Managing the Health-Insurance Bureaucracy

I have dipped and dodged my way through the American health-care system for a number of years. I’m married now, and we have insurance through my wife’s work. It’s very good insurance, and I am very fortunate to have it. But before I was married, I had a period of time (about 3–4 years) when I was no longer able to remain on the plan lingering from my mother’s coverage, and did not have any option for benefits from school or work. I was out there, pre-ACA, on my own. I navigated through the waters and got real creative in finding organizations that could get me access to the group health coverage plans that were, at the time, my ONLY option. As is a common story, the final group plan I managed to find suited me well for a while, and then the organization it was tied to started to have financial difficulties, and the premiums started to rise; the prescription drug co-pays started to rise; the co-pays for doctor’s visits started to rise. I was pretty close to finding myself unable to afford health care when I did get married (and no, the timing wasn’t BECAUSE of health care — it just lined up that way in an act of mercy from the Universe).

I hated those days. I hated the bureaucracy and red tape and knowing the whole time that I was trying to negotiate with an industry that wanted me to just go away. Let’s face it, they would much rather I crawl into a far-off corner and die than deal with paying the costs to keep me alive. We all remember the stories — insurance companies employed whole departments of people whose SOLE JOB was to find little loopholes or errors made by premium-holders so that the insurer could deny coverage, end coverage, or otherwise leave the policyholder out in the cold and bankrupt. It was sickening.

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Fast-forward to today, and my wife and I are reassessing our respective vocational lives. She has been at her job (the one with the great benefits) for many years and is feeling ready to move on to new things, which would likely mean working in a more freelance manner, holding multiple positions rather than being tied to a single, full-time employer. I’m a musician and music teacher and occasional blog writer — a life that has always been freelance by nature. In a country with sane health care, she would most likely move to something part-time while working toward credentials or a degree that would be part of her next step forward. I would likely continue my freelance life, but pick up more hours here and there — whether that means driving for a ride-share a few days a week, getting more recording gigs, finding other writing outlets, or whatever hustle I could find.

But we don’t live in a country with sane health care. We live in America, where premiums are skyrocketing, where pharmaceutical companies are charging exorbitant prices and reaping record profits, where high-deductible plans have taken over even traditional work-sponsored benefits, and where the little progress we HAVE made (the ACA, which I deeply support but also understand has seen the same increasing premiums and high deductibles) is under threat. It’s a mantra that has been repeated millions of times, but only because it’s true: We live in the richest country this round ball of Earth has ever seen, and yet the insistence continues that we simply “can’t afford” to fix health-care costs. This is nonsense of the worst kind. We COULD address it; we simply don’t. We COULD decide that a higher tax rate in exchange for universal health care that’s not tied to profit-motive is worth it (and it is), but we don’t. We could address the ludicrous system of insurance billing that inflates charges to utterly insane levels (hospital dinner for $120 on paper; sure, that makes sense!) so that insurance-billed services are “reduced” while patients without insurance are driven into bankruptcy, but we don’t. Over and over and over again, we walk away from the things we COULD do, leaving in place a patchwork, corrupt system of health care that makes millions in profits for executives, while leaving us out in the cold.

Unfortunately, a comprehensive solution will only come when we elect leaders who actually want to legislate like sane adults. We haven’t had that for a long time, and right now it often feels like we don’t even HAVE a government. And in the meantime, here I find myself again, trying to figure out HOW IN THE WORLD my wife and I will make the transition to the next phase of our lives while living with diabetes. We’ll find the route — I’m not going to let the insanity of our health care-system dictate my life, but it’s going to take time and energy and creativity and perhaps even a downgrade in the choice of doctors, my choice of prescriptions, and my ability to continue using a CGM at all, but we’ll fine a way. I just wish we didn’t make it so damn hard in this “land of opportunity.”

Want to learn more about money matters and diabetes? Read “Diabetes and Health Insurance” and “Do’s and Don’t’s for Saving Money With Diabetes.”