Monday, June 11, 2007

Tag!

Thank you, Anne, for including me in your list of Thinking Bloggers. Thinking – and especially writing to make others think – doesn't feel like my strong suit, so the fact that I've landed on such a list is high praise.

What this means is that I get to pick five blogs that make me think, and they get to pick five and they get to pick five and before you know it we've all read every blog on the internets. Hmmmm. I think that means we spend too much time on our asses in front of the computer.

At any rate, there are rules associated with this honor:

  • If, and only if, you get tagged, write a post with links to 5 blogs that make you think.
  • Link to this post so that people can easily find the exact origin of the meme.

I'm reluctant to choose more food-or-fitness related blogs. Since I'm a knitter, I'll head out in that direction and see where I end up. My 5 tagged thinking blogs are:

Okay, Hungry for Hunger is sort of about food. But he's such a great writer. And the last one's not a blog. But it should make you think about the sad, sorry state of health care in this country.

I don't talk politics much here. Knitting and lard-busting seem to take up all of my available blogging time. But if you've ever checked out my links over there on the right, you'll have noticed Physicians for a National Health Program and Mountain State PNHP [West Virginia's chapter of the national organization].

Mr. Shrinking Knitter was out walking yesterday and stopped to visit with our 93-year-old neighbor. His daughter and her husband were there. The husband has become disabled, so our neighbor's daughter has gone to work in order to provide health insurance for both of them. Her wages cover the premiums; they pay for the rest of their needs with the husband's disability income.

She needs gallbladder surgery, but the insurance company is refusing to pay, citing a "pre-existing condition." Who's providing the health care here, the doctor or the insurance company?

Here's what's worse, though. Our neighbor, who is a WWII veteran and retired from the Army Corps of Engineers, is not eligible for Medicare. Retired government workers do not receive one of this country's "guaranteed" forms of universal health care; they have a different and more expensive form of coverage.

There's just something so wrong about that. I would bet that you all have a horror story or two. I currently have a set of forms from my insurance company, appealing their refusal to pay for my recent annual visit to my gynecologist. According to them, he's not a provider. According to him, he is. And I'm the one who has to spend the time and energy to make the calls and fill out the forms to try to get them to pay. Also? If it turns out he isn't a provider, I have to find a new doctor and cancel the appointments I've made for my mammogram and bone density test. The new doctor will need to see me – that's two gyno appointments in one year, and who knows if insurance will pay for that – to order a new mammogram and bone density test.

The best way to manage one's health in the United States is to never get sick.

Okay, off the soapbox.

Speaking of sick, that's what I was yesterday morning. So I didn't run at all. If you've been here for a while, you know I have IBS. I had a bit of a flare-up yesterday. My IBS is usually the constipation variety, but I've been see-sawing lately and there are no public bathrooms on any of my running routes. I thought it best to stick close to home.

A good rule of thumb, I think, is whether I would have run a race for which I'd already registered. There's no way I could have done that yesterday morning. I'll try a four-miler today.

4 comments:

Elizabeth W said...

Debbi - And you're not even sick! Just trying to stay well. Imagine if you were sick... I spend so much time on my dad's various insurance needs that yesterday we broke down and bought a fancy printer/fax/copier/scanner thing.

I hope to start a 4-miler training course on Saturday!

Hope you have a snake-free week.

Mel said...

Oh how I can relate. I have Marfan Syndrome which is a kind of rare to most Dr.'s connective tissue disorder. I am at risk for aortic dissection basically. On my side of the state you can't find any Dr.'s who have even had a patient like me, I am the educator for anyone who touches me. lol My Heart Dr. sent me to U of M to see a specialist who one day I hope and if neccessary can do my aortic replacement...my insurance didn't auth the visit until several hours after I was seen and they won't auth me to go again because he isn't in network. THERE ARE NO Dr.'s who specialize in my network..what do they expect me to do? So I am in a fight. I thru it into the insurance lap to find me a Dr. in network who meets the same expertise as the specialist I liked and if they do I will go to him/her instead if not..I expect them to give me authorization to who I NEED to see. So as you can see...I know how it goes. lol

Good luck with your insurance hassle.

~Mel

hungry for hunger said...

knitter,

thanks for the shout out.

mel,

ask your insurance company for the, "out-of-network exception criteria," then, take the criteria. Insurance companies often, by state regulation, have to provide, word-for-word, the criteria upon which they base their decisions.

You can then have the performing, out-of-network physician write a letter tailored to the criteria.

Also, suggest that someone at the dr's office or even the insurance company refer to volume statistics. Physicians who perform a procedure more often than others (unsurprisingly) have a higher success rate. Often, these volume statistics are public domain (though not necessarily easy to find, as physicians don't want to advertise if they stink at something).

So your performing physician is requesting an "out-of-network exception." Additionally, someone in-network might need to write a letter as well (your pcp, or a specialist), stating that you need to go out of network for this procedure. Same thing applies. Have that physician address the out-of-network criteria verbatim, as in a bulleted list (no form letters), and send in a letter.

kathleen said...

Thank you for including me in your list.

Do I have to do something now????