Jumping into the fray

While I was dealing with the situation with my hips, I also had a rather stressful situation with health insurance and bills. I didn't blog about it too much, for various reasons. But now, with everyone talking about the health care system in this country, I think it's important to let people know what I went through.

At the time I was diagnosed with AVN, I was working on a fellowship at a federal agency. I was not a federal employee, and my fellowship did not come with a health insurance plan. I was able to extend coverage from my previous job through COBRA for a while, I believe it was 18 months. After this expired I purchased my own individual plan, which is the coverage I had when I was diagnosed with avascular necrosis (AVN). After my diagnosis I ended up going to many doctors for various consultations and appointments, and bills started piling up, and the insurance company started paying less and less of them. I also started receiving letters from the insurance company--they wanted me to send them ALL the records from every single doctor I had seen for the past several years. I had already had to go through a similar process when I first purchased insurance from them, but this was way more extensive. It was pretty obvious to me that they were either trying to prove that my AVN was pre-existing, so they wouldn't have to pay for it, or else they were trying to find something that would make me ineligible for coverage altogether. During this time I had one outpatient surgery. I received bills for thousands of dollars. I did not document all of the expenses because with everything else I was dealing with, I just did not have the time or energy, or morale.

Meanwhile, I had been asking around at work and I found a different type of fellowship that came with a group plan for health insurance. I would have to pay my own premium, which would be raised from $167 a month to $333 a month. However, because of the fact that the individual policy was suddenly not covering anything and appeared to be about to take some kind of further action, I felt that the change was well worth it. I switched to the new plan before my hip resurfacing surgery. Although I stayed in the hospital for four days, I only payed $200. Compared to the thousands I had paid for the outpatient surgery, this seemed like a real bargain! A few other bills came up once I got home, for some therapists who had come by the house during my recovery, but overall this extensive surgery ended up being MUCH cheaper than the minor surgery, just because of the insurance plan I was on.

On paper, these two plans appeared to cover similar expenses. The differences really only became evident after I had had the two surgeries, and could compare costs. My situation didn't seem that precarious from the outside, because I was employed and had health coverage the whole time. But, because of the high cost of the bills, I would have been in serious financial trouble had it not been for my parents who were fortunately able to help me out. Thanks to my parents, I was able to go ahead and get the hip replacement surgery. If not for them AND my supportive employer, I would have had to either stay in pain and disability, or have accrued medical bills to a degree which could have sent me into bankruptcy.

This scary situation made me realize how easy it can be to get in a really bad situation because of medical bills. This can happen to anyone, but it's especially risky for people who don't have the coverage of big group plans through large companies. The way insurance companies work, the bigger group you're in, the better, because there are more people paying into the plan, so the risk is spread. On an individual plan, there is no group to spread risk around, so if one person starts accumulating lots of medical bills, they look for ways not to pay. Because our health insurance system was set up through employers, people who are self-employed, in transition between jobs, work for small businesses or are entrepreneurs are especially at risk. Any of us could fall into this category (until we're old enough to qualify for Medicare). The current health care proposals out there are not perfect, but they all aim to improve this situation in some way or another.

So here I am, nearly two years after my major hip replacement surgery, and more than a year after the most recent surgery on my shoulders. My hips and shoulders feel great and normal most of the time. Sometimes the metal hip feels weaker than the other, so if I walk lots or dance I'm more aware of the muscles than in the other side. Sometimes the right (non-metal) hip hurts, as well as the shoulders, especially when the weather changes, but overall I'm functioning normally. And, thanks to a lot of help from my parents, I think I've finally paid all of the bills. I just don't think it's right that I should have had to rely on them; I think people should not have to choose between their physical and financial well-being.