Wednesday, January 21, 2009

The Hidden Costs of (Mis)managed Care

Being that it's January -- new year's resolutions and all that -- I had decided to do what our culture urges us to do at this time of year: make some health improving resolution. And I did. I got a physical from a new doctor since my dear doctor died. I started a walking program. Shifted some things in my usual eating. You know -- all the usual health and fitness resolutions.

But instead of focusing on my health as I had planned to do, I spent more than 17.5 hours in the first ten days of the new year on the phone fighting with our health insurance over getting one of Sweet M's prescriptions filled.

It wasn't a new medication -- she's taken this medication since early December 2008 when she was diagnosed with reflux. Her doctor chose it because it was *on* the insurance company's formulary -- it was an approved, preferred medication.

But come January 1, the insurance company came up with a new Rx plan with a new formulary and were denying payment -- the week before she has to take standardized tests that will significantly impact where she'll go to middle school. Since changing meds can change her functioning, changes are not a great idea, but they're an especially bad idea this week.

I'd just buy her the medication, but frankly, we're about as short on greenbacks as this weathered tree is.

So I was on it. Making sure they approved her medication -- no substitutions.

Ultimately I got them to capitulate, after the aforementioned 17.5 hours on the phone. Yes, I was counting. And that was 17.5 hours when I wasn't taking care of my health -- wasn't getting in those 10,000 steps folks think we should all fit into our day, wasn't planning healthy meals, wasn't cooking or meditating or doing strength training. And, of course, I wasn't doing the work that I am paid to do.

My health insurance provider professes to want to encourage members to take better care of themselves -- they call it 360° Health. The even trademarked that name. They're very committed to our health and well-being, or so their website with the smiling folks would suggest. The theory is that if I were to get in better shape, they'd likely have to spend less money on me overall -- over a lifetime. Or at least that is what their actuary tables say.

The way I figure it, when the health insurance company wastes our time and creates undue stress in our lives to save a buck here and fifty cents there, they're actually costing us all. Looking at things this way is called real-cost accounting, though most companies would never bother to look at such a complete picture because the costs don't fall to them directly -- they don't appear on quarterly P & L statements. Instead these are the costs that we bear invisibly: in lost work time, and in stress-related illnesses as our blood pressure rises, or our backs go out, or our knees buckle under the weight of all that we bear. Insurance companies can ignore what they cost us, how they wear us out and wear us down.

But we could fix that. We could start invoicing insurance companies for the hours that we waste on the phone with them disputing their arbitrary and capricious denial of claims and those absurdly low limits for putatively "reasonable and customer professional charges." We'd bill them for the time we spend punching in our ID numbers over and over again, listening to the treacly muzak while we're on hold, being transferred from one disempowered customer service rep to another. Bury them in invoices for all the hours they've cost all of us, for all the ways that they are destroying the health of our country and its citizens.

I would love to see this happen.

But activist reverie aside, how do you -- other autism parents -- find ways to take care of yourselves and your kids? How do you strike a balance? How do you stay resolute not only about your child's health and well-being, but about your own?

Photo: Courtesy by Oruwu: Used courtesy of a Creative Commons Attribution/Non-Commercial Use License.


Anonymous said...

this is the theme of my life! i just read another post asking the same question.

first of all, so nice to see you!

second of all, wow, you are my superhero now. 17.5 hours on the phone. shit. that is unbelievable. i could throw my chair through the window at how mad those sort of situations make me, how disempowered we, the consumer, are. but you! you did it!

good luck with Sweet M's testing for middle school. middle school? really? can it be?

balance. hmm. not there yet but moving in that direction. baby steps.

MothersVox said...

Hey Kyra, It's so nice to be back. And so nice of *you* to drop in to my very slow blog. I was in mourning over my dear doc and my aunt and over all the pressures over finding Sweet M a good place to go to school. Seems like that last battle is never-ending, but I guess someday she'll be done with school and then we'll have some similar battle over work placement. Oye. Anyway, as you say, babysteps.

Where was the other post? I would like to read that?

m said...

to me, it always seems like insurance companies are operating with a black market mindset. arbitrary, inconsistent, cruel pricing practices. it's a nightmare.

"We could start invoicing insurance companies for the hours that we waste on the phone"

such a perfect idea. it's generally so hard to have any sort of leverage with these guys...your plan would be a nice remedy for that.

hope you and your sweet one are well.

Club 166 said...

...We could start invoicing insurance companies for the hours that we waste on the phone with them ...

That one line made the whole post. I laughed until I cried.

Good luck with that.

Glad that you finally got them to say "uncle". My wife called the insurance company about six months ago because they sent us a check for too much money. Per there instructions, she kept the check, but did not cash it. They then proceeded to subtract the overpayed amount from subsequent benefits, even though we never cashed the check. She called again, and spent several days on the phone with them, starting with a surly clerk who said it was our fault for not sending the check in, and saying there was nothing she could do. She also refused to direct her to a supervisor. After several more calls we think she's gotten it straightened out, but who knows.

As bad as things are, though, they will only get worse if all health care is centralized under the government.


Anonymous said...

Dear Mothersvox,
at first sorry for this silly nick - I don´t want to stay Anonymous, but I don´t have an Google account and frankly I am not able to go through another registration at the moment. I just wanted to react to your last post as it reminds me of our own situation. In our country it is different - the health insurance companies are all government-owned and strictly regulated so we have so-called "free-of-charge" health care (it is not free of charge at all that but it seems like that and it is probably less heartless than the US-system) but I have had several similar battles with various other kinds of bureaucracy. You see, if you have an ASD child in our country and you need any kind of special care for them, you are in charge of three different government departments with their attached bureaucratic mazes. Department of health - my child is pretty healthy otherwise but he needs regular reports from the neurologist, psychiatrist and clinical psychologue - their reports influence the other areas. For the personal assistant, special activities, social training etc. we need a payment from the Ministry of Social Affairs to that we have to explain and prove over and over that the child really needs them. And for the teachers aide who is vital for us we need co-operation of the Department of Education which is my favourite - your 17,5 hours on the phone are like something from my experience. Then there are some therapies which either belong to the competence of the Department of Education /in this case we pay for them/, or Department of Health /in this case they are paid by the health insurance company/ but nobody is sure how it is... I congratulate to you for your successful battle with the insurance company. And Happy New Year.
Ridwen = Anonymous from the Czech Republic