Yet Another Post on Health Insurance

After reading this article on Bilerico, sent to me by my friend Ed White. I felt compelled to respond with my own experience.

The author makes one glaring mistake that the majority of people in our country make: she has conflated the terms “health care” and “health insurance”.

Most health care in our country is par excellance. The problem is access to this care is restricted by ability to pay. Ability to pay means access to affordable health insurance.

It has only been in the last few years that I have been able to secure health insurance. Every application was denied, returned with the reasoning that “GENDER IDENTITY DISORDER” was a preexisting medical condition. Never mind that the policy specifically excluded coverage for gender transition related expenses.

The income limit was raised high enough that I could purchase CoverTN, a state subsidized limited insurance with a $25,000 annual maximum benefit. With a limit so low, I worried I could quickly exhaust those funds if I had a serious illness or injury. As a recent injury reassured me $25,000 in insurance payout is equal to $450,000 in medical care – that’s near half a million dollars.

What do I mean?

An MRI for a brain scan was billed at $8900 – just for the scan, not the interpretation or outpatient access charge. As per agreement with my coverage underwriter, BlueCross BlueShield of Tennessee, they paid roughly $500 to settle the bill.

In 2003, I unexpectedly awoke in agony  to the point of nausea and near unconsciousness. Frightened, Jaime quickly sped me to the emergency room. While seemingly in perfect health, just days after receiving a denial letter from yet another health insurance company, I was being seen for an unexpected kidney failure.

As I waited and waited, I wailed and moaned in pain and writhed in agony, I was bumped to the front of the line because I was making the rest of the waiting room anxious. The first nurse to examine me was to insert a catheter to relieve the painful building pressure in my kidney. When she pulled back the gown on a seemingly pretty, 32 year old woman, she saw a penis, dropped the catheter kit and we never saw her again.

When I left 24 hours after surgery, I was presented for a bill, which only included the hospital bill, not the surgery, anesthesia, or physician, for $19,000, I could not pay.

At the time I was making a fairly good wage for a single person. The billing department prescreened for TennCare coverage and surprisingly was told I qualified as a single female under some cryptic guideline. I was even assured the visit would most likely be paid in full. Additionally, they set an appointment with the appropriate state agency to have an interview and complete the process.

I did go to the interview. I was told that normally I would have qualified, but the program was for single women, not single men that dressed as a women.

Oddly, a month later I had a service call at the office of one of my business customers. I hadn’t seen the woman in a while and asked how she’d been. She went into detail about a trip to the emergency room – the same emergency room, for a similar kidney issue and similar surgery. Her bill: $24,000. Her insurance’s payment to the hospital which relieved her of further financial responsibility: $1500.

Over the next few years I acquired more medical bills which I could not pay. Eventually, I filed bankruptcy to discharge those obligations. At the time, I was still unable to legally obtain health insurance.

Why, if $1500 can pay for such health care, why if $450,000 in care can be attained for $25,000 do we saddle those that cannot pay with the cash price and those that can for a mere fraction?

Our health care system is controlled by, rationed by, and mandated by insurance. So when I see people conflating a good health care system with a greedy health insurance mafia, I understandably shake my head in disbelief.