Wednesday, October 06, 2010

The Benefits Dance

It's open season on benefits plans here at NWU. I think it's the same at a lot of places: you get the month of October to change plans or whatever, and then it takes effect in January, and no switching in between.

Yes, we're lucky to have benefits. I was talking the other day with a colleague who hasn't had benefits for some years and now does, and what a difference it makes when you get something such as a urinary infection. The thing about urinary tract infections, at least in my limited experience, is that once you've had one, you're pretty sure what it is the next time you have one. You may even know what medicine you took to cure it. But Shakespeare doctors are useless about this sort of thing, and even if my colleague was sure enough that it was a urinary infection, and sure enough that a given medicine had cured her before, without insurance, she'd have to pay $150* up front to get an appointment with another sort of doctor and then get the $4 prescription at whichever store has the cheap prescriptions in your town.

Of course, it's not the $150 up front to get an official diagnosis and prescription that makes uninsured people wake up in the night in a cold sweat; it's the possibility that it wouldn't be $150, which you might have in savings or be able to borrow from friends, but $15,000 which you don't have in savings and couldn't borrow easily (because if you don't have health insurance, it probably has something to do with not having a "regular" job that gives benefits).

Anyway, it's open season here.

I have to admit, I know diddly about health insurance and medical stuff. I know a fair bit about Shakespeare, but useful stuff? Not so much. Let me give you an example:

When I came here, I asked around a little and chose a health insurance plan that some other people had and didn't hate too much. Five years later, I thought I might be ill and asked around to get suggestions about a primary care doctor. Then I took the list, checked which places were listed in my insurance handbook thingy, and called around to find if one of the people recommended by my friends and on the list was actually taking new patients.

Receptionist: Hello, [Clinic Name], How may I help you?

Me: Hi, I'm looking for a primary care doctor and wondering if Dr [Name] is accepting new patients, please?

Receptionist: No, I'm sorry, Dr [Name] isn't accepting new patients.

Me: Okay, thank you. [click]

About half the people were at one clinic, and most of the others at another, but I hadn't quite figured out that I was calling one or the other clinic again and again until the poor receptionist at one of them stopped me and offered to just tell me which doctors at that clinic there were taking new patients. I felt stupid. I also didn't realize that almost no one was taking new patients. (And that made me wonder if it meant something bad that someone was taking new patients when almost no one was, but there wasn't much I could do about that.)

But I got my appointment, and after waiting two months for the actual appointment, I learned that I wasn't actually ill. And that was good.

Then, a couple of years later, the insurance I'd chosen decided that not only did it not want to do business with the clinic I'd been to, but it didn't want to do business with anyone in my area. Bye.

I signed up with another, a cooperative one.

The next year, the cooperative one sent around a thing saying that while previously you could be referred to one place out of state if you got really sick and needed more scary care, now you couldn't go there, but would be referred somewhere else. The thing is, the old referral place was one of those places that people who have a lot of choices choose if they get really sick. The other place isn't. The other place may be perfectly good for whatever gets you, but it doesn't have a good reputation around here. Who knows whether that reputation is deserved? I hope I never do. (Neither is close to here, which has really messed up more than one friend who got ill.)

So that year, I switched to another, one associated with the big place (which the clinic is also associated with), but one that was being newly offered in our area.

And this year, that insurance company has decided that it won't do business with the local clinic, even though it's affiliated with its affiliate.

And so I'm going to change back to the cooperative one, and hope I don't get sick and sent to the scarier big hospital. On the other hand, in the middle of the year, my dentist signed up with the cooperative so I'll have some dental coverage. (Before, I could have gone to the one dentist in town who was with the cooperative, but he didn't have a very good reputation. My dentist was highly recommended to me by several friends and seems very kind and humane.)

And the thing about all these recommendations: I'm basically flying blind. I have no idea that my dentist is really any good. He seems nice enough. My teeth feel nice after the hygenist has cleaned them. But until I need a cavity filled or something else, well, how do I know? I suppose I might figure out gross incompetence, the sort where he looks at your toes instead of your teeth, but minimal versus strong competence? Not a chance.

The same goes for the doctor. She's licensed and manages to keep a job. She seems pleasant enough, and hasn't made me think she's grossly incompetent. But how the hell would I know?

And the same goes for the insurance company. There's never a problem with just really basic stuff, I'm guessing. It's if I get totally sick that they're going to want to deny every claim I try to make.

So I just filled out the benefits change form to change back to the cooperative. (Do you know, in my state, you can now count domestic partners as dependents, but you have to pay taxes on the benefits and attach all sorts of legal paperwork to prove that you're partners. You don't have to pay taxes OR attach any paperwork to prove that you're married.)

I wonder what news they'll have for me next year?

* $150 is a random number. I have NO idea how much it costs to walk into a clinic and get seen and diagnosed for something like a urinary tract infection. Anyone have any ideas? (I just looked on the web sites for a couple of the local clinics, and no one has any pricing information. I guess you'd have to ask before you made an appointment if you didn't have insurance?)


  1. $150 might be a pretty accurate number for someone going to a doctor's office for the first time, receiving an examination - and in your example of suspected urinary tract infection - having an urinalysis and/or other blood work done. I just got a bill for >$465.00 for my son - "well-child" check, various in-office tests and required vaccinations. And that's with insurance (because our deductible is $2K for the family). If you have the choice, a flexible spending account - where you can pay things like deductibles or co-pays with pre-tax dollars - can be very helpful.

    But your observation that you're flying blind when choosing a new plan is on-target; sometimes even physicians don't know what the vagarities of the insurance companies will be - and they can change without warning.

    Make sure that you have major medical issues covered, and that there's no arbitrary "lifetime cap" assigned to various diagnoses (one million dollars seems like a lot, but a couple months in an ICU or a bone marrow transplant will eat that up in a hurry). And trust your gut - if your new doctor isn't right for you, you'll know.

    Sorry to take up so much time and space! Hope all is well -

  2. Planned Parenthood does diagnostics for basic heath problems (men and women) and is reasonable about costs (from what I understand). It's an option for people without heath insurance that gets very little press because they also do abortions.

  3. Ugh, don't get me started on this... the last time our insurance provider here changed, I had to sit down with the paperwork and figure out what level of benefits we wanted, and after a couple of hours of studying how much we had to pay and how little we got for it and how impossible it was to fully understand, I just sat in the middle of the floor surrounded by folders and sobbed. (And I'm not normally intimidated by paperwork.) Now I have to decide if we should get supplementary AFLAC for my husband's dental issues, and I'm afraid it's going to be more of the same...

  4. I moved here recently, and so have been slowly putting together a list of doctors. But I think it's very hit or miss: I like this doctor, so that is good. Is she the best? I don't know. And, as with education, what "the best" means is not clear. Ditto my dentist. He cleans my teeth.

    So yes, it's very much, how the hell would I know?