Monday, October 13, 2008

Health Insurance

I had kind of figured out over the years that health insurance isn't all that it's cracked up to be. First, you meet your out-of-pocket. Then you move into co-insurance mode, on top of a per visit fee. Then you reach the almighty max-out-of-pocket. Sure seems like you could do the math at the beginning of the year, figure out the worst case scenario, and just mail the insurance a check.

But there was always that whopping two million lifetime maximum benefit to fall back on if anything ever went really wrong.


Benefits are limited to what the insurance company deems to be customary and usual, not what they actually cost. And every visit incurs a visit fee. Many prescriptions are not covered. And all this fun after paying a whopping monthly premium for the family. And my husband is in the healthcare field and our insurance is "provided" by a healthcare company.

So it adds up. Anyone who has ever had to travel deep into health care territory has probably experienced this. Many of you may even have less health care coverage, or none at all. And I am empathizing with you and so many others out there who face the real decisions of giving something else up in order to see a doctor or get medications. Or plain old not being able to afford to seek the care you need. This is really getting me fired up!

Here's my kicker: During my consultation visit at Fred Hutch, we were under the impression that I had good covergae for the transplant. Then one day the phone rings and I learn that I will infact have to write a check if I want the transplant due to the shortfall between my insurance coverage and the actual costs. One super huge blow.

The transplant itself, not including HLA typing, donor search, donor harvest, approx. four months of living expenses in Seattle, a required caregiver, travel to and from Seattle, and some other related expenses, is $379,000. My insurance provides $250,000 for the transplant (or for any transplant, for that matter),which includes an allotted $50,000 towards finding a match, leaving $200,000 for the transplant.

Summary: Transplant costs $379,000. Donor testing and harvest is approximately $50,000 ($30,000 for harvest leaves $20,000 for typing and matching at $3,000/per. Cross your fingers for a quick match). Insurance pays $250,000 total. Since the donor testing and harvest comes first, before I could even leave for Seattle to get a transplant, I have to write a check for a minimum of $179,000. Incredible!

A transplant patient is required to live, with their caregiver, within a very small radius of the hospital and transplant center. The average person, accrording to Fred Hutch, needs at least $3,0000 per month during the four to five month required stay, until you are adequately producing your own marrow and thus your own blood cells. So with the living expenses and miscellaneous expenses not covered, it is suggested that one leaves for Seattle and the transplant with $30,000 in their pocket.


Bottom line: No way around it, I will need approximately $210,000 to obtain a transplant that holds the only possibility of a cure.

Accepting this "your life is worth xxxx dollars" has been one of the hardest emotional hurdles for me. It amazes me how that lifetime maximum seemed such a comfortable amount, BEFORE I learned about different riders and limitations that virtually all policies have. The companies have a way at making sure it is not too obvious that you are living within these limits.

Do you think a person could get a heart transplant for $250,000? A lung transplant? Any transplant? Out from underneath you is pulled the safety net, of knowing if you ever needed them, they would be there. Well, they may show up but they don't play the whole game.

PLEASE learn from this experience! Know what your policy will and won't do for you. Know that when you are really and truly in need of that covergae, its limits may not come near tha actual cost of the treatment you need.

I'm pretty pissed about this too. Here we were thinking we had to raise $30,0000. Huge task but somehow it felt do-able. $210,000......well, that's another story.On the one hand, it wouldn't even take every person in Spokane giving me $1 to raise the money. If only life were so simple.

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