Free My Brain From Migraine Pain

Posts Tagged ‘health insurance’

Socialize my Medicine, Please!

September 23rd, 2009

I went to a business lunch & learn presentation today, given by a very nice insurance agent, all about health insurance. He covered the history of health insurance, how we got in the mess we’re in today, and some ideas about how to fix it. His intention was to give business owners an idea of some options and choices that exist now. Well, we didn’t really get far into that last part, as so much of the time was taken up with people’s impassioned views on the subject of our health care system. Not surprising in the USA today.

A lot of views were expressed about how people overuse medical care, and doctors over-test and over-prescribe in order to cover their butts against potential liability, how we expect higher standards of care than in the past, how we take too many prescription drugs and don’t emphasize prevention enough. I can get with most of that, as far as it goes. I think health education and healthy lifestyle choices could be much more emphasized. I think the practice of defensive medicine is a real problem. But I don’t think the answer is to turn back the clock and say if you injure your knee you should just live with the limitations for the rest of your life, rather than having rehabilitation available. I don’t think having real effective treatments for conditions that were taken for granted throughout human history is a bad thing. People don’t have to suffer like they did – throughout human history.

It was more than I could do in the short time we were together to really make the case for chronic illness, though I tried. We all need to be responsible for ourselves, and take care of ourselves, and looking to a doctor or a pill to solve everything is not the answer. But many of us do not have the option to go without medical care – we cannot function without it. And the advances in medicine that may be seen as excessive or unnecessary by some are not happening fast enough for us, to help us function.

Many of us with chronic illnesses are living the healthiest lifestyles imaginable. We’ve cut out the unhealthy things that others just think they should cut out. We don’t have a choice because these things make us sick now. One guy said he thought it was crazy that healthy people and sick people should pay the same insurance premiums. This shows the problem with a traditional, for profit insurance risk model – but how can any rational person say that you have to be extremely wealthy to be a sick person? Should I pay twice (or five times) as much for my insurance as you? In other words if I get sick, if I have a genetic predisposition to disease, have an accident, or am just unlucky, I should go broke and end up an the street in order to pay for my care? Or maybe I should just die? A pure for-profit insurance model like this guy was championing, that’s the real death panel. (Choosing who should live or die based on ability to pay. We have that in this country right now!)

I’m responding to things that I couldn’t respond to at the time without completely diverting the conversation. Unlike some wingnuts in town hall meetings around this country, I’m polite enough not to shout people down. Most of the time.

But what really got me was when we started talking about the Canadian model – interestingly, our presenter was a Canadian, living in the US for the last 15 years. He debunked the myth that people wait years for needed surgery in Canada. The same guy whose views I took issue with above said that in Canada the health care is free but the beer is really expensive. He said, “I’d rather have a cheap six-pack than a heart transplant.” Now listen, he was trying to be funny, but come on. Ask anyone on the street if they’d rather have a beer or a heart transplant, and chances are only those who need heart transplants are going to opt for the second choice. Even if you don’t like beer… The point is, that if you need a heart transplant, you should be able to have one without worrying about losing your life savings, or dying without the care you need. And yeah, go on and tax the unhealthy things to pay for the healthcare. Makes sense to me!

– Megan

Hit in the head image courtesy of Pawel Loj.

Tags: chronic illness, health care reform, health insurance
Posted in Advocacy, Current Affairs, Rant | Comments (4)

Childrens’ Health Insurance Plans Sometimes Cover Parents Too

October 30th, 2008

If you saw my recent post on our family’s Health Insurance Headaches you know I’ve been doing a lot of research into health insurance options lately. I thought I’d pass on some information that might help some of you. In the United States, every state and territory provides low or no cost medical insurance coverage to uninsured children under a federal initiative called the State Children’s Health Insurance Program (SCHIP). The program is paid for by both the Federal and State governments, but each state administers its own program, including (within Federal guidelines), determining eligibility, benefits, and payment levels.

The program was originally designed only to cover children, but has been extended to the parents of eligible children by a number of states. In my state parents of children 19 and younger can qualify for free coverage if they are under a certain income guideline, and for those earning slightly more there is a sliding scale of premiums. Some other states may require the parents to be already receiving public assistance or Medicaid. I mention it because it is worth checking your state’s rules. So many people are temporarily out of work or their business has declined or other factors leave them unable to afford the insurance they once could.

I hope a few of you reading this are helped – or know someone else who could use this information. I know it’s no help to those of you who don’t have children, or whose children are grown, or who earn too much but still can’t afford good health insurance. I hope we have a better system soon! If you live outside the US, I hope you live in one of those sensible countries with universal health coverage!

– Megan

Healthcare clinic image courtesy of Daniel Lobo.

Tags: health insurance, healthcare, State Children's Health Insurance Program
Posted in Current Affairs, Medicine | Comments (0)

Migraine News from Between my Ears

October 17th, 2008

A funny thing happens when you start blogging. There is this little bit of celebrity that arises. I can admit that like many people I once secretly wanted to be famous. My friend Laura told me in High School that she pictured me as a kind of revolutionary leader, with thousands chanting my name. If that had ever been my ambition, I’d have to say that I failed miserably. I’ve made it through nearly 50 years of life and I don’t think even dozens have ever chanted my name. Not at the same time, anyway.

But I digress. I started this blog for a few reasons. I wanted a place to share my thoughts on living with Migraine disease, and the other chronic illnesses I live with. I particularly wanted to share my hope and strength, as someone who has come a long way in managing a life with these conditions. I wanted to join the warm, intelligent, funny and committed community of Migraine and headache
bloggers and advocates who are making such a difference in the lives of patients and in advancing the understanding of this disease. The big reason was this moment of truth I had almost a year ago, when I realized that my chronic illnesses are not just an impediment in my life; they
are an opportunity to
share my professional tools and skills, and the
wisdom I have accumulated, to help others manage their lives with
Migraine. I wrote a bit more about that a few months back in My Migraine Story.

I didn’t really start the blog to keep the world posted on the doings in my own life. I tell a lot of stories, partly because I come from a family of storytellers,and partly because I’ve always made points (with clients and anyone who will listen) by telling personal stories, about things that happen and lessons I learn. So it’s been a lot of fun doing that here. And lo and behold, I learn that people are actually following (to some extent) what’s going on in my life. Little old me, Megan, Rachel & Adam’s Mom, Danny’s wife, Joan & Jim’s daughter, Jon & Ellen’s sister, the lady in the house on the corner by the field, the little red-head… that one. It’s a small and gentle sort of celebrity, but I find when I don’t follow up on things I’ve mentioned, sure enough, you’re actually listening, and sometimes you ask.

So the news between my ears…

I’m looking for an allergist to determine whether I should even pursue this Medication Allergy challenge test idea, because as my friend Medieval Writer of Sparkling with Crystals reminds me, anaphylactic shock can potentially kill you faster than a doctor can save you, even in the hospital with a crash cart standing by.
I’m spending a little time, just a few calls here and there, my head and energy levels allowing, volunteering for Barack Obama’s campaign. Please get out and vote for better health care! You don’t have to chance feeling well enough on election day; you can vote early in many states – go to Rock the Vote to check your state’s rules.
My difficulties with the Topamax are settling down. We’ll see what happens when I go back to Dr. G and increase the dose next week! Tingling has disappeared and the cognitive effects are fading. An unexpected benefit seems to that it is functioning as an anti-anxiety med for me! I am a pretty
anxious person by nature, and I tend to obsess on things, but it seems like the slight loss of focus I have on the Topamax means I can’t focus on something long enough to really obsess and get anxious! Kind of weird – but I’m just not worrying as much! MaxJerz of Rhymes with Migraine pointed me towards this piece on Health Central’s Anxiety Connection indicating that Topamax is sometimes prescribed in combination with other drugs to treat anxiety. Who knew? (Well obviously, someone did, but not me!)
I don’t think the Topamax is having a major inhibiting effect on my Migraines yet, though I haven’t had a really bad one in the month I’ve been on it. I am doing a very slow titration to minimize side effects and will probably increase the dosage when I see my HA specialist next week. Judith Warner wrote a pretty good piece about her difficulties with Topamax (not named, but quite identifiable) in the NYTimes today, but they didn’t publish my comment. I am trying not to take it personally!
Our Health Insurance Hassles and Headaches may turn out to be a blessing in disguise, NO
thanks to Oxford (who I will still refer to as the insurer from hell) because it looks like there are a range of better, more affordable options out there for us. I got a lot of info that may help others, too, and will try to do a whole post on it soon. For others who are struggling with insurance, if you have children, be sure to check out your state’s insurance coverage for children. Some states now extend that to parents of children 18 and under. I know this is no help for childless people or those whose kids are grown; you deserve health insurance too!
In the meantime, I seem to be developing a lot of Acephalgic, or Silent, Migraines (phono & photo-phobia, dizziness, without head-pain) in the evenings. It’s better than having the head pain, but still means I have to retreat to my cave (i.e. bedroom) for the evening and can’t hang out with the family much. Bummer. More to talk to Dr. G about next week.
And, (a drumroll please…) my biggest news… by next week (I hope) I should be launching my new website, containing this blog and other resources for Migraineurs, including relaxation teleclasses – stay tuned for more! Hard at work on it now – soft greens and yellows – looking pretty – can’t wait…

Hope your heads treat you well and you have an AWAP weekend!
– Megan Oltman

Tags: acephalgic Migraine, Adam Oltman Porcher, Adam Porcher, chronic illness, health insurance, medication allergies, Migraine disease, Topamax, vote
Posted in Communicating, Current Affairs, Musings, Weblogs | Comments (4)

Health Insurance Headaches

October 8th, 2008

Warning – Full blown rant ahead. I am so upset I can hardly stand it. I think my head may explode. I know I have criticized the media for using Migraine loosely to describe a hassle, but I’m using it literally here. My health insurance company, which is supposed to guard and foster my health, is about to give me a bona fide Migraine! Adrenaline triggered, high blood pressure triggered, crying triggered, you name it. And then they won’t want to pay for my medication.

I just received a notice that as of November 1, my health insurance premiums will go up by over 60%. I receive group insurance through a professional association, and so I am one of those self-employed small business owners who is paying for my own premiums. These are the group rates, mind you, if I tried to get my own insurance outside the group the premiums would be even higher. Our health care is already the one of the largest costs in our budget, after shelter. Higher than utilities, auto fuel, higher than food. The monthly premium for our family of four will go up about $800, to over $2000. And that’s just the beginning. We already have:

a $30 co-pay for doctor visits;
a $50 specialist co-pay (“specialist” includes physical therapy for headache prevention – $50 out of pocket every time I go – my neurologist wants me going twice a week, I manage twice a month at those rates);
most of the medications our family uses are considered “Tier 3” and have a $50 co-pay as well, so that’s a good $400 at the pharmacy every month;
we have a $2000 deductible for out of network doctors (and we do use some of the same doctors who we like and trust and have used for years – silly us – so picky, huh?);
after we’ve forked out that $2000 deductible, we have a 30% co-pay for out-of-network; and
all claims must be submitted in 90 days or they are rejected.

That last is a doozy – take someone who is chronically ill and has trouble keeping up with paperwork, and you have a perfect formula to never have to pay on some large proportion of their claims. Every previous insurance company I’ve had gave you 6 months to a year to submit claims.

Oh, and I almost forgot. This company routinely loses about 1/3 of everything I send them. So I have to keep to a very strict schedule to get everything in, then I send the claims, get nothing back, call them, they have no record, and they tell me, “Oh, if our scanner can’t read it, it’s destroyed.” Destroyed. I pay these people over $15,000 a year, soon to be over $24,000 and they destroy my paperwork? Then I have to dig out my copies, send another set with a cover letter, and guess what, they send half of those back saying they weren’t submitted within 90 days.

To all the costs above, let’s add that I spend a good 2 days of my time every other month dealing with my health insurance claims, mostly with their screw-ups, uncompensated, of course, taking time away from earning my living.

I’m naming names here. It’s Oxford Health Insurance, a United Healthcare Company. They grant me the privilege of paying them an additional 60% for this abuse starting next month. The reason? Our group has a higher than average rate of claim submission! Aha! So, let’s analyze this – first of all, this is a group of coaches, whose job is to get people organized and on track to achieve their goals – maybe we have a higher than average ability to actually find our way through the impossible obstacle course that Oxford has set up to keep people from submitting claims!

But then, remind me, what’s the insurance for? Call me naive, I thought it was there so I could afford health care! I didn’t realize it was for the profit of the insurance company, first, foremost, and exclusively! I’ve got no problem with business, I’m in business myself, but I do have a problem with the profit motive here, where it’s destroying the very purpose of the product! Dare I suggest a single-payer system? This is not auto insurance. You raise rates on bad drivers, to give people an incentive to be good drivers. So you raise rates on sick people to do what? Punish them for being sick? It is wrong to refuse insurance for pre-existing conditions. It is also wrong to make insurance unaffordable for people who happen to use it. That’s just a sneaky way to try not to cover conditions whether pre-existing or new.

A few days ago I said I would be non-partisan in this blog, and I don’t want to alienate anyone. Please feel free to come here for help and support and ideas about managing life with Migraines regardless of your politics. But I’m sorry, I can’t stay neutral here. We have a chance to finally make a difference with our votes, a difference we sorely need. McCain is proposing a $5000 tax credit to go straight to the insurance companies. That won’t even pay for this premium increase, let alone make me any better off. Does Oxford deserve even more of my money after all they already manage to take? McCain is proposing deregulating health insurance further and encouraging more competition, letting the market take care of it. The market is taking care of it by raising my health insurance premiums by over $9000 a year, because I have the gall to actually use my insurance! What exactly is my family supposed to give up to pay for our health care? Food? Heat?

We need comprehensive, affordable health care available to all of us. We need insurers to give sick people coverage without penalizing them. We need this desperately. People are being driven into ill health and poverty in this country by lack of coverage. Barack Obama’s health care plan goes a long way down the road towards the coverage we need. I need his plan now. I think we all do.

– Megan Oltman

Exploding head courtesy of Alexander Iezzi.

Tags: affordable healthcare, Barack Obama, health insurance, healthcare, migraine
Posted in Advocacy, Rant | Comments (4)

Vote for Better Health

October 2nd, 2008

An election is upon us! (Apologies to readers outside the U.S. but I know our national obsession is big news everywhere these days.) The purpose of this blog is not to take sides politically, so I won’t be pushing a platform. I do want to urge all U.S. citizens to get out and vote!

If you aren’t registered, the deadlines are coming up. They vary state by state. To get electoral information for your state, check out: Rock the Vote. Rock the Vote even has voter registration forms you can download and mail in! How cool is that?! In Alaska you must be registered by this Sunday, October 5th. Several states have deadlines this coming Monday, October 6th. Most others have deadlines sometime between October 14th and 20th, although Idaho, Iowa, Maine, Minnesota, Montana, Wisconsin, and Wyoming permit registration at the polls on Election Day. A big round of applause to those states for actually making it easier to exercise the franchise! But please remember lines can be long on Election Day, and register ahead if you can.

If you are afraid you might not be able to make it out to the polls, get an absentee ballot. Check with your
local Board of Elections, you usually have to request one a few weeks ahead, and in most places you can use it if necessary, or show up and vote if you’re able. Some states have early voting, so you can vote while you feel well in case the migraine monster strikes on Election Day! You have lots of options, so please exercise them, stand up and be counted!

What does this have to do with healthcare? Well, I know I’m not alone in thinking our healthcare system is seriously broken. How about you? Do you have health insurance? Even if you do – Are your premiums affordable? How is your coverage? How high are your deductibles? How good is the care available under your plan? How much are you paying for prescriptions? How much of your total income is going to healthcare each year? Personally, as a self-employed person, my healthcare costs (premiums, deductibles, and co-pays) are second only in my budget to housing costs, ahead of food and transportation costs! I believe we need a new President with a commitment to real change in our healthcare system, and a Congress to help pass the laws that will give us that change.

Please get informed. Don’t vote based on commercials or sound-bites or looks or popularity – look at the issues that matter to you. Do some reading, look below the surface. It doesn’t have to take long. If healthcare is important, as I’m sure it is to most of us, you can start by taking a look at this tool from Health Central: Healthcare ’08 PoliGraph. You can use it to compare where you stand on various aspects of healthcare with where the presidential candidates stand. Get informed and then get out and vote. Thanks!

– Megan Oltman

Ballot box image courtesy of Just-us-3.

Tags: election, health insurance, healthcare, vote
Posted in Advocacy | Comments (0)