In early spring of 2007 I decided to quit my job, sell my house along with nearly everything else that I owned, and to live out of my car while traveling the country. These are my stories (and pictures) of life on the road.

Friday, August 17, 2007

Thank Goodness for Health Insurance!

Thank goodness for heath insurance, that's all I can say. As soon as I turned 19 I was no longer covered under my fathers health insurance coverage so we had to switch it over to my name. So for the last 10 years I've been paying my health insurance dues like a good boy knowing that some day it could save my bacon. I generally only showed up to the doctor once every 2 or 3 years for something pretty minor, I don't think I ever had a bill over a couple hundred bucks. At times I felt foolish for spending all that money on health insurance but I kept reminding myself I didn't have it for the little minor stuff; it's for the larger, unexpected stuff.

So early into my big trip this summer (www.alangage.blogspot.com) when I dislocated my knee in the mountains I was relieved to know that I'd have health insurance to help me out. Seeing as I was no where near home and had no income that was really a load off my mind. I stopped by the local hospital for a check over and some x-rays and the doc said he couldn't see anything in the X-rays but recommended I see a specialist and get an MRI done to check for ligament damage. In the meantime I'd be OK on the knee if I just took it easy.

I got a recommendation from Albin on a great bone and joint doctor in Bellevue, WA so a couple weeks later when I found myself up that way I made an appointment and stopped in. The doctor looked at the X-rays from the hospital I'd already had done, poked around, gave me some options, and we decided to have an MRI done to see if any damage had occured or if anything needed to be fixed. An MRI is a pretty spendy procedure but thankfully I had health insurance to take care of that.

I got the results back from the MRI a little while later and it turns out I had a partially torn medial meniscus and a partially torn ACL; both of which would require surgery to repair. Without surgery my knee wouldn't be as strong as it should be and it would be easier for it to pop out of place again the future, likely doing more damage. Since I'm an active guy and I don't like the thought of having that happen in the mountains EVER again surgery sounds like the way to go. Thankfully the medial meniscus is pretty straight forward with a quick recovery time. The ACL on the other hand is a lot more involved and will require a loooong recovery time and will probably include rehab too. Phew, health insurance to the rescue!

I was trying to decide just when and where I'd get the surgery done when a few days later I find out that my health insurance company, Blue Cross/Blue Shield, denied the claims they'd gotten from the hospital in Baker City where I'd first gotten my knee checked out. Hmm, I didn't like that at all. Did that mean they were going to deny the claims from the specialist and for the MRI as well?

Yup, it sure did.

After getting ahold of the insurance company to find out what's going on it appears they're denying coverage because of a pre-existing condition. You see, when I was 16 or 17 I hurt this same knee. At the time I was covered under my dads Blue Cross/Blue Shield and they covered the bills from the local hospital which included a few x-rays and advice to take it easy and the knee would heal on its own. When I turned 19 however and the plan was put into my name (same insurance company) I was suddenly a “new customer” and that knee problem I'd had a couple years ago was now a “pre-existing condition”. I remember sitting in the office and having them tell me that BC/BS wouldn't cover any injuries to that knee for a period of two years. I thought that was pretty crappy but it didn't seem there was a whole lot I could do so I just went with it and hoped I wouldn't re-injur my knee in the next couple years; which I thankfully didn't.

Now what I didn't hear them tell me, or what I don't remember hearing them tell me at that time was that after those two years were up I'd have to have submit some paper work and be re-evaluated to see if they'd decide to cover my knee. I honestly don't know if they just didn't tell me, didn't make it clear, or if I just totally forgot but for the last 8 years I've been under the assumption that once those first 2 years were up my knee was covered...ooops, guess not.

I can submit that paper work and have it re-evaluated now, but even if it's accepted it's not retroactive so there's no way they're going to pay for the current bills on my knee. And what do you think the chances are of them re-evaluating the situation and saying, “sure, we'd be happy to cover your knee that we already know is going to require surgery to repair”. I don't think I'll hold my breath on that one.

So here I am looking at some pretty steep doctors bills, which I can pay out of pocket thankfully, but that I'm not really happy about having to pay and that will put a pretty good dent in my bank account. And that still doesn't do anything to address my knee, which is still going to require surgery to be back to 100% reliable, I highly doubt I'll be able to pay for that out of pocket.

Gee, what a fantastic system this is. They really seem to be looking out for what's best for their customers. I'm more then willing to admit my share of the blame for not paying more attention to my health insurance policy and for not realizing that little catch. But honestly, how many people out there are really going to take the time to figure all that stuff out on their own? How many people are assumingLink they're covered and will later get a very unpleasant surprise.

No matter what you think of Michael Moore I highly recommend that everyone watch his newest movie, “Sicko”. It's all about health insurance industry and it's a real eye opener. Some of the stuff in there is just plain astounding. I felt he did a pretty good job of staying neutral in the politics on this one, though there are of course some jabs at the president and other conservatives. Democrats didn't get off with a free ride on this one though either. In fact I think we all got slammed pretty hard in this movie, I took it as more of a wake up call to everyone living in the US to wake up and look what's really going on. The only reason stuff like this continues to happen is because we let it happen; just assuming everyone out there really has our best interests in mind and wants what's best for us.

The first half of the movie I thought was particularly powerful, the second half seemed a little more like entertainment then enlightenment but still had some really good stuff in it. I'm sure not going to take everything he says in the movie as gospel and there's always another side to every story; but this side needs to be heard.

Hopefully someday I'll be able to say "Thank goodness for health insurance" and actually mean it! In the mean time, anyone in Canada looking for a good mechanic?

4 comments:

Keeneye said...

I am so angry after reading this post. The fact that you're responsible, that you've paid your health insurance premiums on your own since 19-years-old, and that a minor injury at SIXTEEN is cause to deny you -- this is all so ridiculous!

BC/BS stands for Blue Cross/Bull Sh*t as far as I'm concerned.

John Elder Robison said...

Health insurance sucks. I wish you luck with them, it sounds like a real hassle.

Here in Massachusetts we pay $18,000 per year for that coverage in a family plan. It's just unbelievable.

Justin Serpico said...

Alan,

The meniscus is actually worse than the ACL. I tore my ACL in March 2006 and it was just a partial tear.

Despite bad medical advice I went to a top notch hospital and had it repaired.

Total bill was over $45,000 with rehab. Surgery alone about $30,000.

Anyway, the ACL can be fixed. Unfortunately the meniscus only gets shaved or removed.

once it's gone it's gone, then you have bone on bone.

But the ACL reconstruct will fix some of the wear and tear.

Too bad back when you were 16 they didn't diagnose the ACL tear, you'd probably still have an intact meniscus.

Anyway, the ACL is a long rehab but I had mone done in Dec and I was shoveling snow in March, mountain biking in April, and hiking in April/May. Did some fairly decent hikes and now I'm paddling most of the summer with the expectation of rock climbing, ice climbing, skiing and snowshoeing in the coming months (take a look at my travels below).

Good luck.

Justin
mountainvisions.blogspot.com

Edith said...

Health insurance is a rip off. If they can find a way to not pay, they will. Of course they know all the loop holes, because we pay the premiums that make them money.

I am glad you published who you have coverage with, because it is nice to know who will rip you off.

You've reached the end of the page but that's not the end of the stories. If you want to read more (and who wouldn't!?) then click on the archive links to the right hand side of the page. They're listed by month; the adventure starts in May.

The February archives aren't actually from this trip but are previous adventures I've had, which are worth reading as well.