eating junk food cease to become choices? And how does offering incentives for eliminating said activities, equate with penalizing those who choose not to partake? Even those with genetic predispositions to high blood pressure, high cholesterol or diabetes would benefit from not smoking, from eating healthier and exercising more. What do you think?

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