Sep 212009

There are four of us on my insurance policy.  It’s a good insurance policy, by all accounts.  It’s certainly much better than not having insurance.  Most of the time, anyway.

This whole H1N1 scare, though?  If you’re following all of the CDC best practice guidelines if you think you’re exposed you should go immediately to a clinic and be tested and start on Tamiflu.

The Urgent Care clinic co-pay on our plan is $50.

Tamiflu is not one of the “preferred” drugs under our insurance plan and there is no generic equivalent.  A 10 day regiment of Tamiflu, as a result, is $60 per person.

As such if all four of us were to go and get treated the total cost would be $440 dollars, and I’d only be able to recover half of that from my medical FSA due to the way the laws are written in regards to those accounts (because we are domestic partners and not married K. and J. can not have their expenditures reimbursed from that account).

How many of you have $440 dollars laying around right now without putting it on credit or having to make a decision between paying bills or going to the doctor?  We sure as hell don’t.

This is why our system is broken.  Yes, we have insurance.  We still have to choose between paying bills or going to see the doctor if something unplanned happens.

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  7 Responses to “Yet another Health Insurance Reform factoid”

  1. More insurance joyousness.

    I’ve had full PPO health care coverage since I’ve been working adult jobs. I believe it affords the comfort of knowing I can get myself taken care of just about anywhere I go. And it usually does. But I’ve seen a disturbing trend in even this level of coverage.

    First, most health care plans do not cover weight loss. Not the doctor consults, not the prescribed medication, nothing. Have a heart attack? Sure, you’re covered. Want to NOT HAVE THE HEART ATTACK IN THE FIRST !@#$%-ING PLACE? Oh no, you’re on your own for that.

    Second, wanna quit smoking? Yup, you guessed it, same song and dance. Oh, cancer treatments are covered. But not the way to help you not get it?

    And this is what pisses me off about the disrespectful way the “debate” over health care reform has progressed. Insurance companies aren’t about health care, they’re about taking care of their investors. Without some kind of radical change, this is going to continue until we’re a country of overweight, chain-smoking, flab-bags that the insurance companies can drop because we are to high risk to be covered.

  2. Weight loss and smoking? Are you on crack? These are like the two most self-inflicted things going. Don’t want to smoke? So fucking quit. Yes, it’s that easy. Don’t want to be fat? Change your diet and exercise daily. It’s hardly rocket science.

    If your insurance doesn’t want to pay for that, I can see where they are coming from. Not that I don’t think private health insurance is teh_devil, but I agree with them on this part.

  3. The situation sucks but I’m not sure that the current bill fixes what you outline here?

  4. @Craig
    I don’t think it does either, Craig. Frankly, this bill sucks.

  5. @Stefan
    While I agree with you in theory, Stefan, the fact of the matter is that it just makes sense to promote preventative health care measures from a cost savings perspective. That’s why companies like mine take part in programs that reward you for getting in shape.

  6. One, the purpose of an Insurance COMPANY is NOT to provide healthcare, it is to make profits for its shareholders just as the purpose of GM is NOT to make cars but to make profits for its shareholders. The sooner people realize this, the sooner they see that the current model of “health insurance” makes no sense.
    Two, the purpose of a pharmaceutical COMPANY is NOT to provide safe medicines for patients. See reference to GM above. Anyone who puts any substance in his or her body should understand the benefits and risks of doing so, and realize that nothing in life is risk free.
    Three, how is it that people can believe that everyone is “entitled” to free medical care, but not believe in providing even more basic needs such as food, clothing and housing?
    The medical care system in the US is broken, but the non-sensical proceedings that are currently taking place in Washington will do nothing to fix it. It needs to be rebuild from the bottom up

  7. @Stefan
    ’t want to smoke? So fucking quit. Yes, it’s that easy.

    Actually, for some of us, it’s not. I smoked for 19 years, I started when I was 12. That’s right, 12. I’ve tried multiple times over the last several years to quit, and have always failed until this time. Recent medical research shows that people who started smoking as a teenager actually have altered brain pathways and an altered self-image. Smoking is ingrained into the self-image of the person such that smoking is what feels ‘normal’ to the brain, and not smoking feels ‘wrong.’

    This time the only difference from my previous attempts was a medication called Chantix, which I have responded very well to. The catch? My insurance company would not cover it, even with my doctor’s endorsement and the fact that I have asthma. My husband and I are paying $135 out of pocket each month. The normal run of Chantix for a individual who started smoking as an adult is 2-3 months. For an individual who started smoking as a teenager, my doctor recommends 4-6 months. I’m on month three.

    I still have an extremely difficult time with not smoking. But, the medication has helped sufficiently that I am able to control it. The medication, in combination with my support structure and my steadily improving health are what’s making the difference this time around. I actually believe that when I go off of it at the end of the year, I will actually be able to stay off of cigarettes. Why my insurance company will not pay for a medication that is indicated by my health and doctor is a mystery I’m still trying to figure out.

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