This Might Hurt a Little

Like many of you, health care has been on my mind lately. Mostly because these past four months since my knee surgery has been the first period when I've needed my health care insurance for something other than a routine checkup. After the surgeon grafted a new ACL from my own hamstring and sewed me back up, I was given crutches, a brace, an ice compressing machine, and passive motion machine to use. I was worried about the hospital bill and all the other add-ups. I had no idea if I would be able to pay the bill and didn't know what was covered and what wasn't. Not for the lack of trying to find out beforehand, mind you. The doc had warned me about my provider, United, as being known not to cover all the hardware if I had the surgery done in a much more economical surgery center versus a hospital. United only covers two pins used to hold the ligament in place and my doc used three, but only if the procedure is done in a surgery center instead of a hospital. Huh? I tried to call up and confirm some of these things with my insurer prior to the surgery so I could make a decision where to have my operation, but after being put on hold for numerous hours, not getting straight answers, and getting different answers from different people, well, I'm sure you know the rest. It seems like everyone has a similar experience.

That's the problem. Everyone has a story to tell about their insurance, or lack thereof. It's never simple. Don't get me wrong, it's first and foremost, absolutely horrible that we as a country don't provide free health insurance to the folks that need it and can't afford it. But it's just as incomprehensible that I have paid for insurance all my life and rarely need it, and then when I do, to not be fully covered. It's "we cover this but not that" or "that's a pre-existing condition" or "that's not proven to help given a 100 year study on wounded butterflies" or some bullshit.

For me, I rolled the dice and told my doc I wanted to have my surgery done in the hospital because then my hardware would be covered. I wasn't sure about the deductible. The agents on the phone told me I would have to pay 10% of the bill no matter where I had it done. What's 10% of the pricey hospital bill versus 10% of the surgery center plus the cost of the pins? Why was I put in such a position to try and figure out what game to play with my insurance company in the first place? It's crazy, I tell you.

In the end, I got a bill for $82.42 because I'd already reached my max out of pocket for the year, or at least that's what I think. I'm very fortunate. I paid that bill, like the day after I got it, for fear that it is a mistake and someone will discover it and send me another.

However... now my PT office has told me that United is refusing to pay for any more physical therapy appointments. Evidently, 20 PT visits is all you need to recover from having your hamstring hacked off and placed in your knee. But that's per calendar year, so if I can just put my recovery on hold for three weeks, then I can continue PT in 2010. People, keep this in mind - if you're going to injure yourself, do it towards the end of the year. That makes total sense, doesn't it?

How in the world did health care get so screwed up in this country in the first place?

While on vacation last week in the Domincan Republic, SV and I were riding in a van to dive site with a German guy who works for Procter & Gamble and spoke very good English. So I asked him what it's like to have universal health care. He had nothing but good things to say about it other than the "old way" of thinking in Germany is still present in that they charge a married man based on his income, not a married woman, no matter who makes more money. I asked him if he thought Obama was a socialist for trying to invoke such a plan and he laughed. He asked me why so many Americans were so against it and I apologized for not having a good answer. He asked me to confirm, "You have free school systems, right?"

Right, I said. Point taken.