Toilet Paper

When I first moved out on my own, I adapted surprisingly well from living with my parents and roommates to being completely independent. The week I signed my Teacher’s Contract, I immediately scouted apartments. I knew exactly which part of town I wanted to live in and I was confident I could afford the rent as well as all of the living expenses. I made sure to have the basics: utilities, phone, water and I could even afford cable! I was not fazed by the cost of groceries or laundry detergent. However, it was toilet paper that always made me cringe. Was the expensive brand really worth it? What was the big deal about 2-ply? Can I get by only buying a 4-pack or do I need to stock-up?

For some reason, no matter how much I spent at Target on toothpaste, baking soda or Windex, it was the cost of toilet paper that I could not accept. However, eventually I submitted to the fact that TP was as a necessity. Eventually, I stopped cringing. Finally, I agreed that the “good stuff” was worth it.

Health Care is my new Toilet Paper.

I explained to you that, as a retiree, I can keep my current insurance on my group health plan by paying the monthly premium of $517 to Special School District. When I first heard that number, I was appalled! How could one person be expected to pay that for health care each and every month? Then, I continued my research. I called various insurance companies and requested information for private insurance. Immediately, one company told me that I was uninsurable. Another company hesitated, then sent me a detailed application. Upon completion of the application, I was again rejected. Frustrated, I reached out to my PT Facility’s Office Manager and asked for direction. She suggested that I contact her insurance broker. She assured me that, out of all of the insurance companies available, there had to be at least ONE who would accept me and my preexisting condition.

After contacting the broker, I received this email:

Stephanie,
Unfortunately, you would be an automatic decline for individual health insurance, based on your previous medical history. Since you have the option for COBRA after your group coverage ends, you would also not be eligible for the Missouri Health Insurance Pool. I am sorry that I wasn't able to help you! After your COBRA runs out, I would be happy to help you obtain MHIP coverage.
Please let me know if you have any questions.
Thanks,
Ashley

Seriously? I was rejected again – but this time, by THEE agent of all agents. That settled it. Private Insurance is NOT an option for me.

We contacted Gage’s school district, praying that their Group Plan would me more affordable that SSD’s plan. WRONG! His district charges $590.00 per month for spouses.

As I said in my previous blog, Medicare and Medicaid were no longer options, either. Either we were above the poverty line (Thank God!) or we had too much in a savings account or I did not have the “right kind of” disability according to their eligibility requirements.

I then got out my calculator. $517 each month is $6,204 per year. Would I save money by just paying for all of my doctors and appointments out-of-pocket? Since I require weekly PT visits, I started with that office. Because I have such a strong relationship with The Facility, the Office Manager and The President offered me a deal: Instead of the regular $200+ cost per visit, they would offer me a cash discount of $50 for the first 30 minutes and $25 for each additional 15 minutes. My visits are 45 minutes long = $75.00 each week. That is about $375 per month for PT alone. Okay – that is cheaper… Maybe I’ve got something here. Then, I looked at my last doctor’s bill. A 20-minute check-up with my Primary Care Physician costs about $150.00. And, a visit with my Pain Specialist is the same, without the cost of any injections, which are an additional $200 dollars. This does NOT count my prescriptions. For one medication alone, without insurance, the cost is $80.00. I currently am on 5 prescription medications each month. If each cost an average of $80, then that is an additional $400 per month. During a busy month, where I saw each doctor, PT and filled my prescriptions, I would pay a minimum of $1,275.00.

After all of the calculations and options, SSD’s Group Health Plan of $517 per month was starting to look a lot more appealing than venturing out without any insurance at all.

Bottom line, I need health care – and right now, I do not have choices because of my disability. I can pay my district $517 or I can pay Gage’s district $590 each month. Both offer the same options: health care, vision and dental with 60 PT visits and comparable co-payments and deductibles.

Thankfully, God is finding unexpected ways to bless me and the incredible cost of monthly premiums is not as terrifying as was when I first discovered the amount two months ago. I cannot wait to share with you exactly what these blessings are in my next blog – so keep reading!

For now, it looks like as of August 25th, I will be taking over my monthly payments and shelling out over $500 for health care. Health care is about 100 TIMES the amount of toilet paper, but hopefully, one day, I will adjust to this new expense just like, years ago, I came to the realization that you cannot live without TP…

Health Care CRISIS

I just spent the last two days on the phone with insurance company after insurance company. My employer has been generous enough to cover my insurance benefits for the last year. This ends on August 31st. After August, I have a decision to make: do I continue to keep my current health care plan, paying a very large amount of money each month, or do I look for a new, individual plan and hope that it is more affordable?

In order to keep my current plan, I have to get approval from the school board to ALLOW me to pay them $517 each month. Yes – I have to pay over $500 a month just to keep the health care that I currently have.

I know that this is the way the cookie crumbles. Nothing is free. Everything has its costs. Health is no exception.

I began my journey towards finding a new, independent insurance company last week. I got a few quotes that were significantly less than my Group Plan; however, there is always a catch. One company said that they would accept me – which I’ll get to that in a minute – however, they will only allow 20 physical therapy visits a year and the PT copay is DOUBLE my current plan’s copay. Last year, my plan covered 60 visits, and I got an extension for 20 ADDITIONAL visits because my pain management required it. If I chose this new plan, I calculated that I would pay $1,200.00 in copays PLUS an additional $4,000.00 out of pocket JUST to get the same number of visits that I received this past year for $900.00. This does not count the $1,000 deductible. That is a total of $6,200.00 CASH for Physical Therapy visits ALONE!

But, I need it. I cannot go a week without physical therapy. I am not a person who can “get by” without health care.

I thought to myself, “There have got to be other options for me!” So I kept searching. One insurance company actually told me that I am “un-insurable.” Because of my (you all know this word, say it with me,) “PRE-EXISTING CONDITION” I am a liability to the company. They refused to cover me.

I could not help myself; I started crying. It felt like they told me that I was not WORTH insuring – as if my health and happiness is not worth their coverage.

I started looking into government healthcare. I researched Medicare, which is supposed to be for people who are under 65 years old and are disabled. That’s me, right? Finally, coverage I can afford! But wait, there’s a catch. There is always the fine print: my household needs to make less money to get more affordable healthcare. Oh wait, there's more! There is the SPEND-DOWN PLAN that the government encourages for "people like me." This plan requires that Gage and I spend every cent in our savings accounts, sell our cars and any property that we can liquidate and then, when we do not have another penny to our name, apply for government assistance. Of course, we must prove that we spent all of our money and sold every one of our belongings first. That makes sense, doesn't it? The government is now ENCOURAGING us to spend rather than save before we can get disability assistance. And, the government expects for my husband, who makes a teacher’s salary and supports his household on one income, to be able to afford independent health care which costs as much as a house payment every month. To me, there is something terribly wrong with this picture!

Gage has said this again and again, “Health Insurance should NOT be a company that is allowed to make a profit.” But, in America, billions of dollars are made each year on peoples’ diseases, cancers, pains, illnesses and even deaths.

To me, that is just WRONG!

Unfortunately, I do not have a choice. I need health care. I cannot afford NOT to spend money on insurance. I am in pain every day of my life. I am certified as a Disabled American. I take up to 12 pills and 5 supplemens a day to manage my condition. Regardless of all that, to me, it is the health care system that is making me sick.