Who launches a blog but then vanishes for weeks? That would be me. I have a good reason, not to be confused with the Lame Reasons My Sons Try To Get By Me.
The story starts the day I fell in my garage and hit my head. No one was home to help, I couldn’t get up, and I was bleeding like an extra in a bad horror movie. When my family got home an hour later, they ordered paramedic chauffeured transportation for me – first to the emergency room and then to the hospital. After a night in the hospital and a vomit-inducing vertigo treatment, I got to go home. Then it was time to heal from my concussion and build up my courage again to avoid taking another tumble.
So that’s where the story ends, right? Oh no, gentle reader, we’ve only just begun. Just when I thought I was through the worst, I encountered one motherlode of a nightmare.
Health Insurance Issues
I almost made the tagline for this blog Making Mistakes So You Don’t Have To. You’ll understand why after reading the saga of this walking disaster pit. Please learn from my missteps so that you can avoid the same sh–, I mean, stuff that had me spinning in circles for months.
Mistake #1: Not Understanding Your Policy
Let’s go back to Open Enrollment. I thought I had read my options carefully and chosen the most cost-effective policy. I hadn’t read it closely enough. Sure, the monthly premium was smaller than the other option, but you get what you pay for. I’m stuck with a high deductible and out of pocket expenses.
- Do not rush your decision. Think you’ve read the documents thoroughly? Read them again. Then put them away for a day or so and then read them again. Talk it over with someone else, preferably someone smarter than you are.
- Know what it really costs. Don’t be so enamored with a lower premium that you aren’t properly covered for what you need. Otherwise, you’ll spend most of the upcoming year kicking yourself. Painfully.
Mistake #2: Not Knowing Your Network
Which of the following Emergency Rooms would you choose?
a) 2 miles away
b) 12 miles away
c) 14 miles away
If you picked the one that was only two miles away, you made the same mistake I did. I chose A when I should have chosen B.
The closest emergency room was not in my network. When they decided I should be admitted to the hospital, they sent me to their affiliated hospital. Again, it was out of network.
Thank you, limited networks. Yes, that was sarcastic. In the past, you could go to the closest ER, and your insurance would cover your bill. You got admitted to the hospital? That’s covered too. Network, shmetwork.
Now, we can only go to those emergency rooms, hospitals, etc. that your insurance company has included in your plan. For those of us with chronic illnesses, that means trade-offs. My insurance company let me keep my neurologist if I gave up the primary care doctor, urgent care facility, and emergency room located within two miles of out house.
Game shows send you home with lovely parting gifts. If you go to an out of network hospital, prepare for a painful shock when the hospital sends you the bill for your portion of the bill. If you consider a hospital bill a lovely parting gift, then you’ve got bigger problems than insurance choices.
Remember the new rules:
- Stay up to date. My last trip to the ER was back in the olden days when networks included wider options. I didn’t have to think about where I could go because I could go anywhere. Now, only one of the three area hospitals is in my network, and it’s not the one I had gone to before.
- Don’t assume the closest ER is the right one. I live only a few minutes away from an emergency room that is well-known for its high quality treatment, so that’s the one that came to mind. Does my network hospital have a separate ER, or is there just the one at the hospital? Guess I need to find out that answer.
Insurance Is a Big Ugly Wrench Covered in Goo
So, what happens after you’re discharged from the out of network hospital? For me, it started out simple. My insurance company cut me a check to pay for the hospital bill. I deposited the check and waited for the bill to arrive from the hospital.
But my insurance company wasn’t done with me yet. I got a thick envelope with a revised Explanation of Benefits statement and a bill demanding I pay back most of the money. A few days later, I got the hospital bill…for more than the original insurance check.
What could I do? First thing I did was resist the urge to vomit. Next step? Grovel, I mean, apply for financial assistance. I had to fill out tons of paperwork to prove to them what seemed painfully obvious – I couldn’t afford the bill. And of course this whole sh–storm hits in March, when I’m also dealing with that annoying jerk called Taxman. Between the application and taxes, I was spending loads of time on paperwork.
Lesson Learned – Knowledge is Power
I got myself in trouble because of what I didn’t know, and I changed course by putting together needed information. I had to advocate for myself. The only way I could be my best advocate was to put together and maintain information. I’ve also learned that be my best advocate is a much more powerful image than hanging out on a street corner with a tin cup.
When it comes to chronic illness, no one knows more about our illnesses than we do. But there’s so much information that we can’t just pull it together at a moment’s notice. I usually curl up in a fetal position i the corner for awhile before I get someone else to help me up and put on my big girl pants so I can accomplish something.
Think of some of the reasons we need to use our health information:
- Going to the doctor – How will medical providers know how to treat us if we can’t communicate with them? It’s hard enough to translate all that medical jargon already.
- Handling emergencies – In a crisis, you won’t have a chance to pull everything together. I consider it a victory if I’m not dressed like this:
Photo: Amy Sparks
- Filing taxes – If your medical expenses exceed a certain percentage of your income (currently 7.5%), then you’ll be eligible for a tax deduction.
- Applying for disability or other assistance – People won’t just hand you money, even though that would be awesome. You will have to provide excruciating detail to have a chance at funds to which you’re entitled.
- Living our lives – You can take more control over your life if you understand as much as you can. You can identify new or worsening symptoms. You may see patterns of what worsens your symptoms, such as heat exposure. You can even figure out which people who tick you off so badly that you’ll feign a Bad Health Day to avoid meeting them for coffee.
It’s Too Much To Remember!
Yup.
The first step in reinventing our lives with chronic illness will be to take control of the key information in your lives. That’s what we’ll start with here.
- What information do you need to track? There’s more than one correct answer to this question. I’ll give you some suggestions and then you send you on your way to ignore me or not.
- Why do you want to track it? You could spend 24 hours a day tracking if you wanted, but do you really want to do that?
8:00 am – woke up
8:05 am – leave bathroom
8:06 am – thank hubby for coffee and pour a cup
8:10 am – sit down
8:11 am – spill coffee on tracking notebook
You get the idea.
- How are you going to track it? Once you understand why you want to track information, you can figure out the best way to track it. How often will you need to update the information? Does it need to be portable? Do you really want to use 5 phone apps, 3 online sites, and 4 notebooks? Asking for a friend. These are a few of the questions you’ll need to ask as you put together your information.
In my next post, we’ll get started!
