Posts Tagged ‘Insurance’

“A big (bleeping) deal!”

March 23, 2010

You can always count on Vice President Joe Biden for a laugh. After introducing President Barak Obama at this morning’s signing of the healthcare bill, Biden turned to President Obama and commented, “This is a big (bleeping) deal!

And even though the Vice President wasn’t particularly eloquent, he’s right: We’re living in a different world tonight. The plan isn’t perfect; I am personally concerned about the cost. Unless we’re very careful, this has the potential to backfire like a misused credit card, with costs snowballing and no chance to catch up because of the interest payments.

But it does a lot of good, too. Children with pre-existing conditions can’t be turned down for insurance coverage any more. A lot of parents of Cardiac Kids – and other children with Pre-existing Health Conditions – can sleep a little easier tonight.  In 2014 Adults with pre-existing conditions will be able to buy insurance too, but for the moment we have to wait 90 days before we can buy into an insurance pool or a subsidized program and obtain insurance. It’ll be more expensive than “normal” insurance, but we ought to be used to that by now. CHDers never seem to take the easy way out.

But with the stroke of a pen (several pens, actually. Presidents usually sign major legislation with multiple pens, giving most of them away as souvenirs. President Obama used 22 different pens in signing the Health Care bill earlier today.) the world changed.

It is a big bleepin’ deal.

Hearts aren’t White

August 6, 2009

Here’s an article abstract from a recent issue of the journal Circulation: Cardiovascular Quality and Outcomes that compares prenatal diagnosis of Congenital Heart Disease (CHD) with socioeconomic position, their level of insurance, and even their race. Race was not a direct factor, but socioeconomic position and insurance was… the better off you are, the better the chances of a CHD being picked up during a prenatal ultrasound.

Which brings me to a subject that I’ve been wanting to discuss for a while but never felt comfortable approaching: By far, most of the CHD Survivors I have had the honor of meeting are Caucasian. And I don’t mean just more than 50%, the number has to be close to 85% and possibly higher.

One of the biggest points of Health Care Reform, in my opinion, should be equalizing care. This probably falls under the umbrella of making sure everyone is covered, but I have never heard the point expressed as I see it: A heart defect, we know, strikes 1 out of every 125 live births. It doesn’t care if you are White, Black, Asian, Native American,  rich or poor… if you are number 125, you’re it. And your parents better be able to generate a lot of resources because your treatment is going to be expensive. Not just right after birth, but throughout your lifetime.

We do need to control healthcare costs and we do need to make sure everyone is covered, and we need to make sure that everyone has a chance to get the medical care they need, no matter if they are born with a disease or acquire it later in life. Because hearts don’t have a race.

And every heart deserves to live a lifetime.

You can get insurance

May 28, 2009

Here’s a very helpful article from CNN: Information on how to get insurance when you suffer from a pre-existing condition. CHDers hate those three words: they are the reason (or the excuse) that insurance is not available to us or only available at sky-high prices.

Insurance companies operate on a pretty simple theory: All the members pay into a fund, and that fund is used to cover costs when a member gets sick. That’s a pretty simplistic explanation, but that’s how they work. The goal of the company is to stay solvent by always having money in the fund, which (hopefully) is well managed through investments and generating a profit.

To prevent sudden disasters from emptying the fund, insurance companies make the safe bet. Good drivers pay less. Healthy people pay less. Healthy people striving to stay healthy could pay even less than that. The homeowner in a “safe” part of the country will pay less than someone living where tornados or hurricanes are prevelant. You can’t predict an auto accident or a weather disaster, but you can predict that folks who were already sick are going to need medical care more often. So Phil will likely be turned down when he applies for insurance, because he has HLHS.

If you are lucky enough to have a job and then unlucky enough to lose it, you have the right to buy COBRA insurance. COBRA stands for the Consolidated Omnibus Budget Reconciliation Act, but a lot of people think of the hooded snake: At the prices that you have to pay for it, COBRA can kill you quick. But if you need it, something is better than nothing, and the Stimulus Package will pay a portion of the costs.

Each state has a high risk insurance pool that you can investigate, and you should check out your states ratings when it comes to health. Who knows? You might find that relocation will improve your ability to find health coverage. Yes, it is an extreme option, but sometimes we’ll take any port in a storm.

Probably the best thing to have is a group insurance plan – As one of a crowd, your pre-existing conditions are still covered because the costs are spread out. The smaller the group, however, the less likely you are to qualify for a group plan because the costs begin to out weigh the income generated.

There are some states where you can literally be “a group of one” – self employed, yet able to purchase a group health insurance plan! If that is great, you’re going to think the next point is wonderful: most of the “group of one” states also have “must issue” laws. If your group – even if it is just you – meets the requirements, you have to be offered health insurance!

Some states say that you literally have to have a group – two or more people. Hire a relative. Or hire someone else with a pre-existing condition and solve both of your insurance problems. You can check your state requirements here.  Actually, you can check a lot of things through that link by clicking the list in the blue box.

I am not in favor of obtaining something through dishonesty, but if your state allows very small groups – and occasionally individuals – to obtain health insurance, I think you should look into it.

“Like sands through the hourglass…

December 4, 2008

… so are the days of our lives.”

Ever notice that the sand in the hourglass on the daytime show Days of our Lives never runs out? It just keeps going forever and ever and ever…

To bad it has nothing to do with reality. There was a very alarming report in the Boston Globe that states the bad economy could drain Medicare part A pretty quick. When that money runs out… it’s gonna get nasty. Doctors are already upset; the government is running them out of business. Some doctors are doing their own laundry to save money and others can’t afford to replenish their drug supplies. It’s getting scary out there, folks.

If I were a doctor I’d probably be looking for something else to do. Some of them are, and others are changing their mind about going into medicine in the first place. The Association of American Medical Colleges (AAMC) recently did a study that showed the numbers are dropping as the demand is rising. Massachusetts is already getting slammed. The Canadian system isn’t the answer, either. USA Medicine is ahead in technology, but the men and women of the Maple Leaf have better office systems. An alliance is looking pretty good right about now.

Dr. Wes bemoans the fact that healthcare costs are climbing more than inflation. Health Insurers are willing to forget about pre-existing conditions (Yay!) and insure everyone if the Government does certain things. (Now wait a minute… where’s the money coming from?) And whatever happened to all that savings that was supposed to occur if we switched to generic drugs?

We need to close the bar and then check ourselves into rehab.

For these links we give thanks

November 26, 2008

Just in case you didn’t know, helicopters don’t glide very well. There have been a rash of medical helicopter crashes lately, which makes some people wonder if they are used too often. This issue is being investigated, and the use of air ambulances is down. So either the number of serious illness and injuries are down (doubtful) or the choppers are flying less. Hmm… why would anyone call for an airlift when it wasn’t needed?

Don’t go here for your medical information, they’ll scare you half to death. And don’t always believe these guys. And if you are looking for drug information, don’t look here. Check out Medscape instead. It’s FREE, and Medscape has a much better drug reference page.

Dr. Wes’ brother asks “Hey, you wanna see an operation?” If you want to see an operation (double bypass heart surgery) click this link. WARNING: The blood is real, and the bone saw is pretty loud.

Laurie smells a familiar smell on a subway car and it takes her back… to an unpleasant place.

Got Heart Failure? Then work it, baby!

I think I know why he is the Happy Hospitalist… he leaves all his frustrations on his blog. Here, Happy tells the story of the guy who thinks that free = more. I’ll take an eye exam, and a rotator cuff repair, with a side order of dental. Oh, and clean out my earwax, too; someone else is paying for it! The costs add up – an implantable defibrillator costs almost as much as some people make in a year. And when you consider this, you realize that our financial situation is just going to get worse. Pay off those credit cards, folks!

Maybe they’ll let us use a spider as payment.

Sometimes though, especially around the holidays, what we really need is a friend.

It’s almost Thanksgiving Day, and I’m spending Thursday with the family. Friday, a friend and I were supposed to just have lunch together, but she has the entire day off! So I’ll be away most of Friday, too. Have a safe, happy, and wonderful Thanksgiving; and remember to be kind to your fellow man and your four legged friends.

And don’t forget, Saturday is Red and Blue Day!

Always yours;


The Funky Heart

“The Wrong Place to be Chronically Ill”

November 19, 2008

We’ve got problems.

I think anyone can agree with that, but this editorial in the New York Times reports the results of a study published by The Commonwealth Fund shows we’ve got BIG problems. Chronically ill adults from eight industrial countries were surveyed, and in the United States: (Read or download a .pdf file of the report HERE.)

* 54% of Americans did not receive care or fill a prescription because of cost;

* 34% say that their care was delayed because of “lack of coordination”… in other words, the results of a test or procedure not being available when needed;

*34% also said they had fallen prey to some type of medical error.

That’s shameful. Congenital Heart Defect survivors are living proof that the United States provides the best medical care in the world… And this report proves that not everyone can take afford to take advantage of it.

So what’s the answer?

My answer, I hate to say, will scare you: “I don’t know.” I don’t think that Universal Health Care is the answer. Chronic Illnesses already cost Americans a LOT of money. How much? Did the recent 700 BILLION dollar bailout give you a chill? We already pay two bailouts each year just to cover the costs of Chronic Illnesses. And we need more Primary Care doctors.

The head of the Massachusetts Group Insurance Commission recently said that insurers can help to keep costs down by limiting patients to just the cheapest and best hospitals. The problem is, we don’t think like that. People believe that bigger hospital + better reputation = better results. That’s not always true – but you’ll gladly pay for it.

So what to do? If you read Funky Heart, you’ve already read The Happy Hospitalist’s rant about the cost and effectiveness of drugs vs. spending the time and effort to imporve yourself. It’s obvious that we’re going to contiune to need our drugs, our physical exams, and occasionally surgery, but we can help ourselves.  Follow Happy’s advice and get down to the gym. Go for a walk. (And I’m talking to myself here, I positively HATE cold weather, especially since I am taking bloodthinners. But it has to be done!) Take a dip in the pool. It doesn’t matter what you do, get active.

As my dad like to say, “Off your seat and on your feet!”

You own it, you pay for it!

October 4, 2008

You had best watch out, your insurance company is up to no good.

I wear a nasal mask connected to an oxygen concentrator when I sleep, breathing 6 liters of oxygen. (I think it’s 6 liters per minute, but just my luck it is a different measurement.) It’s not a “must-have”, and I can miss a few nights. A few years ago I didn’t use it for ten nights in a row while I was on vacation. But it sure does help my batteries recharge, and after about three nights without it, I sure can feel it.

Needless to say, when this thing breaks down, it breaks down during the middle of the night. When else would it, since I don’t use it during the day? And when it goes on the blink, it doesn’t just shut down… it activates a buzzer that stays on until the machine is reset, fixed, or turned off. I’m sure that it is set up that way for anyone who needs their oxygen 24/7 so I can’t really complain, but when you just need it for a little while it can be irritating.

So my concentrator broke down last week. I know a few “tricks” that can usually fix it – press the reset button, wash the filters (they get washed once a week anyway, a buzzer just gets them an extra wash) and sometimes just turn it off and wait a few seconds does the trick. But not this time.

So I make a phone call to the company that rents and maintains the machine; and they look up the records. No problem, we’ll be out tomorrow, and your fee will be $150.

Fee? What fee?

Your father owns these concentrators, and we charge a $75 per concentrator fee for a repair call. And that is just the repair call. Parts and labor will be figured out once the machines are serviced.

Oh, be assured that my father was thrilled to hear that. So we did some investigating. His insurance did originally pay the rent on the concentrators. But after a period of time (usually a year) the insurance company decides that the concentrators have lost some of their value through depreciation. And when that happens, they just buy the machines outright, and transfer them into your name… and never mention it to you. So when it eventually comes time to have them repaired, surprise! Here’s a bill!

And we couldn’t do anything about it. There was never a question of changing the insurance company’s mind – like that’s going to happen – but my father used to work at a textile mill. As time passed, the mill was purchased, mis-managed, and eventually closed. So there is no mill, no insurance company, no customer service or Human Relations Department to fuss at… all that is left is an empty building. I guess I could kick the building, but that probably wouldn’t accomplish very much.

The original insurance plan was great. An unmarried child of an employee was covered from the time he or she was born until they turned 21 or graduated college, whichever came last. And if the child was disabled, they were covered for as long as the employee was covered under the group policy. (In other words, had a job there) That insurance plan paid for the bulk of three heart operations, hospital time, drugs, and Lord knows what else, so I am very thankful for it. But transferring the concentrators without our knowledge just didn’t seem to be quite on the up-and-up.

So the only thing I can recommend to you is to read that policy. Reread it… often.