When I was 57, I didn’t have health insurance. I was healthy and I didn’t worry about insurance. One day I was working on my roof when suddenly I felt strange. I knew something was wrong with my heart. I dropped my tools and went inside my house and lay down. After an hour I felt no better, so I drove to the local hospital. Doctors diagnosed a dangerous heart rhythm called atrial fibrillation (a-fib). After spending a few hours on meds in the ER my heart was still in a-fib, so the ER doctor admitted me to the hospital. Untreated, a-fib can cause a stroke.
I spent the night hooked to an IV. The next morning my heart’s rhythm converted to a normal sinus rhythm and the meds were discontinued. My doctor kept me one more day for observation; she said she needed to make sure my heart was stable before I was released. That little adventure happened in 2004 and cost me almost ten thousand dollars. The hospital room cost a thousand bucks. The ER physicians sent me a bill. There were lab tests: chest X-ray, echocardiogram, blood tests. And there were specialists who analyzed the tests. For weeks afterward, every few days a new medical bill appeared in my mailbox. If the same thing happened to me today it would probably cost twenty thousand dollars. I put it on a credit card and I paid every penny of that debt.
I was talking to a friend who works at a hospital. She says her hospital gets a lot of low income people without health insurance. They come to the emergency room and complain that they have a headache, or their stomach hurts, or they sprained their ankle. Sometimes they call an ambulance to take them to the hospital. A lot of these people are regular visitors to the emergency room. My friend says, “They come in with a minor complaint and when we pull their record, it’s a stack of x-rays and CT images and lab tests this high.” Here she puts one hand three feet above the other, and says, “And that’s just the last ten years of records we keep! We look at their chart and find out they got a CT scan just last month and there was nothing wrong, the CT revealed nothing. But the doctor orders another CT scan.”
Who pays for this? Does Medicaid pay for it? Meaning, do our tax dollars pay for it? Does the hospital recoup its losses by charging everyone who pays their bill an even greater amount? Do insurance companies pass these higher bills onto employers and individuals by increasing their health insurance premiums? Somebody pays for all these services, and I’m pretty sure it’s not the low income people coming to the ER. I’m pretty sure it’s all the rest of us that pay. You may say, “I don’t pay because I never go to the doctor.” But the food you buy, the automobile you buy … everything you buy costs more. Because the people who grow the food or assemble the auto, if they have health insurance, are now more expensive workers. So the price of what they grow or make goes up.
Around the time I had my a-fib attack, I had to hire a plumber. I told him about my hospital adventure. Then he told me his story. He didn’t have health insurance, either. One day he became ill and had to enter the hospital. He had an unknown virus. The doctors gave him supportive therapy: an IV to keep him nourished and hydrated and maybe some meds. He lay in a hospital bed for three days and his bill came to thirty-five thousand dollars.
I started thinking what would happen if I was in a bad accident or had a serious illness and had to spend weeks in the hospital and perhaps have surgery, too. What would my medical bill look like? I realized it could easily be hundreds of thousands of dollars. There’s a reason many health insurance plans limit their lifetime benefits to a million dollars. It’s because a lot of people hit that million dollar mark and keep going.
After my trip to the hospital I decided it would be a good idea to have health insurance. So I set about trying to buy some. I applied to company A, to company B, to company C. No one wanted my business. I had pre-existing conditions. I had been in the hospital within the past year. My blood lipids were marginally high. One agent simply told me the truth, “I can’t write you a policy. No one can. You’re too old.”
In Virginia there is a law that says Anthem (Blue Cross Blue Shield) is insurer of last resort. Anthem has to offer everyone who applies some kind of health insurance product. So Anthem, after denying me a regular policy, offered me a plan in their high risk pool. It was expensive; Anthem had a market without competition. No other company had to offer me a policy. And it offered poor coverage. The insurance plan they offered me didn’t even meet Virginia’s minimum requirements for health insurance. But the lawmakers had given Anthem a loophole: Anthem’s health insurance plan did not have to meet the law’s minimum requirements as long as the company revealed to me that it didn’t.
My health insurance plan has a five thousand dollar deductible. At first the premiums were $443/month but they increased every year. After five years, the monthly premium is $927/month. Because of the high deductible, Anthem has never paid a penny of any medical bill of mine. On the other hand, over the last five years I have paid Anthem $46,119.
One time I had to go to the local hospital to get a CT scan. I presented my Anthem card, and I was told the scan would cost $1800 and that I had to pay half up front before I could get the scan. I felt like a second-class citizen, and in terms of health insurance I was. People with Medicaid breezed past that obstacle, while I got pulled aside to hear the words, “Show us the money.” I put away my Anthem card and pulled out the card they really wanted: my credit card. I paid the $900 down payment and got my scan, and then I went home and waited for the bill to arrive.
A final note about that CT incident: the hospital informed me that if I had not had insurance the scan would have cost just under $6000. You see, if you have no insurance your medical bills are much larger. If you have private insurance the bills are smaller. If you have Medicare or Medicaid and the hospital or doctor accepts it, the bills are even smaller.
To that ten thousand dollar hospital bill I mentioned earlier, add 5 years of doctor visits with the normal bumps in the road that happen as one gets older (CT, an ultrasound, blood work, meds) and I’m out-of-pocket $18,000 for health care. Add that to my Anthem premiums and I’ve spent about $64,000 on medical bills during the last five years. I had planned on replacing my 16 year old Jeep by now, but that’s just a nice dream.
What is Anthem like as an insurance provider? Near the end of the 12 month period during which they don’t cover pre-existing conditions, I went to my doctor. I had several things to discuss with her but the one she coded as primary was a condition that was pre-existing. (I hadn’t gone to her about that issue, I merely took the opportunity of being in her office to ask a question.) Anthem didn’t cover the visit because to Anthem it was for a pre-existing condition. I wrote Anthem a letter to point out that my doctor visit had been just a few days from the end of the 12 month exclusionary period, and I asked if they could give me a break and cover the visit. I would still be paying 100% of the bill and they would still be paying nothing. But if they covered it, I would pay less. They refused to cover the visit. Technically, they didn’t have to cover it. But it would have made for good customer relations. Especially as Anthem had just given their then-CEO, Larry Glasscock, a $42.5 million dollar cash-and-stock bonus.
Having Anthem high-risk insurance has taught me one thing, though. If I can handle a $927/month Anthem premium while paying 100% of my medical bills, I think I can handle a $110/month Medicare premium and a 20% co-pay.
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