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Going For The Throat: Confessions of a Health Insurance Neophyte

Post Published: 10 March 2010
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Category: Column, Going for the Throat, Health Care and Health Care Reform Column
This post currently has 25 responses. Leave a comment

I’ve had health insurance of one kind or another my whole life.   I’m fortunate for that, and I know it.   But it wasn’t until my diagnosis with Hashimoto’s disease last June that I actually paid attention to my health plan.   The good news is that not only am I paying attention now, but that it appears that my family’s latest health plan is a good one (I think…).

It’s not that I’ve never used coverage before–I am no stranger to doctors and hospitals.   But in the past, my care largely fell into two categories: routine yearly health check-ups, and catastrophic/accident care.   Yearly routine care was pretty much my annual gynecologist appointment, which usually went without incident.   But, being an active individual who has been involved in relatively high risk activities for most of my life, I’ve had my share of, ahem, unforeseen health issues.   There was the tibia fracture in 1993 slam dancing in the mosh pit at a Stuck Mojo concert.   And then the freak-accident fall with my horse while just walking back to the barn (after successfully schooling some hairy cross country elements) that resulted in a concussion in 2002.   The lacerated thumb ligament from a horse kick aimed at my face in 2004 occurred almost a year to the day after a young horse actually did land a kick right between my eyebrows–although both those incidents were covered by Worker’s Compensation.   I wish I could say this was the extent of it, but, unfortunately whether due to known, calculable risks, or plain and simple bad luck and balance (hello, fractured metacarpal 5 from falling off my Dansko clog), I have had plenty of cause to actually USE my health insurance benefits more than I would have liked.

The Hashimoto’s deal is different, of course, and something to which I know you can all relate.   I’ve now entered the realm of chronic disease.   For most of us, once we have a diagnosis with an auto-immune disease, endure a thyroidectomy for cancer, or take that radioactive pill, we gain admission to a world where we, and our current and future insurance companies, know that we are gonna rack up some medical bills for the rest of our (hopefully long) lives.

While I was working at getting my diagnosis (which, like many here, took some time), I was too concerned with my health to research my health insurance.   My husband (who actually has the policy) didn’t really know anything about it either.   Up to this point in our lives, our health insurance knowledge consisted of “fill out these forms” with an HR person, which resulted in some sort of card to stick in our wallets.   Over the years, through various employers, we’ve had Cigna, Tri-Care, Great West, and now a Blue Cross/Blue Shield (BCBS) plan–and to be honest I have not noticed any difference.   When your employer has a deal with an insurance company, your options are take it or leave it–while individual health plans (ie, not employer-sponsored plans) may offer you more choice, it usually comes at significant cost.

So, empowered with the determination to really understand and get the most out of my health plan, I started with the most basic step–I visited their website.   As predicted, this was not going to be easy.   The website is huge–deeply layered with all kinds of information, of which I have barely scratched the surface.   Once logged in, I could easily access my claim history information.   In the last 10 months, my doctor visits and testing have cost just over $10,000, of which BCBS paid an “allowed benefit” (the agreed amount for an in-network provider) of just under $5,000.   For this coverage, my co-pay was $200.00.   OK, whatever.   I want the REAL GOODS.   What have you done for me lately?

Again, it’s not an easy website to navigate, but so far I have found some areas that I will be checking into deeper (and reporting back anything of note):

  • They have a section with online tools and services, such as finding new doctors, estimated costs, and different forms and contact numbers.   Eh, mildly interesting.
  • OOOHHH! A section of discount options for “alternative therapies” and fitness centers.   A quick look reveals that with my insurance card I can get a 20% discount on acupuncture, pilates, somatoemotional release (I don’t even know what that means), nutritional counseling and dozens of other programs.   Wow, who knew?,   Not me!
  • Another section has an exhaustive “Wellness” area.   On a brief tour it is less than impressive: weight management has food diaries, exercise logs, fast food restaurant nutrition data (as if?), healthy weight calculators, etc.   The nutrition portion is just as bad.   Looking at the children’s nutrition section, one of the many articles has 5 fresh lunch ideas for kids.   One of these is called a “Bacon Cruncher”.   Your honor, I rest my case.

Admittedly, I have not delved too deeply into the website’s resources. I would assume, however, that I am not the only person who does not have hours to waste spare, either.   Regardless, I would give the additional “wellness” resources a C+. The information is hard to find, not necessarily helpful, and in some cases, not necessarily correct. But, it is there–a health insurance company’s attempt to prevent disease through healthy living?  Call me a skeptic, but for now I think it may just be lip service.

Check it out yourself, let me know what you think:,   www.carefirst.com.

Find out more about Robyn.

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25 Responses to “Going For The Throat: Confessions of a Health Insurance Neophyte

  1. Kaytee says:

    I was slogging through the Kaiser “Wellness” site yesterday…. There is a section on “alternative treatments” and herbal medicines, and in there you can plug in your “conventional” prescription med name, and get a list of things that affect it.

    Did you know CELERY interferes with thyroid hormone???! Not that I eat anything for an hour after taking my dose, but still….

  2. Dear Thyroid says:

    Kaytee – Celery interferes with thyroid hormone?!?!?! I had no idea.

    Thanks for sharing.

  3. Dear Thyroid says:

    Robyn – “Blue Cross/Blue Shield (BCBS) plan” Is this a personal plan or a plan through a business? I will definitely check it out. I’m in between insurance providers, slated to get a new one in April. If this is better, I want it.

    You gave me great food for thought, thank you. I’m going to delve much deeper now.

    Great read.

    Thanks.

  4. Myka says:

    $10,000 for only a year of doctor visits of which you had to pay %5000 plus $200 in copays (I am assuming this was for either ten visits at $20 copay per visit or twenty visits with a $10 dollar copay) Wow, Endo visits have sure gone up. I am sure you could get much better care and much cheaper if you were to switch to an ND. They actually take an entire hour with you per visit and treat your body as a whole unit.

    And yes, many foods and prescription meds too (especially antidepressant SSRI’s) interfere with thyroid hormone, its absorption or use. And it doesn’t always matter if its eaten within an hour of your synthetic or natural thyroid dose. I have totally given up eating soy and raw goitrogenic foods like broccoli now. I love broccoli though so I do eat it but only cooked and only occasionally.

  5. Dear Thyroid says:

    Hi Myka;

    Thank you so much for sharing your thoughts and points, it’s much appreciated.

    Regarding health care, in my opinion, we’re looking for the best of the worst plans. Once you’re diagnosed with certain chronic conditions, the cost of premiums skyrocket. Moreover, it seems less is covered.

    I know about SSRI’s and other goitrogenic foods, but I hadn’t heard of celery. That was a new great fact.

    What other medications interfere that you know of?

    Thanks for more info! Much appreciated.

  6. Lori says:

    Robyn, I also have BCBS HMO plan for many years now and have visited the website many times, and your skepticism is not ill-judged. It is nothing but “lip service”. IMO, their attempt to prevent disease through healthy living resources is a joke. I do not go there for reliable up to date information. Insurance is “business”.

    However, as an HMO plan I’ve been pretty happy with it until the last two years. In December ’07 when I had lumbar spine surgery, the hospital costs including the surgery were $100K. I only had to pay a $250 deductible and I thought that was bad because before that, I never paid more than $10. Now between higher copayments and large deductible, it’s costing us well into the thousands. My husband’s company is fairly small and I often wonder if they are forced to make these plan changes each year in part because of my high health care costs.

    On the other hand, if my hormone deficiencies were diagnosed properly many years ago, I would not have lax ligaments, degenerative joint disease to the point of collapse, reconstruction surgery for lax ligaments that look like stretched out elastics, and painful nerve compression and nerve damage from myxedema, to name a few. The cost of these has been astronomical. The waste is really sickening to me, not to mention the costs for specialists, testing, MRIs, scans, lumbar punctures, injections, etc. etc. all which could have been avoided if I was diagnosed properly, which at first it was thought ten years or so, but now they are guessing it dates back to pre-teen to teen years.

    The point is, I am only one person. I am wagering there are probably millions of people who, because of being misdiagnosed, are costing the system unprecedented amounts of money driving up the cost of health care. I realize this is only one part of the problem but I think it must be a very big part of the problem.

  7. Dear Thyroid says:

    Lori – I’m having big thysurance love for you right now. Aside from how horrific your situation is for you to have to deal with day in and day out, which I am very sorry about; your point about being diagnosed properly and early was/is BRILLIANT.

    Because of misdiagnoses and mistreatment, the cost for treating my disease has exceeded 100K in total. As you said, we are probably not in the minority.

    Insurance is big business. Every time I hit an insurance site, even the one that Robyn posted, the one thing you simply cannot miss are the reasons why health care reform is WRONG. Shame on them. Shame. Shame. Shame.

    Presently, like so many of our thybrothahs and thysistahs, our premiums are through the roof as are our out of pocket expenses.

    Hang in, kid; it’s gotta get better.

    xo

  8. Robyn says:

    Myka–I don’t think I was clear. I racked up $10K in “bills” but the insurance negotiates with “in network” docs to what they decide is a “fair” to pay. I did not pay the difference. I’m not sure where the numbers come from on either side. To date, I have *only* paid my co-pays.

    My yearly total includes an MRI and a CT, because I *insisted* there was something wrong in my neck, but the ENT disagreed. Seriously that accounted for almost $4K and were basically done just to “shut me up”. As Lori discussed–WASTE WASTE WASTE–SHAME SHAME SHAME! Diagnosis ultimately only involved bloodwork and an ultrasound at much less cost.

  9. Joanna says:

    I also have BCBS (PPO) and have had it for several years. I have been “pleased” with it, but this year my deductible went up and a few months ago my co-pay for specialist visits increased to $35. About a month ago I got a letter in the mail from BCBS telling me I can reduce my annual deductible if I complete two “wellness” activities. One is an online personal health assessment. The other is a wellness exam, either a routine physical or routine gynecological exam. It might be worth looking into to see if other insurance plans offer similar incentives for being proactive about healthy living. I don’t know how much of an incentive this really is, but for me every little bit helps.

  10. Dear Thyroid says:

    Interesting, Joanna. I’ve never received anything of that nature from my insurance provider. I also haven’t heard of any type of incentive such as the one you mentioned. I’m definitely going to look into it!

    Thanks for sharing. Super happy to hear that you’re ‘pleased’ with your plan. We know what that means.

  11. Robyn says:

    OK–I had been spending this BEAUTIFUL East Coast day outside and offline, but I’m back now!

    Kaytee–I did not know that celery had *anything* in it, much less something to interfere with thyroid meds. Curious!

    Katie–I have the BCBS BluePreferred (PPO) plan. It’s difficult for me to really delineate the differences between all the PPO plans, but for us, serendipitously, it is ideal. We live in NC, but my husband (who works overseas) is employed by a DC company. This plan has a “travel” provision that if you travel or live outside the “covered area” (metro MD, DC, VA), then all docs are considered “in network”. This is great because I refuse to choose my doctor based on networks–I chose those for whom I get good word-of-mouth referrals. BCBS plans usually run regionally, so you should be able to find a similar plan in you area. I have no idea how much it costs, though. Hubs gets it through his employer, and they pay 100% of the premium as far as I know (at least, none of his pay stubs indicate a premium).

    Lori–you are for sure preaching to the converted here. Between REAL wellness programs and prompt proper diagnosis, the whole health care industry could save MILLIONS!!!! I’m not sure why insurance has not “awoken” to this *novel* idea of way to save money. I wonder if they take their blinders off before they get in their cars to drive home?

    Joanna–that is interesting, and IMHO, fantastic. Let us know if you follow through, and what sort of cost savings you see. I will have to check out if my BCBS has a similar program that is “buried” on the site. I do love that wellness visits are all co-pay free. We should not be “penalized” for regular, routine health maintenance.

    Kurtis–great quote!

  12. HD inOregon says:

    Here are a few of my insurance issues (I call one of my ailments I, ²S, ², or insurance induced stress syndrome).

    1. When I needed radiation treatment for my throat cancer (which I had in addition to the thyroid cancer) and the insurer wanted to send me to a radiation lab 110 miles or 2 hours away (one way) for 35 sessions each work day. Ludicrous! Luckily my Dr. and we talk the insurer out of this nonsense.

    2. Three times now it happened that I got a bill from a Dr. office for 20% copayment. – What happened the doctor dropped out of my insurance plan, but neither doc, nor the insurance company bothered to tell us. Now these docs are “out of plan” and I have to pay 20% of the cost, even if the deductible is met. Grrr.

    3. Since I am retired I am self-insured. My rates (for both me and my wife) went from $6000 in 2001 to nearly $12,000 for 2010. And that is with a huge deductible of $5500 per year. Since I had tree cancers, I need relative frequent check-up scans. A CT-Scan is around $3000 and a PET can go as high as $5000, which means I am reaching my deducible almost every year; meaning I am out of pocket at least $18,000 per year – which is a sizable chunk of our retirement income. — Waiting for turning 65 to be able to have medicare.

    4. Of course with having had cancer I will (under the current rules) never be able to find another insurer that will take me on. I am stuck with the one I got, and that one can raise their fees at will. (Like the 39% that were in the news lately in California). — I really hope that our politicians get their act together and fix this very, very broken system.

    If you have a job and good insurance, try to keep it at all cost (I know if people who hate their job, but stay because they or one of their loved ones is seriously ill).

    Being without insurance, or on your own, really sucks!

    Those are my 200,000, ¢.
    You can tell insurance stuff is a hot button of mine.

    HD in Oregon

  13. Robyn says:

    FYI–I have added a topic over on the forums if you guys want to weigh in/debate/etc.
    http://www.dearthyroid.org/forums/viewtopic.php?f=26&t=203

  14. Robyn says:

    HD–your point(s) are well taken. My husband frequently switches “employers”–his actual job doesn’t change, just the who won the government contract, and therefore, pays the employees. One of my big fears is that he has an employer switch which really screws us because of my “pre-existing condition”. One of the problems with health care being directly linked to your job (for the majority of the country) is that if you have no job, are self-employed, or switch jobs, you can end up no longer being covered.
    If they asked me (and they didn’t ;p), a single-payer system that takes the employer out of the loop would be ideal for the US. Of course, I expect Hell to freeze over first.

  15. HD inOregon says:

    Robyn,

    Why is healthcare tied to an employer? My car insurance isn’t. My home owners insurance isn’t. My liability insurance isn’t. My travel insurance isn’t. Etc. – Large employers have the advantage because they can negotiate for tens of thousands of employees. Small businesses and private people who need insurance are shaftet.

    Why not pool people to negotiate good insurance terms and prices? Allow “groups” (unions, clubs, AAA, AARP, etc) to negotiate for their membership etc. And above all, create competition. – I am reading that in parts of the US one single insurer has a quasi monopoly on their coverage. That is unacceptable, if you ask me.

    HDinOregon

  16. Robyn says:

    HD–I totally agree. I have no idea how the employer/insurer system began, other than it being a group deal as you mentioned. Well, I only “work” part time now so I can be a Mom, but I do belong to a lot of “groups”–professionally (AVMA, etc.), social (USDF, USEF, YMCA, etc). Plenty of buying power with those numbers.

    Or maybe premiums could be more reasonable to start, by curbing costs as Lori outlined above, and then it could be tied to the individual ONLY.

    It sounds perfectly logical to me!

  17. Kaytee says:

    “Why not pool people to negotiate good insurance terms and prices? Allow “groups” (unions, clubs, AAA, AARP, etc) to negotiate for their membership etc. ”

    That is possible, and does occur. Professional organizations often will have something available if it is a profession with a lot of “independent contractors” and/or self-employed members. The costs and coverage vary, of course, depending on the number of enrollees in a particular plan. Some that do are SAG, and other Arts related professionals, and small business associations. AARP has something– I think a discount on the Medicare portions, if you chose certain providers. CHAMPUS plans cover military dependents and retirees, with variable deductibles/co-pays based on plan chosen.

    About the celery (actually, in the explanation, it says celery seed):
    “Armour Thyroid (Levothyroxine, Liothyronine) <> CELERY
    Interaction Rating = Moderate Be cautious with this combination.
    Talk with your health provider.”
    Here’s the website (I got the link from the kp.org (Kaiser) site)
    http://www.naturaldatabaseconsumer.com/

  18. Liz says:

    Robyn, I wonder if it went like, “What the hell kind of a catchy name can we come up with that will make kids like this shitty food?… Oh, how about ‘Bacon Cruncher’… sounds meaty *and* refreshing!”

  19. HD inOregon says:

    If you are, like we are, privately insured there is another thing to watch out for. We had a rather good private plan in California, and (silly me) I assumed we could continue the insurance when we moved to Oregon (after all it was a rather big nationwide company). But not so, not all insurers work in all states. We had to find a different provider (which is a pain). – Something to watch out for if you move across state lines.

    HDinOregon

  20. Kaytee says:

    Re: health insurance plans
    My first coverage was military medicine– while I was on active duty and when, as a dependent, we were overseas. There were advantages/disadvantages attached to each status regarding services, and in comparison to “civilian medical services”…. Stateside as a dependent, we had CHAMPUS, going to military CHAMPUS clinics and PP contractees (they no longer operate clinics, at least not here). Then, when hubby got off active duty, Blue Cross– a private plan with surcharges added because both kids were considered “high risk”/high usage of services. I’m not sure why #2 son was, but #1 son had over $250 in co-pays/month for dr visits and meds (ADHD/ODD– and psych services had a higher co-pay than regular medical); we were paying over $700/month for basic coverage… did a lot of shopping at thrift stores during that period….
    Currently, we’re covered by a Kaiser plan through my husband’s work. His choice was “take it or leave it”, so of course, he took it (he works for Kaiser in N Calif). It’s a great plan, if conventional medicine works well for you, and if you are lucky enough to get a “real doctor”, instead of a “technician” with a MD after his/her name…. It matters a lot WHICH Kaiser district you are in as far as services and policies go… where hubby works, the policy for my primary dx (fibromyalgia)is a team of specialists, including alternative medicine providers, take an “integrated medicine” approach. Yes, I’d still have to pay for the treatments outside Kaiser, but records would be freely available for all providers involved, and an integrated plan created and followed. Here in S. Calif, after diagnosis by a rheumatologist (who you need a consult to see), tx is in the Primary Care clinic, by a family practice/adult medicine dr, and I have to find for myself the alternative providers (after figuring out which might help), and personally report on findings from one to the other… and the Kaiser policy here is to NOT put anything in the treatment record they don’t provide. My acupuncture clinic (attached to a school of acupuncture/”oriental medicine”) is happy to have any other information to put in their records…. Right now, I’m looking into the possibility that “estrogen dominance” may be causing both the fibro and the hypothyroid symptoms– again, without input/guidance from the HMO which is SUPPOSED to be providing health care services for me. (Dx from a private thermogram clinic) Currently waiting for OTC “alternative” meds to be delivered.

  21. Robyn says:

    Kaytee–I guess I never paid attention to other groups. That is encouraging, but I still think, as a basic RIGHT, health care should be tied only to the individual, at a reasonable cost.

    HD–I recently heard on some NPR blip that part of the problem with the “national health care reform” (Ha!) is that states each have different health care laws, and therefore a national program may have issues with state law conflict. What a fargin’ mess!

    Liz–I almost choked on my lemonade. Seriously! Now, of all meats, bacon was (is) the hardest for me to give up. When I made the decision to basically only eat locally, humanely raised meat sources (usually I like to actually meet the animals, if possible), it basically removed pork from my diet. It is the very rare occasion that I eat pork–if you ever met a pig you would understand why. Pigs are more intelligent than dogs, have “human” eyes, and are super affectionate. But when I smell it, I feel like Homer Simpson…”Mmmmm, bacon”. I hope you get a chance to peruse the nutrition area–it’s a complete crock! Of course, if you don’t know, then you don’t know the advice is suspect, do you?

  22. HD inOregon says:

    Robyn,

    Laughing out loud that Washington DC is afraid of impacting state laws. BS. Haha, that would be a first, they always override state laws (see the trouble with organic labeling and California’s much stronger law, the Feds just overruled it).

    This wasn’t meant personally in any way, I know you’re only the messenger, Robyn.

    HDinOregon

  23. Hypogirl says:

    Robyn – good writing girlie! I was surprised at what my insurance had to offer as well. However, A LOT of my holistic stuff isn’t. It is considered experimental. Go figure right. Blood test are experimental as well as an office visit! I had blood work ran through my providers hospital and I ended up paying $200.00 dollars! I had my urine tests at another independent clinic and ended up paying $10.00 dollars for and $80.00 test. Mind you the blood work I had at the providers clinic was a full blood workup – but a few years ago I wouldn’t of had to pay anything. It is surprising how much insurance has changed in the last few years. I have a $500.00 dollar deductible and have just about meet it this year. All starting in Jan!

    One last thing – How yummy does Bacon Cruncher sound?? 😀

  24. Wakela says:

    Unfortunately, it really isn’t the insurance companies that run the medical industry. Its the drug companies. They make more money off of people being sick, then if they were well. Even our little medical office directory has ads for the various drug companies throughout.

    I have worked in the medical field for about 20 years now. I have seen so many people denied the treatment that they need because the insurance company didn’t feel it was a necessary treatment. In fact, when I have to get authorizations for CTs, MRIs, and PET scans, I tend to have to lie to the insurance companies to get them to ok the exams. Its sad at how they can so quickly deny coverage for tests that can help diagnose patients, yet not have total knowledge of their medical circumstances. You have to answer a few questions and based on your responses is how the insurance determines whether they will approve or not.

    It is really disheartening. I went into the medical field because my grandmother and my mom were nurses. However, my mom told me not to become a nurse because the profession was heading down hill. She said if you want to go into medical, then try to get into the office end of the field. Here I am and I am extremely disillusioned.

  25. Yong Laurino says:

    i would like to hear more on this topic please

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