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Is The Public Option Really Dead? September 29, 2009

Posted by Admin in Health Insurance.
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It is up to you. Today, two amendments with the public option failed to make it out of the Senate Finance Committee. You remember the public option, right? As Senator Rockefeller described it, this optional plan would avoid placing profits before the American people. remember, this is a voluntary choice, open to the public. What about the word optional don’t people understand?

Please call your Senators tomorrow-it is not too late.

The public option would provide a public plan as competition for the current plans offered by the insurance companies. It would have the same (or better) benefits at a more affordable price-due in part to lower administrative costs.Why are they afraid of competition? Because this might drive our premium costs down. Right now, if the bill passes with co-ops only, prices will not go down due to the smaller number of people in each plan. With a national plan as a public option, there would be millions of people in the plan, which would be fabulous-lots of healthy people included and the risk from the heavy users will be spread out over a bigger population. This is more complicated that this summary, but let’s face it, as Senator Stabenow just said, “If the current system was actually working, we wouldn’t need change…”

In addition, the insurance companies will currently receive a half trillion dollar subsidy over ten years with Sen. Baucus’ bill, plus millions of new customers. What did they sacrifice to get this? $20 billion, one time. Those are great gambling odds. 25 to 1. I guess all that lobbying money paid off.

To see if your Senator is on the Finance Committee

visit this site or for another perspective,

visit Rock the Vote and watch their video, posted today after the amendments failed to pass.

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If Travel Worked Like Health Care… September 27, 2009

Posted by Admin in Health Insurance, Humor.
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A quick, funny article simulating the travel industry run like our health care system. I just found this on another blog.  Perhaps your legislators should know about this. Could be a great argument for single payer-or at least more centralization.  Isn’t there an industry standards committee, as there is in mobile phones?

Reminds me of the old article called If Microsoft Made Cars...this link has the one I remember.

Branches or Tangled Polymers? September 26, 2009

Posted by Admin in Cancer.
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Spruce Tree

Spruce Tree

Thanks to GINA-Testing Day is Now September 26, 2009

Posted by Admin in Diary, Health Insurance, Women.
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Double Helix

After eleven years of waiting, I have finally submitted my blood for a DNA test. Even now, this was not an easy decision to make. However, in 2008, legislation which limits the opportunities for discrimination in employment and health insurance. http://www.ornl.gov/sci/techresources/Human_Genome/publicat/GINAMay2008.pdf. The law is called GINA-Genetic Information Non-Discrimination Act of 2008. http://rarediseases.info.nih.gov/GARD/GINA/ is also a good source for specifics.

[picapp src=”a/3/2/0/The_Genetic_Information_5235.jpg?adImageId=6139126&imageId=965196″ width=”234″ height=”158″ /]

Title One went into effect this past May and covers discrimination by insurance companies. Title Two goes into effect this November. This one has to do with employment discrimination.
Normally, I love tests. I even took the Foreign Service exam for fun-twice. Since I became a cancer survivor, my attitude towards these tests is different. There isn’t any way to study to do better. Responding to the outcome is always what is at stake. And do you really want to know the answers? One of my friends once told me that she would never do the test for the BRCA gene mutations. I asked why and her response was  that she probably wouldn’t do anything different when she had this new knowledge.  This test is to see if I have the BRCA1 or the BRCA2 gene mutations. These are known as the ”breast cancer genes”. Ironically, the researcher who is the pioneer in this field works at the UW-just down the road.

Her name is Dr. Mary-Claire King. “Mary-Claire King, Ph.D., is American Cancer Society Research Professor of Medicine and Genome Sciences at the University of Washington in Seattle. She was the first to prove that breast cancer is inherited in some families and the characterization of inherited breast cancer remains her primary research focus.” From her  web page

In a couple of weeks, I will know whether I have either one of those mutations or not. My vial of blood is at the only lab in the country which does this work. The reason this test was approved as “medically necessary” is that both I and my maternal grandmother had “early-onset” breast cancer (pre-menopausal). This means that there is a higher chance than normal of my family having this gene mutation but not the highest. The real reason to have this test then, is to eliminate a risk factor; not just for me, but for other family members. What GINA will do for me is not allow my insurance provider to see the results unless I disclose them and also they cannot use the results to deny me coverage.

If I do have the gene, then other decisions will present themselves. One will be to decide on a prophylactic surgery for me. More on that in a couple of weeks.

Section 125 Plans-Are You Covered? September 23, 2009

Posted by Admin in Health Insurance, Money.
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As I consider my annual health expenses, what tools are available to manage them? My employer has the basic Section 125 plan, which allows us to deduct our medical and dental plans from our salaries on a pre-tax basis. Parking and transit expenses are covered too. That is handy especially as I am required to pay for parking. In other words, the funds I spend for those expenses are not taxed as wages. These plans are also commonly used for child care expenses and reimbursement.

In addition, your company can set up a Flexible Spending Account-I believe it’s part of the section 125. If I had this part, then the out-of pocket expenses I have incurred could have been paid  from a pre-tax account. A couple of things-I have to be wiling to set aside the funds throughout the year to cover planned medical and dental expenses, plus I need to make a plan ahead of time as to what expenses I will incur. For me, I would include my deductibles,  enough co-pays to cover my “regular” appointments and maybe an extra $200 to cover $20 of $1000 in “procedures” throughout the year. That would be $680 or $56 per month or $28 per pay period deducted from my pay. Not too bad. When I get reimbursed from my own money-it is for the full amount.

  • Pros: less taxable income and payments deducted throughout the year
  • Cons: reimbursement paperwork can be a hassle and if you don’t use the funds, they are lost for that year. Keeping up with paperwork is essential if you really need the cash flow.
  • Does it cost a lot for the employer to add this to an existing plan?
  • If it was on an iPhone-there’s probably an app for that.

I wish that my employer would add this one on-it would save everyone a little tax money and might increase that warm, fuzzy feeling……or not.

It’s a “Procedure”-Until the Bill Arrives September 22, 2009

Posted by Admin in Cancer, Health Insurance.
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Then it’s surgery! Well, the colonoscopy paperwork arrived today. Total costs before adjustments: $2809 (no biopsies or polyps-that gets it to almost $9000). After provider adjustments $2243.46. My share $402.19. And I’ve already met my deductible, so if that wasn’t the case, make that $602.19.  I am most grateful that only one CPT code will apply to the surgery, I mean procedure.

I also noticed that the lovely, lovely injectable drug cost $70. My last dose of nitrous oxide at the dentist cost $100 and was not delivered through an IV. I would have thought that IV delivery would be more expensive. Especially for a person like me who needs drugs in order to receive drugs!

I’m not saying that it’s too expensive (how would I know?), or not worth it (this I do know), only that this is getting to be an expensive month for me. And I have insurance in a PPO plan where I receive 80% coverage. I know some plans are now 70/30 splits. Would I have been able to find to find a discount or lower cost provider? In theory, there is a “Colonoscopies R’ Us”, in practice would you want to go there?

Total today $402.19

Month to date:$650.68

Out-of-Pocket Day September 21, 2009

Posted by Admin in Diary, Money, Women.
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Today I caught up with the billing department at my local health care provider. I had to pay an outstanding (and by outstanding I do not mean super cool) co-pay from when I got my routine mammogram this summer. (To quote a friend of mine-did you not hear the President-mammograms and colonoscopies should be covered as preventive care!) . I was hoping it was preventative before he was but I was wrong. $20.00 for that one, plus I had to pay the % portion left over from an endometrial biopsy last spring. (Hint on that procedure-ask for drugs. No, really.)

I always wait until the insurance has sorted itself out on these charges.  I don’t really want to pay these bills in full prior to learning what the “adjusted HMO payment” will be. That was $38.15. And the end of the month is still 9 days away!

Total today: $58.15

Month to date: $$248.49


PS How many “routine” mammograms have I had in my life? Let’s see; one a year since the first cancer, plus the years where I had to have one every six months. I’ve probably had more than 30 mammograms. Those of you who have the luxury of waiting until age 40-don’t put them off. If you get started then, you too may live long enough to have more than 30 in your lifetime! By mammogram, I also mean the appointment, not the number of X-rays. Sometimes you get to play in a bonus round. For a fact sheet on breast cancer, visit the National Cancer Institute website.

Just Relax-This Won’t Hurt a Bit September 19, 2009

Posted by Admin in Women.
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This summer I bagged three more departments at my local medical provider, dermatology, orthopedics and gastroenterology. Understand that this was not what I wanted to “do on my summer vacation”.  Plus they were not part of a medical treasure hunt-they were just things that it was time to have looked into (no pun intended). To date, the “life list” includes hematology/oncology, internal medicine, ob-gyn, urology, dermatology, physical therapy, radiology, the MRI department, gynecological oncology, and general surgery. Other trips in the last 6 months included an oral surgeon (also a first this year) and a repeat visit to the endodontist, in addition to the dentist (2 visits).

It’s hard to compare myself to others in my family, because I had cancer very early-so I’ve been a survivor for half my life. This means that I am accustomed to a high level of annual interaction with the health care delivery system. How does this compare with men in my family or younger people I wondered? I found a study called “The Lifetime Distribution of Health Care Costs”, which had two quick clues for me.

One, I am female and two, I am in middle age. (Now, If 60 is the new 30, then I am absolutely not middle aged, and I am younger than Rickey Henderson.)

But I digress. In this 2004 study, the authors found that the  “per capita lifetime expenditure is $316,600, a third higher for females ($361,200) than males ($268,700). Two-fifths of this difference owes to women’s longer life expectancy. Nearly one-third of lifetime expenditures is incurred during middle age, and nearly half during the senior years. For survivors to age 85, more than one-third of their lifetime expenditures will accrue in their remaining years.”  (The Lifetime Distribution…..Alemayehu and Warner, 2004)

So ironically, because cancer did not kill me the first or second time, I will live longer, spend 1/3 more on health care than a similarly aged male and in my middle age I will spend 1/3 of my lifetime health care cost. Plus, with women’s generally lower average lifetime earnings, the health care I pay for  will be a larger percentage of my overall budget.

I am not more relaxed, nor do I feel better, but I am more informed. That’s the current tradeoff.

It’s Payday! TGIF September 18, 2009

Posted by Admin in Diary, Money.
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Half of my monthly premium comes out of each paycheck. My medical, dental and vision coverage (a rare thing, I know) is $43.34 per pay period. The medical portion is for one person. Family members are covered elsewhere.

Total for the week:$ 103.34

Total for Month $190.34

2009 Premiums Paid YTD: 780.18

PS Would I have been better off with a Medical Savings Account? I still prefer Universal Coverage, Guaranteed Acceptance as Gov. Howard Dean called it.

12% Increase and How Much is Too Much September 17, 2009

Posted by Admin in Money.
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Well, I anticipated correctly. Today my company handed out the preliminary notice about open enrollment. This year’s health insurance increase will be 12%. I pay 25% of the monthly cost and the company pays the other 75%. I haven’t seen a 12% raise for a while, have you?

Also, I was at a meeting today where a speaker reminded us that some of our fellow health insurance users might be using too much health care because “well, I already paid for it”. I understand the process that might lead someone to have procedures done that might be available but not always necessary. Would I have not had my colonoscopy if I had to pay a greater share of it? Is that procedure cheaper than having cancer? Probably. Did I research that? Well, no. But I do have previous experience…Did I shop around for the cheapest colonoscopy? Well no. It was hard to even get an estimate and the insurance company wouldn’t even give me the amount that they would reimburse the clinic because they worry that the clinic will then charge that amount. Does my colonoscopy affect the double digit premium increase in the aggregate?

Here’s one reason that I went and did this right away, unlike some people I know who have postponed that procedure to age 52 or 53. I think I wanted to know if I had any risk factors for another type of cancer. I got to hear the physician tell me that no biopsy was needed.  I’ve not heard that a lot. No return procedure for ten years also great news. I agree with President Obama that colonoscopies, like mammograms, should be considered part of preventive care. But I couldn’t afford to wait for the  bill to pass! (No pun intended.)

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