Insurance
Testify!
Austin Texas
So the last couple of days haven’t exactly turned out like I expected. I’m sitting in a car repair shop in Austin, Texas trying to get some work done while I wait for my car to be repaired.
Some people connected with the Christian Life Commission of the Baptist General Convention of Texas read my story about our family’s insurance mishaps. It so happens that our state legislature is considering the powers and direction of the state insurance oversight department. I was asked to come to Austin to the hearing and give testimony.
The idea was to drive to Austin Tuesday (about an hour drive), tell my story, then drive home that afternoon. Well, that was the plan anyway.
Then my car broke down south of Austin. It acted like it had run out of gas, but I had plenty in the tank. Shelton Green (Political consultant for the CLC and a GREAT guy) helped me find a mechanic. I waited on the side of I-35 for about an hour and a half, waiting for a tow truck. Waiting on the side of the road in Texas in June is not pleasant, especially not at noon. I retreated to a nearby tree to wait in the shade, only to be attacked by rogue birds. Well, maybe attacked is a strong word, but they were definitely agitated by my presence and flew menacingly around my head.
This bird and his friends did NOT trust me
My car was towed to Lamb’s, a local mechanic shop, and Shelton drove me to the capital where the Sunset Commission was beginning testimony on insurance issues for our state.
Initially I was concerned that I might miss my call to testify, but that fear was clearly unfounded since I wasn’t called until almost 9 pm. From 2 pm until 9 pm, the legislators charged with analyzing our state’s insurance oversight department listened to a steady stream of lobbyists and advocates speak to various esoteric and painfully detailed insurance issues. I just wanted to tell them how easily working families can find themselves labeled as uninsurable. My 5 minute story might have been helpful since the legislators pay close attention to unpaid citizens who come to these things at their own expense to tell their stories.
Sunset Oversight Commission for the Texas Department of Insurance
Afterwards I had dinner with some new friends, various political advocates who work with non-profit organizations - the good guys. By then it was too late to get my car, so I had to spend the night.
And now....it’s 1 pm on Wednesday, and my car still isn’t ready. I have a 1999 Chrysler Concord. That’s not particularly new, but it is new enough to be run mainly by computers and various sensors. Something is telling the car it is out of gas or shutting it down for some other reason. The mechanics feel it is not a mechanical problem with a fuel pump or anything like that. They are replacing the crank sensor, which is apparently sending faulty information to the car’s computer.
So here I sit.
Observations from my time in Austin:
Politicians and the political process - As I watched advocates and lobbyists and citizens parade before a legislative committee, it was clear that there was no way I was going to be able to understand the complex power structures of our state political process. Sometimes the legislators seemed bored. They sometimes left and didn’t come back for a long time. But there were various aids listening and taking notes. I’ve been an insider in enough systems to recognize something complex when I see it. I decided that my story might or might not make a difference, but I came to tell it in hopes that it might. Someone is watching and taking notes. “A concerned citizen drove to Austin because his family cannot get health insurance due to being unfairly profiled.” Perhaps my testimony will end up being such a note in someone's report.
Still, the politicians definitely do sit up and take notice when an average citizen speaks. I think there were only two or three of us during the entire process. But we were treated very respectfully, whereas many of the lobbyists received some fairly pointed questions and criticisms. One of the senators called them, “suits.”
What I hope comes out of this is a greater understanding on the part of our state leaders that everyday men, women, and children are being profiled and labeled as “uninsurable” by private insurance companies. You have some protections seeking insurance with a group through an employer, but if you are seeking insurance on your own, you can be rejected for unfair reasons. With no incentive to take you, the insurance company can reject you for for any reason, real or imagined. Why should they take a chance?
This is a problem because health insurance is not a luxury item. You have to have it if you are going to get good medical treatment. No one can afford to pay for their own health care anymore. Even a simple mammogram followed by an MRI and a series of lab tests can easily cost $5000. A family of five with a health problem or two in a year can find themselves hopelessly in debt in no time without insurance. And of course, after you pay all that you have for the treatment - which will not be enough - you will never be able to afford the medication they prescribe.
Cars - The question with cars is not "Will they break down?" but "When will the next breakdown occur?" You never know when. And when it happens, you just have to swallow hard and deal with it. I hate spending money to fix cars, certainly, but I hate the loss of time even more. I don’t have a lot of time margins in my life. We have a retreat coming this weekend. I have a sermon to prepare for Sunday. And I have a lot of work to do with the blog networks I run. I did not want to lose most of Tuesday and - apparently - most of Wednesday.
It’s a spiritual exercise to take a deep breath and try to let go of worrying about things you cannot control. I’m better at this at 46 than I was at 36, but still not there. One spiritual excercise that helps me deal with this kind of stress is to intentionally pay attention to little things. Okay, I'm on the side of the highway, so what can I watch and learn while I am here?
That brings me to plants on the side of the road - While walking to my shade tree beside I-35, I stumbled through a strange kind of grass with spear-like points. By the time I got to the tree, I noticed that 8 or 10 spears of seed-laden grass had impaled themselves on my shoelaces and were on for the ride, hoping I would take them somewhere where they could continue to propagate their species. I’m always impressed with the various ways that nature has evolved to seize any opportunity to survive. In this case, these stalks of grass ended up in the trash, but their heroic effort was duly noted and appreciated.
rlp
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More Insurance Stuff
Yeah yeah, I know, I'm talking about insurance again. But I got a couple of emails that interested me, and I wanted to respond to them. One of them was pretty funny, I thought. Well, mean and funny.
Oh, I tried to keep this to my traditional 6 minutes. I went over a bit. Not that much.
rlp
Oh yeah, I didn't write about this, but Humana messed up AGAIN. This time canceling only Shelby's insurance. Another "show up at the pharmacy and be embarrassed when they announce that your insurance has been cancelled" episode followed by angry phone calls, etc. We pay one premium as a family, so you'd think it would be all or nothing. No, just Shelby was cancelled. Another round of phone calls got her reinstated.
Do you think they just hope to wear people down?
Insurance Insanity
More insurance insanity. I don’t know if anyone is interested in what I’m writing. It’s all I can think about today. Maybe it’s a good case study. Our insurance situation is so complex that I can’t explain it fully here. The short version is that my wife no longer has a job, so we’ve been using the COBRA law to keep our health insurance with Humana, the insurance company used by her former employer. The COBRA law says that you must be allowed to keep your insurance for 18 months after you leave a job or lose a job.
At one point it seemed that I was going to have to leave Humana and lose my mental health benefits. That’s when I told you that I was trying to figure out how to buy Wellbutrin, the drug I take for depression, online.
This is one of the hard things about trying to figure out insurance. Things change all the time. Jeanene had to break away from our family plan because she needed some yearly examinations. We were worried that if the doctors found anything, she wouldn’t be able to get insurance later, when we have to leave Humana. Technically that’s true for all of us. However, my middle daughter has no other option but to remain with Humana until that coverage runs out. We’ve decided it makes better sense for me to stay on that plan with her and the other two girls. So I’ll have mental health benefits for another year or so. That means I can buy Wellbutrin with a reasonable co-payment.
Now there has been a colossal SNAFU with our insurance company. When Jeanene left Humana in March, they mistakenly cancelled the policy for our entire family. No one told us. We got no cancellation notice. I went to the pharmacy to pick up my prescription two weeks ago and was told that my insurance had been cancelled. I knew a mistake had been made because we’ve never been late with a payment.
I Need Some Help Scoring Some Drugs - Seriously
I need some help from anyone out there who knows about buying drugs online. Here’s the situation:
Some months ago I wrote about our situation with health insurance. My wife left her job, and we foolishly thought we’d be able to get insurance. After all, we felt like we were pretty healthy people.
That’s when we found out the truth. If you work for a company with group insurance, you’ve got it made. As long as you stay employed and insured, the insurance companies have to cover you, even if you have pre-existing conditions. If you lose your job you have something like 60 days to find another one with insurance benefits and jump onto their group policy. That new policy must cover you and your family with all of your pre-existing conditions.
However, people who are self employed, disabled, unemployed, laid off, or work for a company without health care benefits are on their own. Being on your own is not a good thing. You’re at the mercy of the insurance companies. They can turn you down for any reason or limit your coverage if they even suspect you might have a health issue.
And believe me, they will call your doctor and found out everything. The people you deal with when you try to get individual health insurance are paid to find reasons to turn you down. That’s their job.
Unfortunately, every company we contacted turned down me and our middle daughter Shelby. Me because I take Wellbutrin. Shelby because she had some emotional troubles and spent some days in a psych unit in 2007. She was diagnosed with bi-polar disorder and put on medication. She’s done wonderfully ever since, and we’re thankful to have had that time at the psych unit. It saved her life. (She’s fine with me telling you this)
In desperation we contacted a health insurance specialist who explained things to us. “Shelby is uninsurable,” he said. “Forget about her. She’ll never get health insurance.”
“Can’t she get some kind of insurance that wouldn’t cover her for any mental health issues?”
“Nope. She’s not going to get any insurance of any kind as long as she’s taking her medication.”
“That puts us in a hard place,” I said. “If she stops taking that medicine she’ll fall back into that horrible state that she was in. The medicine helps her.”
“I know it,” he said. “But that’s the way it is. You best just forget about her being able to get insurance. Put it out of your mind. No insurance company will touch her with a ten foot pole. You’ll need to keep her on your wife’s old plan with COBRA until that runs out in 18 months. I know it’s expensive, but after that she’ll be eligible for the Texas pool for the uninsurable. But she has to exhaust every other possibility before they will take her, so keep her on COBRA until they kick you off.”
“As for you, Gordon, I know an insurance company that will probably take you. I’ll have to talk to the underwriter, but I can help her understand your situation. You’re not in counseling, are you?”
“No. I’d like to be. Can’t really afford it now that COBRA insurance costs us like $1000 a month!”
“Thank God for that. If you were taking Wellbutrin AND in counseling, I couldn’t help you. That’s the kiss of death.”
“Yeah, but doesn’t counseling actually help people who are depressed? I mean, isn’t that actually a good way for them to get better?”
“Doesn’t matter. The insurance companies don’t like it. They don’t like the sound of someone in counseling AND on medication. It makes it sound like you’re a high risk person.”
“Do you know I’ve never been in the hospital since I was born? And I’ve only missed two days sick at work in 18 years.”
He didn’t look up from his papers. “That doesn’t matter.”
“Now Gordon, understand that if I can get you covered - IF I can - it won’t be with any mental health benefits. That’s over for you. I think I can get you health insurance, but anything having to do with a psychiatrist or any medications like Wellbutrin, well, you’re going to have to pay for those yourself from now on.”
I swallowed hard. “Okay.”
Here's the part where I could use your help:
Does anyone out there know anything about buying drugs online?
I’m about out of Wellbutrin and will have to purchase my first batch myself. I found out that one month’s supply of Wellbutrin is $475 at our local pharmacy.
Yeah, right. I mean, isn’t that just laughable? It’s a handful of little white pills. How is that $475? I’ll tell you how. The drug companies try to soak the insurance companies for money since the insurance companies have to pay. That in part fuels the insurance companies' fears about getting involved with people like my family. Since they have to pay for all the people with group insurance, they are especially fearful about individuals. Again, you’re fine if you have group insurance with a company, but God help you if you don’t have insurance that covers medication, and you have to pay for it yourself.
You don’t even want to know how much Shelby’s medication would cost us. My gosh, it’s not like these pills are made in outer space and flown in on the Space Shuttle.
I’ve heard that you can buy drugs online at a discount from Canada or wherever. I tried to look online, but I have found that the online drug industry is filled with con-artists, counterfeit drugs, and other illegal activities. But I hear there are some legitimate places.
I have to find a place to get my medication at a reasonable price. Does anyone out there have any experience in negotiating the rather frightening world of online drug sales?
Let me know. I have to figure something out pronto, or else I just stop taking this medication. I can’t tell you how much I’d love to stop, but I backed off of it experimentally a few months ago and it wasn’t a good thing.
Waiting to hear from someone....
rlp
I've written rather extensively about my struggles with depression. I’m unhappy about needing Wellbutrin. I’m even a little embarrassed about it. I feel suspicious about the diagnosis process in general. But I can’t argue with the profound difference it has made in my life. I’m a better husband and father with a little help from Wellbutrin.
You know, three years ago my physician said, “You’ve got a chemical imbalance that is causing you all these emotional and physical problems. Here, take these pills."
I didn’t want to, but I did. And it helped. I don’t know that I would have done anything different, but it would have been nice to have known that by taking those medications, I was putting my ability to get health insurance at risk.
Health Insurance in the U.S. - A Broken System
Maybe you noticed I was gone for a few days. I had some pretty important stuff going on, and I just didn’t have any energy to write. I’m going to tell you what happened to us. I could have written this without so much detail, but I think the details might be important for someone who is in the same situation.
Four days ago Jeanene and I were looking at the real possibility of our entire family being medically uninsured. No insurance of any kind for us or our children. Jeanene quit her job, as I’ve mentioned. After 20 years of chaplaincy, 20 years of being on-call for emergencies, she was through. I could see it in her eyes. Some essential part of Jeanene was gone. Used up. And our children, particularly our middle daughter, really need a parent at home right now.
She had to stop. An opportunity for me to do some blogging work with The Christian Century and The High Calling gave us a chance to let her retire from being a chaplain. We're taking a significant pay cut, so it's risky. And there is no guarantee the blog networks I work with will continue. This was an important decision for us and we agonized over it. But sometimes in life you take a leap of faith. The faith we have is not a faith that God will rescue us physically and make sure that everything is okay. The Creator of the Universe has obviously made peace with the idea of mostly letting things unfold here according to our choices and the natural movement of the planet.
The faith we have comes with believing that it was the right thing for her to leave. The right thing for her health and our family. We felt peace about it. So we held hands and jumped.
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About 6 years ago, when Jeanene was laid off for a period of two years, we called Blue Cross Blue Shield and had health insurance for our entire family in a matter of days. We thought we’d be able to do that again.
We were wrong.





