I hate health insurance

. . . and I wish we could go back to the good old days of patients directly paying doctors real money for services rendered. There. I said it.

Now, I know that hospitalizations are a whole ‘nother ball of wax, and that mere mortals would rarely be able to pay such costs. And then there are prescriptions; yet a different whole ‘nother ball of wax, too, although I think our family could probably foot those bills without insurance – if we didn’t have to pay my sky-high premium PLUS all the charges that my insurance won’t cover.

Today, I got the most ludicrous information from my insurance company. First, it must be understood that due to my obesity and a psych condition, I am virtually uninsurable. In the early days of our marriage, I was on our family’s HMO through Scott’s work. Sweet! Three kids born (total fees $21,000) and we didn’t pay a dime. Literally.

When My Hero left that job and began his own business, we were COBRA’d onto the same HMO coverage for 18 months, after which we bought a family policy with Blue Cross. It costs one arm and covers Scott and the kids. They wouldn’t take me, so I was uninsured for a couple of years.

I got antsy with that status, so about seven yeas ago we dug a little deeper and found a company that would insure me – for an arm and a leg – with a sky-high deductible. That was fine until the company, First Health, began raising my rates. And decreasing my coverage. Now it costs two arms and three legs.

My insurance premium alone is close to $400 a month, not to mention Scott and the kids’ Blue Cross policy. I think my deductible is something like $5000. So, given that background, you now have permission to laugh at the hilarious piece of information I received today.

My doc of nine years, whom I adored, had the nerve to move out of state, and the clinic where she practiced hired in another doc. I recently went to him for my annual exam, something I do at the same clinic every year (duh). My insurance always covers most of that joyful visit, and then we are billed for the few dollars that remain. No big deal. So imagine my surprise when today’s mail produced an Explanation of Benefits saying that of the $383 charge from that visit (!!!), I owed $283 to the clinic.

I played Phone Follies the rest of the morning. You know Phone Follies. It’s that game where you dial, click through one or more menus, get told that your call will be recorded for quality assurance (does ANYbody believe it’s not really to prevent a lawsuit down the road?), and listen to scratchy music on hold for an undetermined amount of time. When it is your turn, you speak briefly to a human, who either puts you back on hold, transfers you to another automated menu system, or gives you a different number to call.

Today’s seven-round session of Phone Follies actually went fairly smoothly and I was privileged to talk to a lot of nice ladies. I even got to make one laugh out loud for an extended period of time.

The lady at First Health confirmed that my new doctor, the one my clinic hired to replace my old doctor (who had been in the First Health network), is NOT in the First Health network, and since I went – unknowingly! – to an out-of-network provider, First Health didn’t cover most of the charges. Lovely. I plan to tell Scott that it’s just money, right?

But lovelier than that is this little factoid: Just because the huge hospital system in the nearest city (we’ll call that system SJ) is in the First Health network, that CANNOT be construed to mean that the doctors who are affiliated with that hospital and who practice medicine at any of the dozens of SJ clinics in several counties of two states are also in the First Health network.

Furthermore, it is incumbent on me as a patient, not only to locate a new in-network doctor, but to locate any in-network physician who may treat me; even though I may never see him/her or even know his/her name! For example, I am scheduled to have a mammogram in a few weeks, at the SJ mobile mammogram bus. I have known all along that my insurance requires me to utilize the SJ hospital, SJ physicians, and SJ clinics – which I did and do. Hence, I made the mammogram appointment through the SJ system and as they said it would be easier for me to have it done on the bus (11 miles from home) than to go to the SJ hospital (35 miles from home), bus it will be. And I am fine with that.

But during today’s Round Three of Phone Follies, I realized that I need to get two pieces of information before arriving at the pancake bus: 1) Are the mammogram bus and its technicians in the First Health network?, and 2) Is the radiologist who will read the mammogram in the First Health network?

Now, really ladies, how many of you have met, can recognize by sight, and/or are on a first (or even last) name basis with the radiologist who reads your mammograms? How the heck am I supposed to know who will do that fine task?!?!? The answer: more Phone Follies!

In Round Four today, I was able to learn that the answer to #1 is a definite “yes”- according to “Connie,” and Connie had better be right! Also, there are only three radiologists in the entire SJ system who read mammograms, and all three ARE in the blessed First Health network – so the answer to #2 is yes, also. I felt calmed and reassured by this information, but Jamie, the head of SJ’s Breast Clinic, did remind me that these three radiologists ONLY read mammograms.

This means that if I ever want to do something exotic like contract pneumonia and have a chest x-ray, be in a car wreck and have a leg x-ray, or give myself an ulcer and have an upper GI, I will first need to locate an in-network chest-x-ray-reading radiologist, leg-x-ray-reading radiologist, or gastroenterological-reading radiologist and request him/her by name to read my scan.

All will be well and good assuming I am as lucid as I am right now, but God help me if I happen to be unconscious and unable to search First Health’s website at that crucial moment – or if my preferred radiologist is on jury duty or vacationing abroad!

The fact that my beloved insurance company is requiring me to jump through such hoops is what had Barbara, the lady in charge of the SJ mobile mammogram bus, in stitches. She said (between bouts of uncontrollable laughter), “I cannot BELIEVE it! I have never heard of such a thing. I cannot IMAGINE any insurance company requiring a patient to jump through such hoops! That is the most absurd thing I’ve ever heard.” And, catching her breath between chuckles, “That’s the funniest thing I’ve heard all day!”

I would have felt more successful as a humorist, but the day was young; it was only 11:00 AM, and I had only been playing Phone Follies for ninety minutes.