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.