Thursday, August 15, 2013

Obamacare and Me

I have health insurance. I probably wouldn't have health insurance were it not for the Affordable Care Act.

My room-and-board bill after eleven days in the hospital back in January, 2011, was $145,000. That's for the bed and the sheets and the cleaning staff and the food and the aides and the nurses.  It doesn't include any of the tests, procedures, materials, surgeries, anesthesia, physicians, therapists, or consultations. It cost that much for me to sleep there... though I didn't do much sleeping, if the truth be told.

I was lucky.  My costs were covered by several government programs which come into play when you are shot standing ten feet from your Congresswoman.  That's called "participation in a federally protected activity" and interfering with my participation in that activity is the reason the shooter is spending twenty of his 140-years-after-his-seven-life-sentences in a Federal penitentiary.  Getting shot is never a good idea.  If it's going to happen to you, though, I suggest standing near a Congressperson.  The benefits are awesome.

The Victim Witness Compensation Fund and others have covered most of my care.  I am lucky enough to be able to front the cash and be reimbursed.  We're into five figures for 2013... the third year of my recovery... and there's no end in sight.

My policy with Blue Cross/Blue Shield of Arizona doesn't cover much in the way of therapy. It's not interested in Pilates (the single most effective modality I've found) nor massage, even when the physiatrist states that I have tissue issues which are treated best with myofascial release. I can do it at home, with a foam roller, but LouAnn at Precision Touch Therapy, has magic fingers and amazing strength and I walk better after every session.  I'm covering the costs myself.

Still, my mammogram was covered and my so was my gynecologist appointment.  I can see a family physician and Blue Cross will cover all but the co-pay. I wouldn't have those benefits were it not for the ACA.  I'd maxed out my lifetime limits by February, 2011.  I would be among the uninsured... the uninsurable... the oh-I-hope-I-don't-get-sick populace.

G'ma received a check from her long-term care policy provider.  They had not spent enough on patient care and education in 2012; her refund is their acknowledgment that they must do better, or charge her less.  TBG and I received a similar - and much larger - check from BC/BS/AZ last year. One has not yet arrived in 2013; perhaps the company is spending more of my (exorbitant) premiums on care than advertising or CEO salaries and we won't be receiving one at all.  That would be fine with me.  I don't mind paying for something if it does some good.  I like knowing that someone is watching out for my dollars, even if it is some anonymous bureaucrat in Washington, D.C.  I'll take whatever help I can get.

There are still issues.  Hospital bills are inexplicable.  Could G'ma's Operating Room Services really cost exactly $14,300?  Did she spend exactly $2,210 on Supplies-Sterile? I can understand that the Occupational Therapy cost $467; the therapist (who I don't remember seeing and about whose charge I must call) might well earn an exact dollar amount, without any cents at all.  But supplies? Drugs-General are listed at $773.20 and $780.80 and the Drugs IV Solutions cost $25.85.  I refuse to believe that there what she used added up to a round number.

Not that there is anything I can do about it.  There is no way to determine which supplies she used, nor how much they cost. Did they charge her for the incontinence pads on her bed?  If so, I wish I had taken the ones which were in the open baggie at the foot of her bed.  They were hers, after all. She paid for them.  I have the bill to prove it.

This is not a rant about skyrocketing hospital costs, so I will move on.

Today's mail brought a questionnaire.  The Affordable Care Act wants us to evaluate the first home care agency. I can tell someone how they left us in the lurch, discharging G'ma with no follow up plan.  I can report the fact that they left us in the dark about required medical follow-up and that they were unresponsive to my inquiries. I wrote to the company itself, but this is going further up-stream.  As the letter accompanying the questions noted, these results will be compiled and promulgated so that consumers can rate an agency's performance before becoming a client. I can't imagine that we were the only people who were disappointed in this way.  It would have been nice to have access to that kind of report when I was setting up the plan.  In the future, I will.

The hospital sent a list of comparative pricing structures at similar facilities in our area.  The physician's office sent an evaluative piece, as well. We are making our voices heard and we are being given answers.  It's not enough.  There are wrinkles. It's not perfect.  But, I have health care and, for the moment, that satisfies me.

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