About Healthcare And Insurance

I've been griping about my kidney stones for over a decade. You poor supportive bloggers have only been subjected to my whining since you discovered this blog.

You may be thinking, "Shut up and get your sorry ass to a doctor." In fact, I think the same thing. I scare myself thinking that maybe it isn't stones but kidney cancer or tumors. My mind can run wild.

But the way our healthcare system is set up, the deck is stacked against me.

Some facts:

• I am self employed and carry a personal insurance policy through a major HMO. At the time, I was turned down by several companies because of pre-existing conditions (stones) so I feel fortunate to have a policy at all.
• Over the years, as medical costs have skyrocketed, I've had to choose plans that were less comprehensive so I can afford the premiums. Now I pay $190/month for what is essentially catastrophic coverage. High deductible, minimal coverage.
• Policies carry riders (extra money for known conditions) when you are on a single policy. I finally had my kidney stone rider of 25% dropped a couple years ago precisely by not going to the doctor when I was passing a stone. For corporate policies with many covered, these costs are spread over the pool of insured.
• I had two major lithotripsy surgeries in the 90's. Each, when all the dust was settled, was over $20,000. I don't know how much it would be today.
• At that price, it isn't likely that surgery would be approved unless it was an emergency. When I say "emergency" I mean that kidney damage could result that might cost the HMO even more. They'd rather put you on a liquid drip to force fluids and put you on IV morphine to deal with the pain. Much more cost effective, don't ya think?
• If I go to the doctor, and they say I have kidney stones but there isn't anything more to do at this point, I'm right back where I am now only the insurance company has been alerted that I have kidney problems. That could cause my premiums to go up or, I fear, my policy to be canceled.

Now you can see that I'm between a rock and a hard place. I'm boxed in to getting care only if something tragic happens. It's like being in a car accident. You have to decide if the damage is less than your deductible, or even if it is more, whether you are going to report it to your insurance company because you know your premiums will go up. What may save you $200 in the short term may cost you thousands in the long run.

I continue to believe that these stones are from a year of drinking Diet Coke to lose 25 lbs last year. Oh, the weight is back, and now I've got painful health issues, too. Bah.

And that, dear readers, is why I don't go to a doctor.
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