Diabetes Blog Week-The Healthcare Experience

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Most people who live with a chronic illness end up with a lot of experience when it comes to dealing with healthcare. How would you improve or change your healthcare experience? What would you like to see happening during medical visits with your healthcare team? How about when dealing with your health insurance companies? What’s your Healthcare Wish List or Biggest Frustration? Today is the day to share it all!

EEK! This is such a big topic, I don’t even know where to begin! I’ve shared my frustrations with both doctors and insurance companies in the past.  I’m pretty sure I could write a whole book on my frustrations with both doctors and insurance companies.  I would change EVERYTHING! I could write a long list of changes but instead I will focus on one change I would like to see.  I would like to see insurance companies GONE! This is a bit drastic, but let me explain.

I'm not sure who to credit this image but Kerri Sparling at Six Until Me shared it on her Facebook page

I’m not sure who to credit this image but Kerri Sparling at Six Until Me shared it on her Facebook page

I often feel like if we didn’t have health insurance companies, our lives would be much better off.  For starters, we wouldn’t have a health insurance company dictating what brands or companies we can use for our health care.  Diabetes companies might be more incentivized to innovate and/or keep prices down if the competition was stronger because insurance companies weren’t dictating who we could use.

Doctors might also improve their care if it wasn’t for the hassle of health insurance companies.  A friend of mine shared this link and I thought it was such an interesting article.  It’s a little long but it is about how doctors get paid and provides a very interesting analogy to make you think about how messed up the system is now.  The article leads to another good point in that insurance companies have so much paperwork that I’m sure a majority of the costs we pay are just going to overhead and administrative fees and not the actual healthcare that we are being treated for.  Case in point, earlier in the year I had an insurance mishap and had to change plans in February.  I had paid the total amount I owed for February but because it was higher than what I owed in January under the old plan, they refunded me the difference.  Then I guess they realized that I still owed money for the new plan, even though I had paid in full but because of the refund, it looked like I owed the money back so I then had to pay again.  I had to talk to several people to get it straight what had happened.  I had no idea why I was receiving a check nor did I know why they were saying I wasn’t all paid up.  It was so unnecessary.

If we didn’t have insurance companies, we wouldn’t have to waste time calling them up and arguing about coverage.  We wouldn’t need to deal with insurance brokers.  We wouldn’t need to worry about being screwed over.  Doctors wouldn’t need to worry about being screwed over.  Medical supply companies wouldn’t need to worry about being screwed over.  I think its crazy when I receive a claim for a service and it says the doctor’s office charges $200 but the allowable charge is $100 but then I owe $50 for my copay.  Why do doctor’s need to charge the inflated rate?  Because health insurance companies negotiate with the doctor’s offices to get preferable rates.  If there weren’t insurance companies, then maybe a doctor’s office could charge $125 and they would be getting more money and people who don’t have good coverage could pay less, a win-win for all!

With no health insurance, I also wouldn’t be screwed financially every year.  Right now, I have an individual health insurance plan with my husband and son.  We pay a pretty high premium but still have a high deductible and out of pocket max.  For simplicity’s sake, I’m going to generalize my costs.  Say I pay $1,000 per month for my health insurance premium, that is $12,000 a year.  Then let’s say I have a $3,000 deductible, meaning I pay 100% of the costs until I get to $3,000.  With my out of pocket max being $6,000, I could end up paying up to $18,000 per year in health insurance costs.  Unless I am pregnant, I don’t usually reach the out of pocket max so let’s say I pay the $3,000 deductible plus an additional $1,000  in a year.  This still totals $16,000!  If I had just paid for everything myself and not had health insurance, I would be paying less.  If I break down the costs, this is what it might look like:

  • Endocrinologist, quarterly: $100.21 per visit, $400.84 total
  • Medtronic Minimed pump supplies and test strips, quarterly: $1,879.29 each, $7,517.16 total (diabetes is freaking expensive!!)
  • Insulin, quarterly: $1,080.29 each, $4,321.16 total
  • Eye doctor, once a year: $120.81, $120.81 total
  • OB, once a year: $57.66, $57.66 total

Total charges: $12,417.63

$12,000 is a lot cheaper than $18,000.  Now I realize that this won’t always be the case.  This year, for example, I am pregnant.  With the high-risk OB and regular OB visits and more frequent endocrinologist visits, not to mention the delivery, I would be paying a lot more than the $18,000.  Or if something catastrophic happened or even just an ER visit, it would be more beneficial to have health insurance.  But on a normal year, having health insurance isn’t really saving me anything.

I definitely understand the need for catastrophic insurance so that all parties aren’t screwed, either the patient themselves left with a huge bill or the medical practice that provided the service that might never get paid, but on a “normal” basis, insurance companies are just getting in the way of better care.  Granted, I have had a really difficult time with health insurance companies over the last few years so I am extremely biased that they need to be gone.  I don’t want someone dictating what insulin pump I can use!  I don’t want a doctor’s office to give me poorer care because of all the red tape they have to deal with with the insurance companies.  I want to pay for good service and have my health be positively impacted by the care.


9 thoughts on “Diabetes Blog Week-The Healthcare Experience

  1. oh my god, I feel so blessed to live in Australia whenever I read posts like these! I have private health, but only because I want a pump covered and always need a physio haha. I agree with you, scrap those US insurance companies and jump into some universal healthcare! xx

    • I don’t know much about universal healthcare but I was proposing an idea that isn’t very feasible-to get rid of insurance all together, no private or public haha. I don’t want someone telling me what devices or medications I can and can’t have…like Medicare (public healthcare) in the US is telling people they can’t get CGMs, I would be so lost without my CGM!

  2. There’s no question it’s a bad system. Bad for us and for the healthcare industry in general. I don’t know if it’s better or worse for us to be more like consumers, but I know what we have isn’t working so well.

    How were you able to find out the out of pocket costs for your doctor’s visits? We’ve changed insurance a few times, and I’ve always wondered what would happen if I went to a doctor I liked but our new insurance didn’t cover.

    • A couple of ways-through the claims form they say what the billed cost is, what the cost is minus the insurance negotiated discount and then what I owe and also I have gone to the doctor a few times when my insurance didn’t cover a certain doctor and had to pay 100% of the costs

  3. You have definitely been in the trenches of Healthcare USA for quite a few years. Can you imagine if you weren’t somewhat intelligent and educated, and you and your husband employed?

    • Yeah, it’s something I knew would happen when I started working for my husband’s small business but I had no idea just how many headaches we would be dealing with, just in the last few years! I do feel very blessed that we make enough money that we can afford to do this, working for ourselves.

  4. Wow, I’ve read a lot of essays on insurance but I’ve never read about actual costs before. Ditch the insurance companies, otherwise you should definitely consider moving to Australia 🙂

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