What Really Bothers Me About Today’s Insurance Call

25Mar09

Our health plan renews April 1, so today we were all made to sit in on a conference call in which the nice man who procures our health plan for us explained in excruciating detail how we were all costing the firm a fortune and to knock it off already.

That’s not hyperbole.

He framed it as a bunch of suggestions, but what it boiled down to was “watch your health costs.” Which bothers me a great deal, for a number of reasons.

1. Being “responsible” for my health costs, in the sense that I should feel badly about spending money on my health, feels way too much like blaming me for having chronic genetic conditions in the first place.

2. Being told to “watch costs” puts me and everyone else in the very dangerous position of making decisions about our health based on dollar amounts involved in any testing, diagnosis, or treatment. We’re not doctors to begin with. Expecting us to make educated decisions about our own health based on evidence we don’t yet have is nigh impossible; expecting us to make uneducated decisions about our own health based on someone else’s bottom line is madness.

Example: Last fall, my internist scheduled me for a full-spine MRI because I had within the past three months developed symptoms including widespread body pain, stumbling, involuntary twitching of major muscle groups, and an intolerance to heat. Said MRI cost well over a thousand dollars. Said internist was concerned I might have multiple sclerosis. Had I made my decision solely on cost, I would have postponed a diagnosis, perhaps until it was too late to save a significant portion of my useful life.

In case you’re wondering, I had the MRI. And I do not have MS.

3. Unlike, say, car insurance, where I can choose to buy the nice safe sedan instead of the deathtrap sportscar, I cannot choose to have a new body. I cannot choose to just suddenly stop having [insert condition here]. (I’ve tried that. It doesn’t work.) Insurance therefore punishes me for posing “risks” over which I have no control, except to manage them to the best of my ability by going to all my doctor’s appointments, taking all my medications, and submitting to the testing my doctors want to do. But see #2.

4. I’m not a “person.” I’m not a “disabled person.” I’m an “uninsurable risk.” And my heathen uninsurable riskiness is boosting everyone else’s insurance costs. (I shouldn’t have to explain that this is because the insurance model is wrong for issues of human health, not because I am in fact “less-than” for being disabled.)

5. When asked to “think of ways you can reduce your costs,” my only available response was “quit taking all my meds and go on disability.” First, this is not any kind of productive solution. Second, the insurance company would not mind in the least if I started getting my health care out of taxpayers’ pockets (of which there would be one less, because I would not be working anymore) instead of their coffers. See #4.

6. We were specifically exhorted NOT to use the emergency room as our primary care. No mention was made of whether I was allowed to use the emergency room as an emergency room.

(Not that it mattered, as I have specifically avoided going to the emergency room on four separate occasions in the past six months despite desperately needing care, solely because I could not afford the out-of-pocket portion of the cost. So I guess the “real” answer to #5 is “stay in bed in excruciating pain, except for the parts where you can’t stop vomiting.”)

7. We were given a list of questions to ask and ways to haggle our doctors and pharmacists into cutting us better deals. Never mind that one of the benefits our premiums supposedly pay for is the insurer doing the haggling for us before we get there. (Also, haggling over price, which nine times out of ten the doctor/pharmacist cannot control anyway, introduces a tension into the doctor-pt relationship that just shouldn’t be there. Period.)

8. Near the end, we were advised to “save costs” on our medications by (a) obtaining free antibiotics and the like whenever possible, and/or (b) asking our doctors if we could cut all our pills in half. (A) bothers me because it’s obviously taking advantage of a charitable program designed to help people who genuinely cannot afford medications, not people like us who can afford them but just have insurers who want to save a buck. (B) gave me a barely-controllable urge to ask, “So will our long-term disability plan cover me when, after years of cutting my no-generic-available Maxalt in half, I succumb to brain lesions caused by insufficiently treated migraines and have to spend the last twenty years of my life on a ventilator?”

(Yes, I know the lesions don’t occur in the brain stem and so I would not wind up on a ventilator. But I’m betting the insurer didn’t know that, and in any case it would have made my point.)

9. Does he seriously think I’m out having MRIs and lumbar punctures and fluoroscopy for fun?

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