Tag Archives: healthcare

Healthcare

Go to the Doctor… or Wait Until January 1? A case of a restarting high deductible.

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Following a sore throat-turned-larigiytus, I had a five day period of optimal health, then started sneezing out of no where, bringing on my current quite bad chest cold. It’s rare for me to get this sick, and this often – but for a pregnant woman apparently it’s normal to have a drop in immunity (to not reject baby) and thus you’re susceptible for a whole host of ills. Fun!

Colds, as anyone who has been to the doctor knows, cannot be helped by medical intervention. They just check your breathing and tell you to rest and drink lots of fluids. This is why, unlike my mother and sister – who manage to get antibiotics every time they so much as sneeze – I tend to avoid the doctor in the case of sniffling or coughing. Continue reading Go to the Doctor… or Wait Until January 1? A case of a restarting high deductible. →

Health, Healthcare, Mental Illness, Pregnancy

To go to the doctor, or not go to the doctor – that is the question

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High deductible health plans are great when you hit your deductible – except when they’re not. Specifically, they’re not great when over the course of the year you have to start over paying your deductible due to company health plan changes and/or changing companies. Thus, this leads me to move away from my former infatuation with the HSA-enabled HDHP.

In November, my $2600 deductible restarted. I figured I could survive until the end of the year without seeing a doctor. Then, I got pregnant. And then, I got sick. Sick with a cold / sore throat / lost voice that’s likely a virus that has no cure anyway… not worth a doctor’s visit and certainly not worth spending $300 on. I already made that mistake a few times this year when I didn’t realize my deductible had not only reset, but doubled (thanks to my former company who didn’t notify me that as of Aug 1 they switched plans and the $1500 deductible was now $2600 and reset *cough*bullshit*cough.*) Yes, that cost me $1000 in medical fees that I expected to be covered due to a series of “fuck I lost my job and I’m incredibly depressed” psychologist appointments (nothing like a surprise $1000 bill you fix your mental health!)

But now, I’m going back and forth on whether to go to the doctor. Being pregnant changes things. I’m five weeks, two days pregnant… and, 3 weeks, 6 days away from a brand new year of health insurance and deductibles. Since I’m switching to Kaiser, my medical costs are going to go way down next year (it’s a $1500 out of pocket max, no deductible,  no more surprise charges PPO BS. I hope I do not regret this decision.) Can’t I just stop talking for a few weeks (who needs a voice anyway) and hold out?

I do get to see my reproductive endocrinologist tomorrow – or at least the nurse – and perhaps they’ll be able to advise if I should do anything about this stupid cold. Luckily, my follow up appointments for my pregnancy at my RE are “free” (well, covered by my monthly $800 cycle fee) until I’m handed off to an ObGyn… so I’m hoping they can help at least provide some medical advice of what to do if I’m super sick and cannot talk.

The good news is I haven’t had a fever yet. I know fevers can be dangerous to baby and the second I get a high fever I’m paying that $300 and going to the doctor. For now, I think I just need to figure out how to get some rest and eat a lot of chicken soup.

Health, Healthcare, Taxes

Open Enrollment & Pregnant: Anthem or Kaiser? PPO, HDHP or HMO?

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It’s quite the luxury to fall pregnant the month of open enrollment. This means hubby and I can (theoretically) make smart financial decisions when it comes to selecting health insurance for next year which covers both the birth of our first child and their first six months of medical care.

Even with this great fortune, it’s unclear which of our options is the right one. Luckily, my company provides relatively good insurance. Given how much health insurance costs in this country, the $200-$300 we’ll be paying a month as a couple (and $200 to $400 as a family) is nothing compared to what insurance on our own would cost. Still, I want to make a smart choice here.

It’s hard to make smart choices when the data is all hidden. Plus, not every decision in life should be based on financial impact alone. Delivering a baby is serious business, and having the option to choose my doctors (especially in case anything goes wrong) feels, to me, like a must have. My husband disagrees.

As a “Kaiser baby,” he speaks highly of the whole Kaiser health system (which also happens to be our lowest-cost option by far.) While some people report Kaiser is horrible, it seems to be that they have their shit together in California. Still, it makes me incredibly nervous to switch to a new health system now with its own style of care.

According to the calculator provided by the open enrollment system — with maternity care and other costs this year (for family of 2) our Kaiser total out of pocket costs would be $3000 or less for the year, whereas Anthem PPO (low deductible) would be around $5000-$6000 and Anthem HDHP would be $8000 (but also includes a $6900 contribution to HSA pre-tax, so that’s about a $3000 discount long term if we buy and hold.)

Financially-saavy me thinks — go for Kaiser — it’s clearly a lot cheaper and it’s not bad – just different. People who dislike Kaiser seem to have rare medical conditions that the organization doesn’t find fast enough since they have no incentive to spend more money on your health, and you have to advocate for yourself. Their maternity situation actually seems to be well regarded. It might not be a horrible idea to go to Kaiser and save $2000=$5000 next year. Lawrd knows we’ll need it for daycare* (more on that in another post.)

Before I was pregnant, I found an ObGyn who looks great (lots of 5 star reviews online) and she didn’t have an opening until January so I booked it a while ago. I planned to talk to her about infertility but now that I’m pregnant, it works out that it’s week 10 of my pregnancy and likely ok to be my first prenatal appointment (I’m assuming — especially since my Reproductive Endocrinologist provides ultrasounds and bloodwork until I’m turned over to the Ob.) I’m just not sure if that trade off is supposed to happen at 8 weeks or if 10 is ok… but I’ll find out.

So… I’m leaning towards Anthem… even though it’s a waste of money. If we start with Kaiser now, we’re stuck (I’ll have a pediatrician selected for my child through them, and unless that doctor is horrible, we’ll likely want to stay with that pediatrician for our child’s entire… childhood.)

Regarding the Anthem options – I’m torn between the HDHP and the PPO. The PPO is cheaper, according to the calculator, and for my husband it’s nice that it has a $250 deductible. The monthly cost is definitely higher and doesn’t include any company contribution, so that’s why it starts to even out. Then the HDHP has that HSA which I love so much, being able to invest nearly $7000 in pre-tax dollars in an account we can invest in and use for healthcare later in life. That $7000 invested over 10 years at 5% would be worth $9.4k – $2.4k back, plus the $3000 or so savings in taxes up front, which is $5.4k, which covers the cost of the difference between this plan and Kaiser.  And that’s with 5% growth and only over 10 years. So is Kaiser really cheaper? — That said, we’d have to pay $7000 up-front now out of our take-home income (though it would only feel like $3500 lost, comparable to the Kaiser costs, I think?)

Either way, I’m fortunate to have a job that pays well enough to be able to be able to decide on this. Keeping my job has never been this vital, and every day I step in the office I know I have to get my game face on and make this work. Somehow. I haven’t told my boss yet that I’m pregnant (one doesn’t do that until week 12 or so, apparently), but I’m nervous about sharing this news with him since I’m not covered by FLMA until 3 months after giving birth to my child. More on that, later…

Health

The Giant American Prescription Drug Scam

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In the US, we pay more for prescription drugs than ANY OTHER COUNTRY. By a lot – more than double. The reason for this is complicated. And the amount of attention brought to this issue ebbs and flows. Last week, a bunch of pissed-off parents made it clear that the epic price hike on the EpiPen (used for major life-threatening allergy attacks) was not an acceptable move on the part of drug manufacturer Mylan — the same company whose CEO received a 671% salary increase in just eight years from under $3M to over $18M.

[Sign the Petition Against EpiPen Pricing Here]

Luckily, I don’t have allergies or the need for an EpiPen – which now costs $400 per pen or about $415 after insurance for two pens. In Canada, a hop, skip, and snowshoe north of our borders, the pens are distributed by Pfizer and cost just $100 a pen. In France, the pens cost $85. Perhaps allergies in Canada are not as vicious as those in the States? Maybe French people are allergic to allergies so they just don’t get them? No — the EpiPen in all countries serves the same exact purpose… it’s just a lot more expensive to acquire in the US. Continue reading The Giant American Prescription Drug Scam →

Culture, Mental Illness

27

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This post is dedicated to the 27 people who lost their lives in the senseless tragedy in Newtown this week. To the children, ages 6-7, and to the brave educators who were accidental heroes that day. To the survivors who will forever be changed. To the parents who have lost their loved ones. To the family where a mental illness ran deep, and clearly no one thought to or was able to reach out to help.

Events like these certainly put everyday problems into perspective. Any day could  be your last, and at that point who cares if you have $5 or $1M in  your bank account. But this week’s events also speaks to an issue I’ve discussed here before – mental health awareness and access to quality mental healthcare.

I’m lucky in that I would never hurt another soul. I don’t have it in me. But there are days when I consider hurting myself. I haven’t yet, and I probably won’t, but sometimes the world becomes so overwhelming that you just want to find some way to feel like you’re in control. It seems for males especially, this control they seek becomes a fantasy of violence and destruction. For women, it’s more often hurting oneself, through cutting, or binging, or even suicide.

People who are healthy will roll their eyes at you, say to pull yourself together. To grow up. But it takes more than growing up. For some, there’s an actual chemical imbalance. For others, their environment shaped them to be the way they are. No matter how they got to the point where all feelings of normal control and stability are lost, it’s important that the person gets help.

I’ve spent a lot of time, like most in this country have, about the 27 innocent victims in the tragedy this week, and about the killer, who maybe was not evil since birth, or who could have been helped. I’ve wondered, like many of you have, what his childhood and life was like, if his mother pushed him too far, if she pulled him out of school and isolated him from others because he was too autistic  to handle being around others, or if a decision to pull him out of school and isolate him led to the tragedy this week. I don’t know, and I’m not sure anyone will know. But I want to believe that deep down there was some good in this kid. That there is good in everyone. I’ve learned, however, that evil is real, and some people are born with a penchant for chaos and destruction.

I’m fighting my own battles, my inner demons, alone as I find therapists who take my insurance are not taking new patients. Therapists that don’t take insurance cost $250-$300 a session. I end up seeing a new therapist — splurging on treatment — when I feel myself breaking down. When I seep from a rush to depression, when my Bipolar II takes a turn for the worse, every so many years. But I usually know when it’s “that time,” and I find help. I can’t say any of it has cured me, or been overly effective, but instead of hurting myself, I had someone to talk to, and it got me through to the next week.

But how many people don’t have the ability to access quality mental healthcare? How many are either unable to afford it or have parents who don’t want to put their children into therapy because of the stigma around it? It took a note that referenced suicidal ideation that I sent to one of the school counselors for advice for my parents to bring me to a psychologist. But I was depressed for years before that. They thought I was just being a typical moody teenager.

Today, the 27 innocents are in my thoughts. I can’t imagine the pain that everyone around their town and those closest to the victims are feeling right now. I am worried that the next tragedy is just months, or even weeks away. As more people see how much chaos others can cause, they may be inspired to act out on their own plans. They may want to see how much more destruction they can cause. It becomes a twisted game and I’m terrified of what evil is lurking in the corners. Is it safe to go to the mall? To the movies? To a school? To work? How does one protect themselves and their loved ones from evil?

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To COBRA or Not to COBRA

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My mom would say get your ass on COBRA asap, but she doesn’t understand the financial implications of COBRA healthcare costs when you’re unemployed.

Last time I had the opportunity to go on COBRA after losing a job, I had been on a PPO plan (a really good one) so I was looking at $405 a month for continued healthcare coverage (not counting all the extra copays and such I’d actually have to spend if I ever went to a doctor.) I denied my COBRA coverage — that time I didn’t even have unemployment since I was talked into “resigning” my a boss who was otherwise going to fire me (I just didn’t have the chops to be a full-time journalist-blogger, go figure) so COBRA coverage, which cost half my rent, wasn’t much of an option. At the time I also thought I’d be able to find cheaper high-deductible insurance for just-in-case problems for less. And soon I discovered that my health history of having irregular periods and treatment for depression disqualified me from being able to get any sort of health coverage without lying on my application. So eventually I lied and spent $150 a month on healthcare with a $5000 deductible which could be revoked at any time if they found out that my periods were in fact irregular or that I sought treatment for being depressed. Which made me EVEN MORE depressed.
This time, I thought maybe since I was in a high-deductible plan at work my COBRA coverage wouldn’t be as expensive. It was a decent plan, but only due to my company putting in an extra $150 a month into our HSA accounts. So the plan, which has a $2000 deductible, wasn’t a bad deal. Now, on COBRA, it’s going to cost me about $300 a month to stick with this plan. So that’s an extra $3600 per year which… only covers freak accidents that would otherwise cost my life savings. Worth it? Not so sure. Possibly. Especially since I won’t be able to get other, more affordable coverage which most people would recommend to a girl in her 20s. Because my periods are irregular. And I’m sad on occasion.
I wish Obama could get his act together on healthcare. I’m not sure what a person like me should have to pay for healthcare, but these costs just seem prohibitively high. More so, I feel it is unfair for the health care system to kick me out just because my ovaries are not perfect and I actually sought help for my depression so I could get back to being a productive member of society. I learned my lesson then to NEVER pay for mental health care using health insurance (even if the booklet they send out makes you think it’s a good idea.) At least with an HSA plan it really doesn’t matter a whole lot if you pay through insurance because ultimately you can use your HSA money for therapy, and if you pay with insurance you’ll basically have to pay the whole fee anyway, it will just go on record. It may cost a little less since the few therapists who take insurance these days are forced to charge a fee which is lower than what they’d want to charge, but then you’re also extremely limited to which therapists you can see. So for now I am seeing a woman who is an intern in a psych program who is letting me see her for $20 a session. I don’t think she’s the best therapist ever, but right now, having someone to talk to weekly so I don’t jump of a bridge is important, and I can afford $80 a month for that. $300 a month for basically nothing but insurance is a little hard to shell out when after taxes your unemployment income is maybe $1500 a month. If I ever get the unemployment income, I’m still working on figuring out if I’m eligible, etc.
This all limits the otherwise decent option of seeking out contract work. I know a few people were angry at me at my post where I asked… should I do contract jobs while getting unemployment (since doing work lessens your unemployment pay) but in reality you’d make more doing NOTHING because contract jobs require you to pay 15.3% more in taxes just because you’re considered self-employed. Unemployment pay, as far as I know, doesn’t require you to pay the extra 15.3%. I agree that I should not be lazy and mooch off the government, but it seems silly to do work to make less then I’d make by instead spending my time job hunting and even teaching myself new skills. And my current contract job is not going to lead to a full-time anything, it’s just a freelance blogging gig where I can make up to $500 a month, I’ve been doing it for over a year now, and it was nice extra income when I had a job, but now it’s the question of doing that and making less than I would on unemployment or just going the unemployment route. And I’m not sure what to do…
For now, I need to figure out if I’m going to go COBRA or without healthcare again. What do you think I should do?
Mental Illness

Group Therapy: Cost Effective, but is it Helpful?

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As my loyal readers and those who peek at this blog on any given occasion know, I suffer from anxiety, depression and ADHD. That’s not to say my life is miserable, but I’ve gotten myself into one of those ruts and decided to seek help. Due to refusing to go through insurance for mental health therapy (until a healthcare bill passes that does not allow denial of coverage due to pre-existing conditions), I have to be careful about my monthly costs to get help. Because it’s all out of pocket. (*since I have a high-deductible HSA account the only real benefit of going through my insurance company would be to have the fee go towards my deductible. Group therapy isn’t covered anyway, and mental health therapy for non serious conditions (ie ADHD, anxiety, minor depression) isn’t covered much either.)

There’s one doctor who is supposedly an expert in ADHD who, located nearby my work, charges $700 for the initial consultation. What? I know I live in a wealthy area but come on. That’s absurd. I found a career counselor and therapist who offered a free consultation. She normally charges over $200 per hour but has package rates. Ultimately, though, I decided I need to see a psychiatrist first to find out if I need to be medicated. I kind of feel emotionally out of control. And while I had going the pill route, at this point I’m willing to try anything. The psychiatrist cost $280 for one appointment. A short, 20 minute follow-up appointment will be $150. She prescribed me Celexa (which I still need to get and find out how much that will cost me.)

But I know weekly or biweekly therapy would help greatly. And given my current state, weekly therapy would be best. I shopped around and tried to figure out the most cost-efficient option. That led me to group therapy. While the rates were $75 per session, I was quoted $50 per session to get started, with her hope that I’d also seek out individual therapy twice a month.

As the Wall Street Journal puts it, “Group Therapy Offers Savings in Numbers.”

After two sessions of “process-based” group so far, I’m attempting to weigh the pros and cons of this treatment…

Pros:

– more affordable than individual therapy. $50 – $75 per 1 1/2 session.
– can afford to meet weekly, and its sometimes nice to just have that safe space that often.
– the value of your therapy doesn’t depend soley on your therapist
– you get to find out what other people think about you and your actions
– other people are counting on you to show up so you go even if you don’t feel like it
– you’re required to pay for every session in a month even if you don’t go, so you make an effort to go to every session.

Cons:
– even though the session is 1 1/2 hours long, it goes fast, and often isn’t about you
– you’re required to pay for every session even if you have to go out of town or get sick
– the benefit of the therapy depends on the dynamic of the group
– most people in group are also seeing individual therapists, it’s hard when you’re not
– the therapist has an odd role in trying to ask everyone how they’re feeling at the moment, but holding back on actual counseling (that’s for the individual sessions, which cost a lot more per person, after all.)
– while people are supposed to agree to at least 12 weeks when they sign up, people come and go. I can already tell the true value of the group comes from one that has been going a long time with the same people. Granted, bringing in someone new every once in a while and dealing with people leaving (abandonment) is theraputically good. However, too much of that and all you talk about is how you feel about people leaving and joining.

Have you ever had group therapy? What was your experience like?

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Election’s ’08, Holding My Breath

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Tuesday is a very important day. It will decide a great deal about our nation’s future, especially in terms of the years of my life when this sort of stuff matters.

That is, as a child I was relatively oblivious to politics, financial market upsets, and while I understood what war was, it didn’t effect me personally. Now, as a soon-to-be 25-year-old adult, all of this is very relevant in my life. If Obama wins, I may have health insurance again. If McCain wins, well it’s 4 more years of Bush. I don’t mind McCain, it’s Palin I’m afraid of.

I believe in the constitution, and strongly believe in social and economic freedom that, for the most part, goes unregulated by government. Because government is usually wrong. But when it comes down to things that make the people of our country better – healthier, smarter, and prepared for the competition in the international marketplace, the government needs to help out. Look at China – its people may not be doing all that well, but economically they’re thriving. America is no longer the big shot nation. We’re one of many. And before we fight for democracy, we need to prove why it is so great. We take care of our people. That means providing quality education, health coverage, and mental healthcare. The school system should have a class in finance, explaining why sub prime mortgages don’t work. We can’t bail out banks, because that defeats the purpose of capitalism. This isn’t Mario. You can’t just be like, oops, do over. (Though, apparently, you can.)

It never ceases to amuse and confuse me that those who believe strongest in liberty and freedom from centralized government are the same exact people who speak out against gay marriage. In California, there’s Prop 8, which will add an amendement to the state constitution saying that marriage has to be between a man and a woman. Now, regardless on your opinion on gay people, isn’t that kind of ridiculous? After all, if we’re fighting for our freedom – freedom to spend as we please, teach our children what we believe, do what we think is right, then shouldn’t everyone have those freedoms? The biggest hypocrisy is fighting for freedom, as long as people agree with your beliefs.

Sorry to go a little off topic here, but this issue really irks me. All the people who are so set on defining marriage as between a man and a woman. Marriage, in itself, is a religious concept. I personally believe that the government should remove itself from the marriage process, and that everyone who wishes to be married can sign up, legally, for a civil partnership, and then let people define marriage as they please. I went to a wedding this last weekend, and while it was lovely, all the traditions and everything were a religious ceremony – that’s what marriage is. Two people can love each other and be together forever without being “married,” the only difference then is the lack of rights. The lack of freedom to have these rights.

The last thing I have to say about this is how if every marriage between a man and woman were perfect, then maybe it would make sense to say that marriage is this special thing that must be preserved. But look at the marriages in our country. Many end in divorce. Many that don’t remain abusive. My good friend just eloped so she could have her fiance’s health benefits. This is reality. And letting two people who love each other get married, whether they have different genitals or not, well, that really shouldn’t matter. Marriage is about a commitment to someone you love, to share your life together, to be there for each other in sickness and in health. It’s not restricted to a man-woman relationship. That’s all I’ll say about that for today.

I’m feeling good about Obama’s standing in the polls, but still worried that McCain will pull ahead. I remember election day 2004, when the results were coming in and it was clear that Bush was going to win. Well, it was never really clear, except I knew it because he did a great job of scaring people into thinking if anyone else won the terrorists would infiltrate our country. Fear is a great campaign to run on. McCain is trying it too, but people are maybe a little smarter now that they’ve seen what Bush has done.

Obama isn’t perfect. But he understands this country. He understands what we need. He may be liberal, he may believe in equality for all, and that may scare a lot of people in this country who, on the extreme, think that America needs to be white in order to still be America. I’m worried FOR Obama, it’s obvious that him being African American makes him the target of tons of assassination attempts. He is the next JFK, he inspires hope, and scares the shit out of people who don’t want things to change.

But that’s really it, why Obama still may not win. The fear, the fear of a president who isn’t white, and even more so, the fear of a president who’s middle name is Hussein. My mom is voting for McCain because she thinks Obama will not side with Israel. People think he’s too soft. He’ll let the terrorists walk all over him.

You know what Obama is? He’s human. He’s a real person. He’s smart. He’s really smart. And that’s what we need as our president. Not someone like this…

Stumble It!

Health

The Costs of Being a Girl… Without Health Insurance

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(First of all, I want to apologize for being so behind on updating this blog. My life has gotten quite busy, which is a good thing, but I definitely haven’t updated this site as often as I should, or as often as I’ve wanted to. I do hope you’ll bare with me until I can make more frequent updates.)

Today’s post is brought to you by The American Health Care System. Due to failures in the system, this post is vastly underfunded, but luckily I’ve got plastic to pay it off…

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One you’ve started bleeding (down there) or having sex (down there) – if you’re a girl – which I am – you’re supposed to go to the gynecologist once a year to get the basic test. Swab in, swab out. Needle prick. No sir you have no STDs, thanks for coming. The whole nine.

Prior to getting super-high deductible health insurance (with a $3000 deductible, so I count that as no insurance at all), I didn’t think twice about scheduling my yearly paps. The co-pays for the appointment, tests and pills were a bit annoying, but nothing that set me back any large sums. I barely went to the doctor anyway, so this wasn’t a huge deal.

Then came contract life. It took me forever to get accepted for any health insurance at all. Finally, I got accepted to a high deductible program. That sounded like a good idea. I’m young. Somewhat healthy. Well, I know what’s wrong with me, PCOS – ie, polycystic ovary syndrome – and the likelihood of my falling to the floor in pain due to anything other than a ruptured cyst is near zilch. That’s what the high-risk insurance is for. Accidents. Not day to day, or year to year stuff. That’s all out of pocket.

So my yearly health insurance, which covers nothing except a hospital visit (after I pay $3000), costs me, oh, $1600 or something like that. $1600 in case I fall down and break myself. That’s important to have.

But it’s not going to help me make sure I don’t have cancer or any other life-threatening illness. It’s not at all about prevention. It’s about post-intervention.

Ok, so I’m really sensitive to screening before things happen right now because my dad was just diagnosed with prostate cancer. And while I know that I’ll never have prostate cancer, I’m still very concerned about being at high risk for ovarian and uterian cancers due to PCOS and having, like, 2-3 periods a year (sans bc pills).

I want to be “good” and get tested yearly. I’m 24, nothing should be wrong, but it’s good to be safe. Plus, I like to have STD screenings every once in a while, just in case an earlier one was wrong. It takes like 6 months for some of those diseases to show up on tests. And sometimes tests lie.

Anyway, today I was scheduled for my annual pap and checkup with a gynocologyst I had seen about a year ago when my cyst ruptured and I felt like death. She did an ultrasound on me then, and perscribed me – tylenol. At the time, it was cheaper to perscribe me it because I had good health insurance and I got a cheaper price to buy it under the cover as opposed to over. Those days are, apparently, long gone.

Although a few weeks ago I had a very, very painful period and pre-period period, and felt little alien slugs were attacking my innerds, I opted to avoid spending $200 on another ultrasound that would likely end with the words “take tylenol.” Instead, I figured it made sense to schedule my annual pap with the doc, and then to ask her what was wrong with me then, or at least inquire as to what could be wrong with me given my symptoms, and go from there.

When I called up the gyno’s office, they told me the annual appointment, sans insurance, would be $180. Ok, so $180 isn’t a big deal. I mean, it is, but when you consider the cost to get better insurance that would actually cover that sort of thing would cost me about $180 A MONTH more, it wasn’t so bad.

But when I got to the office today – I was running late – it turned out I missed the appointment with the doc. Which actually was a good thing, because I was soon informed that the $180 for the appointment did not include any costs of labwork. Umm… isn’t that THE POINT of having a pap? Let’s just scrape my cervix for fun, why don’t we? Use the swabby stick as a paintbrush and have a little creative fun on the wax paper I’d be sitting on, sounds like a plan. Totally worth $180.

No one could really tell me how much the tests would cost. I guess they’re not used to seeing people without insurance. Or with crappy insurance, like my insurance. I got such mixed answers today. The lady at the front desk said 100s, and then the nurse pratictioner who I finally went in to see said the basic pap test would be only like $35 – $50. I don’t trust ranges.

What I really needed today, urgently, was treatment for my likely UTI. Yup, I have and have had a full-blown, painful urinary tract infection for over two weeks now. (TMI? Sorry.) I knew I needed antibiotics. I know when I have UTI. I get them all the time. This one was caused by drinking about 6 large glasses of iced tea and promptly getting on public transportation for about an hour. Lets just say my bladder was not a happy camper, and it made me pay for what I did to it.

At the doctor’s office, I ended up getting a “talking” appointment with the nurse practicioner because she happened to have a cancellation. They had me pee in a cup to test my urine for the UTI. Again, no one told me how much this would cost me. I was told – well, the doctor will look at your pee, then decide if we need to send it out. And sending it out – would be a lab fee. Ok, how much am I looking at? $50? $100? More? Can’t someone just give me antibiotics? I’ve been having UTIs all my life, I know I have a god damn UTI, I can tell you exactly how it happened. I can even reproduce the situation. Got any iced tea???

Well, I went into the examining room, and the nurse practioner came in to talk. She was really nice, but I could tell that she didn’t exactly love that I was wasting her time. Well, I wasn’t wasting her time, because she ended up charging me $65 for the appointment, but at least I left with a perscription for some generic antibiotics. Not sure how much those will cost me, but she said they’re and old brand and should be cheap. Right now I’ll pay anything for antibiotics, as that’s what I really, really need.

However, this doc told me that it prob makes sense for me to go to Planned Parenthood for my pap and checkup, since it’ll likely be cheaper. I was thinking of calling Planned Parenthood but I figured my income bracket would prob be too high for getting treated there. But this nurse gyno lady convinced me it might be best, and since I’ve never had an abnormal pap before, she didn’t seem to think there was any urgent need for me to get the test done.

Maybe she’s right. I’m 24, I have cysts on my ovaries, I get a period once in a blue polka-dotted moon and a UTI when the moon is full and white. What else is there to know?

Still, I want to get tested. So I left the doctor’s office $65 poorer with perscription in hand.

… a few minutes ago I called up Planned Parenthood to schedule an appointment. I was told by a friend that it’s better to tell them you have no insurance if you have high deductible insurance so they will see you. As, again, my insurance has such a high deductible it’s pretty much no insurance, I didn’t feel like that was much of a lie.

So I called and asked for the appointment. They proceeded to survey me about my age, ethnicity, and income. When they asked how much I make, I didn’t know what to say. The truth would surely be too high for any sort of affordable care. But I kind of did tell the truth. I told them I’m a contractor. Which is true. They asked how much I make per month. I said, well it ranges. She asked what the low end was. I picked a number out of the air. $2500, I said. The truth is the low end is like $400 when I don’t have a job and the high end is like $5000 when I do have a job. So I averaged it. What’s $2500 a month? $30k a year? Not quite poverty, I guess, but the only way to get reasonably costed checkups in this country is to be poor, apparently. Not that I’d wish for that, but when I was making less than $30k, I had health insurance, like real health insurance. And now… well, you know… not so much.

So I figured on a sliding scale, $2500 a month income might get me some discount on all the tests. I was told, by someone else, that she basically got free care at planned parenthood. And she had money, it’s just that she wasn’t making any money. She was a grad student, but she had money, somehow. Anyway…

I was told I didn’t qualify for a discount. So their pap would cost $300 (which, I think, includes lab services) which is MORE than what I was going to pay at the doctor’s office this morning… she was going to do the exam for $165 plus lab fees. Well, she said the lab fees were “$35-50” – whatever that means. Maybe it’d be about the same. Still, so much for finding cheaper care.

Meanwhile, I found out that at Planned Parenthood, you could get birth control pills without a full exam. It’d just be $30 for an appointment and $22+ for the pills, depending on which ones you want. I guess most of planned parenthood’s funding is really about not making babies, not, not having cancer (which makes sense. It’s not Planned Ovarian Health Org). And the cost of a full STD screening at my “level of income?” $150.

I think all of this has me rethinking my career. I love my job. It’s wonderful. But I just need REAL health insurance. So maybe I’ll start looking for a job that provides that. I hate to do that. My company seems to have health insurance for “full time employees” (not contractors who work 40 hours a week) but even their health insurance, I think, is high deductible. I’m not sure, I haven’t really looked into it, but it sounds like they all have HSA plans which means they must be high deductibles, I think. They’re a small 8ish person startup, so they can’t afford good health insurance. Can’t blame them for that. But I don’t even get that. Everything comes out of pocket. And my pretty good contract rate starts looking less and less good…

It’s just hard to figure out the total cost of everything when it comes to healthcare. And in this case, the comparision between a year of being on crappy healthcare at $140 a month and having to pay for all health costs out of pocket and working as a contractor where I can work from home on some days and save on gas money, versus getting a “real job” with a salary and benefits, and having to go in every day and spend money on gas and extra travel time and being miserable and needing to spend money on a therapist.

It’s impossible to really compare that. Maybe I should just pay $300 something a month for an HMO. I can’t decifer if it’s worth it. I have an HSA plan but haven’t even opened an HSA account yet because that kind of seems like a joke. They charge you a fee to open the account, and to maintain it. It’s basically another RothIRA, but I go for index funds, and then I have limited choice in investments, and – the kicker is it’s not even tax-free in California. So…

blah.

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When Do I Go to the Doctor?

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I have high-risk “catastrophic” health insurance. COBRA would have cost me $400+, and any full health insurance would have cost me a small fortune. I also had a lot of trouble getting insurance in the first place (see here, here, and here) so I’m ecstatic to have the minimal health insurance that I have for something like $138 a month.

Two days ago I noticed a fairly large, hard bump on the back of my head, a few inches from my ears. It was swollen and throbbing. After doing some research online I’ve determined that the lump is a swollen lymph node.

Swollen lymph nodes can be caused by a lot of different things, ranging from a minor infection to cancer.

I doubt I have cancer. The good news is the bump (although still really tender) has shrunk quite a bit in the last two days. So it seems that it’s just an infection and it’s going away. I noticed there are actually two bumps there, but they’re slowly shrinking.

My concern is that — what if they were the warning signs of cancer? At what point do I go to the doctor to get such things checked out?

When I had “regular” insurance I barely ever went to the doctor. I hate the doctor. I’d go only if I was really, really sick and I’d wait it out for a while to see if I could get better before heading in for a diagnosis.

But I no longer have the luxury of going in to get something checked out for free (minus the co-pay). Going to the doctor is quite expensive. It’s not even so much the doctor’s visit as much as the fear that the doctor will either tell me that it’s nothing (=waste of money) OR the doctor will order a bunch of expensive tests that will add up to thousands of dollars out of pocket.

I can make an educated guess about whether my head lump is something I should worry about or not, and I can wait longer than I would to get it checked out and hope for the best… but the crappy thing about not having regular health insurance is that I just can’t go to the doctor for every little thing like this.

At what point should I go to the doctor to get this lump checked out?