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two broken wrists. and the saga continues. [k.s. friday]

and the saga continues

bananas.  they were $.49 lb.  we picked up a bunch and walked to the register.  a moment later, with no question or drama, we paid our $1.17 and left.

the next step in my two-broken-wrists saga is occupational therapy.  not because we do everything with our hands.  not because we write with them and open doors with them.  not because we use them for our personal hygiene or because we cook with them.  not because we drive with them or dress with them or shake hands with them.  but because using my hands IS what i do.  the therapist asked me how long i have played the piano.  53 years.  it’s what i DO.  so getting my wrists back to pre-snowboard-fall is imperative to me.  there are no other options.

before we went to this first appointment i, responsibly, called our healthcare insurance company – the one we pay $29,000 a year to – the one with the slogan ” for the care you need at a price you can afford” – to check in about the coverage of OT.  i was told, after much menu-choosing, that i am limited to 20 visits and that the cost will be $50 per visit.  with the OT’s recommendation that my getting-these-wrists-back-trajectory would involve appointments twice a week, that would add $400 to the already-$2400/month in healthcare costs.  bracing.  impossible.

the OT office checked in with me to remind me of my appointment, coincidentally, just after i hung up with the insurance company.  i told them what i had just learned and they insisted i was wrong.  “no,” i was told, “we have never heard of molina charging ANYthing for a copay.”  I asked them to please double-check for me and they assured me they would and that they would apprise me at my appointment.

when i arrived, the receptionist checking me in told me that they had their 23-year-insurance-veteran in the office check and that there would be no copay.  i asked them to provide a written document to that effect so that if and when i was billed i would have recourse.  they assured me that they would triple-check and to stop back after my appointment.

at the end of my appointment with the therapist, the receptionist told me that “no, you don’t have to pay $50 per visit.  it’s actually worse.  instead, you have to pay 100% of all fees until your thousands-of-dollars-deductible is met.”  what?!!!!  now this is the third story i am hearing about the same service with the same provider and the same insurance company.  who am i to believe?

i stood there and literally cried in front of the receptionist in the middle of the waiting area.  you mean to tell me that our $29,000 a year doesn’t really cover much of anything???  this is blatantly wrong, grossly outrageous.

bernie sanders, if you have listened to him speak, has given a example of the perverted and pathetic healthcare in this country.  he speaks about a family who makes $60,000 a year and that this family must pay $12,000 for healthcare.  “that’s 20% of their gross income,” he bellows.  what i wish he would add is this next example:  consider a couple who makes say $65,000 a year (this is the magic healthcare cliff for two people and only $5000 more than the previous example).  that couple will pay anywhere between $24,000 and $29,000 for a policy that will still have high deductibles and yet (clearly) not actually have good coverage.  i want to jump on the bernie-bellowing-band-wagon and yell, “that’s 45% of that couple’s income!!!  what is wrong with that???? EVERYTHING!”  how is it that we can live in this country, the richest country in the world, and have the worst healthcare for our populace?  how is it right to set the populace up for financial disaster when they have to deal with the eventual health scare, injury, illness??  (on a side note, i won’t even beGIN to start talking about Covid-19, for i have nothing good to say about the administration’s handling, lack of information or truth, and unpreparedness for this pandemic that will truly test the resiliency of our country.)

when i could take a breath at the receptionist’s desk i asked, “what do these appointments cost?”  how much is my professionalism worth to me, i am thinking.  i earn my living playing the piano, i am thinking.  i have fifteen albums of piano music, i am thinking.  i am a pianist, i am thinking.  i just need care for my wrists so that i can do what i do, i am thinking.  at what cost, i am thinking.

but healthcare is not like bananas.  i was told, “we can’t answer that.  we don’t know.”  i beg your pardon???  “billing handles that.  and it’s different depending upon insurance plans and whether or not you have appropriate insurance.”  i beg your pardon???? “what if i just wanted to pay cash right now?” i ask.  “you can’t,” she says.  “we don’t know what it costs.”

i wonder if it would be more if i paid cash – after all, i’m not an overstuffed insurance company that has the capacity to deny portions of the billing or disallow costs or base payment on the coding used to describe my treatment, while at the same time accepting ridiculously high premiums from clients with the knowledge that the insurance offered is incomprehensibly lacking.

no.  i’m just a person who needs her hands.

we left, went to the store and bought more bananas.

read DAVID’S thoughts this K.S. FRIDAY

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two broken wrists. [k.s. friday]

two wrists

day 4

it broke more than both my wrists, that snowboarding fall last monday.

it broke my ability to do many things for myself.  it fractured my independence.

it exploded my previous gratitude of those around me, loving and caring for me.  it expanded a dependence on others, particularly david.

it broke through my vulnerability threshold.  it made me acknowledge my modesty and encouraged me to try to stand tall in my new temporary disability.

it broke what i knew about others around me.  it both surprised me in all the best ways and surprised me in all the worst.

it broke my assumption that all things – all my relationships – all my work – would stay the same.  it shattered any sense of security.

it further broke my trust in our country’s healthcare coverage.  it pointedly drove home that point.

it broke through any calm-in-the-storm-around-us i had found.  it exacerbated a profound sense of worry.

it broke my muse.  it scared me, really scared me, and it made me wonder if i would play again, write again, perform again.

day 5.  my quiet piano welcomed me into the studio.  i stood in front of it.  determined.  and i played.  nine fingers, not ten.  not the hand-span of all other days, but never mind.

day 12.  eleven days after breaking them i still wake up, after night’s elusive sleep, surprised to see my wrists, well, more accurately, my cast and hard splint.

i think, “here we go,” and i set out to see what’s beyond two broken wrists.

read DAVID’S thoughts this K.S. FRIDAY

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“emergency room/urgent care.” [merely-a-thought monday]

er or uc

emergency room to the right.  urgent care to the left.  it was a choice point.

as we drove from the ski hill back to our town, i was worried.  terribly worried.  but my worry was less about my two broken wrists.  it was less about the pain.  it was less about all the things i could see – already – that i couldn’t do for myself.  it was less about my piano and, thus, my life.  it was less about how long it would take to heal and what that healing would look like.  it was less about how important a role david would play for me in this process of getting-my-wrists back.  it was less about how this injury would impact me.

my worry?  it was about what it would cost.

i wracked my brain for all the research i had done in selecting this year’s healthcare plan and how the deductibles work and what is covered and what is not covered and whether x-rays were completely billable sans satisfying our deductible.  i worried about the cost of the emergency room, the cost of the ER staff, the cost of radiology, the cost of casting.  there was a moment, driving through paddock lake, that i began to sob, thinking of the financial worry of all this.   my wrists throbbing, our health “insurance” a whopping $29,000 a year out-of-pocket, and i was sobbing, in the middle of post-injury shock, at the worry of the additional burden this would put on us.

and that’s pretty pitiful.  what a pathetic country in which we live that the first set of thoughts when injured is not getting well, is not healing.

i believe in an effort to more fully understand what i was going through, ptom told me he read a few blogposts written by or about people who had broken both wrists.  it occurred to me that might be a good idea so i googled them.

the first post made me made me frustrated.  after telling the story of her injury, deborah, who lives in new zealand, spoke about her experience with the socialized healthcare in that country.  i wept as i read the motto is “prevent, care, recover,” and there was no cost to her – at all – through diagnosis, treatment, healing, extra care helpers, rehabilitation, transportation.  she lost no work salary during the time of her recuperation.  every single thing was covered and paid.  she states that, “this has been a huge relief to me and has definitely aided in my recovery, because I’m not stressed.”

why am i so amazed by such a humanitarian approach to a nation’s care of its populace?  is that not of utmost priority?  should our population have to worry about seeking care to remain in or regain good health?  what kind of country does not put the health of its people first?

as we approached the hospital in kenosha we had a choice.  emergency room or urgent care.  i asked david to park by urgent care.  in the middle of pain emanating from both my wrists, two slings fashioned by ski patrol around my neck, i thought i remembered that maybe the co-pay or coverage would be more palatable in urgent care.  we sat in big red for a few extra minutes; i repeated i wasn’t sure what to do or not do.  not sure about the differentiation between urgent care and the emergency room, i thought we could at least ask if urgent care could handle what i presented – a need for x-rays and exam and treatment.

we walked into a crowded waiting room.  indeed, they could handle my injuries.  we waited hours with all the others there, many of them with masks covering their mouths and noses.  everyone looked worried.

a very kind doctor examined me, did x-rays, cast me, gave me directions and sent me on my way with follow-up to an orthopedic doctor in a few days.  at that office, a very kind doctor examined me, re-cast me, gave me directions and sent me on my way with a follow-up and more x-rays in ten days, a likely change of cast-type in four weeks, physical/occupational therapy on its heels and a standing invitation to see the reigning hand specialist whose expertise had been proffered.

and, of course, we haven’t received any billing yet.  i’m quite sure that will be the icing on the cake, well, so to speak.

or maybe i should say – that will add insult to injury.

read DAVID’S thoughts this MERELY-A-THOUGHT MONDAY

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healthcare.gov [flawed wednesday]

healthcare.gov

this could get ugly.  it could also get too honest.  and maybe too personal.  and too detailed.

this is the week.  i’ve been dreading it for months.  it is the final week to select health insurance for 2020.  sometime this week i will wait online for probably hours to take my turn, to take my turn to sign up for a plan on healthcare.gov. i have been awake all night on and off for weeks.

we are artists.  both of us.  neither of our jobs and none of the other work that we do provide health insurance or benefits.  we live in the state of wisconsin and have four options of healthcare companies on healthcare.gov.  an insurance agent pointed out that we could opt for short term health insurance (up to 360 days) instead of a regular policy, but those do not cover any pre-existing conditions, do not provide for physicals and most preventative care and are basically catastrophic plans.  hmmm.  as a grown-up who has been working my entire grown-up life, i would really like to have grown-up insurance.

so.  four companies.  bronze, silver and gold plans in each.  none of these companies provide nationwide coverage and a couple do not even allow for emergency room coverage out of network. two of those companies do not cover our doctors, professionals with whom we have established relationship through years; last year (2018) our coverage did not allow us to go to our own doctors, so we didn’t.  we paid for coverage and never visited the doctor’s office at all.

so let’s get more mealy here.  there are plenty of arguments about healthcare out there and plenty of naysayers and supporters -each- of the affordable care act.  are you even familiar with it?  if you would prefer not to know, i would stop reading here.  but if you really want to know more, please read on… but keep in mind, i love math and research.

we are 60 and 58 and healthy.  these four companies on healthcare.gov presented bronze, silver and gold plans that will cost between $1600 and $2800 per month out of pocket, which is a total of $19,200-$33,600 per year.  the $1600 options have deductibles between $14,000-16,000.  in many cases, this is what you must satisfy before the company even begins to pay a portion.   that would mean you have paid in the neighborhood of $33,200 a year for you and your spouse to be treated on a bronze plan, without figuring in the actual cost of the treatment.

let’s explore an example for example’s sake.

let’s say you make a combined salary of $70,000.  let’s assume a meager (and understated) tax bracket of only 20%.  $70,000-14,000 = $56,000.  now let’s assume you own a house or pay rent and your mortgage plus escrowed real estate taxes are about $1200 combined (also underestimated in most cases). $56,000-14,400 = $41,600.  add to that your utilities bills; let’s just estimate that at a lowish $250 per month, which is $3000 year.  $41,600-3000 = $38,600.  now subtract out for cellphones, home phones, cable, wifi again lowballing at $250 per month, $3000 per year.  $38,600-3000 = $35,600.  at this point you have not included any of your outstanding student loans or parent plus loans, nor have you subtracted out for home insurance, car insurance, life insurance, dental insurance, any kind of retirement savings or a car payment.  nor have you even considered food, clothing or gas for driving to and from work, even if you don’t drive anywhere else.  any outstanding rotating credit card debt or medical related costs that you are paying on installment are not subtracted.  but you are sitting at $35,600 usuable income.

so.  if you take the bronze plan you must assume that you have approximately $16,000 in the bank for the deductible and you must subtract $19,200 (27% of your gross income) from your $35,600 leaving you with $16,400 to cover all the aforementioned items we hadn’t subtracted and maybe perhaps saving a little to cover the percentages of medical expenses you need to cover post-deductible.  OR you can take a silver plan, which is in the neighborhood of $2200 per month or $26,400 year (38% of your gross income) leaving you with $9200 to cover loans, home insurance, car insurance, life insurance, dental insurance, car payment, food, clothing, gas, etc.  you clearly can’t even consider a gold plan at $2800 per month (the most grown-up plan) because that would cost $33,600 a year, leaving you with a mere $2000 to spend on the rest of life (as listed above).  again, that’s assuming a meager 20% income tax rate and not considering state or local income taxes as well.

i’m sure you are beginning to see my point.

and then there are the subsidies.  yes.  if you earn below 4 times the poverty rate in your state, you are eligible for subsidies for this healthcare insurance.  naturally, the more you earn, the less subsidy you are able to receive.  that makes sense.  it feathers out as the numbers go up.  and then?  there is a dollar level – one dollar this way or that – that a granted subsidy would drop from hundreds, even more than a thousand or fifteen hundred to – ZERO – .  for instance, if you are granted a subsidy because of your level of income and sometime in the year (as you have worked hard to earn more to live a little better) you go over the healthcare cliff by ONE DOLLAR, ONE dollar, you will owe back the entirety of the insurance plan.  in the above case, that would be anywhere between the difference of what you paid in and the plan total of $19,200 or up to $33,600.

we are the poster children of this so-called sweet spot in the healthcare crisis of our country.  a bit older, working hard, multiple jobs, no job-provided healthcare.  not making enough to scoff at spending say $29,000-$33,000 (silver or gold plans) or even $19,200 (bronze) for one year of health insurance, nonetheless be able to actually budget that, but making a bit more than the cliff.  no ropes.  no guardrails.  just a cliff.

the professional insurance agent on the phone said she had “a lot of people your age in that circumstance.”  she suggested considering short term health insurance, the kind i mentioned above that precludes pre-existing conditions etc etc. etc.  that doesn’t sound like grown-up health care to me.  and the deeply disappointed, frustrated cynic in me asks this question – when will breathing be considered a pre-existing condition?

something needs to be done.  is the health of the people of this country important or not?  it’s a basic question.  with an obvious answer.   where do we place value?

read DAVID’S thoughts this FLAWED WEDNESDAY

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