3.02.2010

the healthcare system is FINE.

i need to get a wisdom tooth pulled. the United States Navy did me the service of removing two of my four wisdom teeth way back when i was 18 or 19, as a matter of standard procedure for any sailor bound for the submarine service. i guess they didn't want to have to deal with emergency dental surgery while underway on nuclear power. of course, their extraction of two means that two remain. last February - almost exactly a year ago - i awoke the morning after the 2009 Atlanta Supercross with the right side of my mouth in excruciating pain. at first i thought it might be my inaugural cavity, accelerated by the amount of cotton candy i had consumed the night before, in an attempt to mitigate Lucas' intake of an astounding amount of sugar.

i went to visit my dentist soon after, where he examined me and took x-rays, et cetera, before declaring my discomfort was a result of me grinding my teeth in my sleep. i've spent the last twelve months occasionally wearing a night guard, brushing exclusively with Sensodyne, and avoiding chewing hard things. in that time, i can feel my upper right wisdom tooth beginning to break thru, and my teeth touching in different places than they ever have before. this week, i again called my dentist for another consultation, and within a few seconds on the phone he concurred that it must actually be a wisdom tooth. apparently he actually looked at the x-rays this time.

anyway, he had to refer me because he doesn't do dental surgery. it must not be profitable, or something. i called the dental surgeon he recommended, and they were more than happy to schedule the extraction of my wisdom tooth this week. during the hashing out of the details, i was trying to ask "how long will that take?" so i said to the nice lady, "so what does that look like as far as..." and she quickly answered, "yes - cost breakdown will be $70 for the consultation and $360-475 for the extraction," to which i replied, "oh - i'm not worried about that, i have Blue Cross....," and she then answered,

"we don't accept that plan, so you will have to pay for this in full on the day of the procedure."

i was silent for a few seconds, before quipping, "well, what the hell do i have insurance for, then?!?"
in what i could tell was a well-practiced script, she said, "alot of our patients ask the very same question, so i understand your concern." note that she didn't answer the question. she did say she would "file for me." i guess it's possible that i'll get a rebate, then?

something is definitely broken, if i'm paying almost $50 a month for dental insurance, which, from what i've been told, most dental providers have declined to honor. the reason i was given is because the insurance company's reimbursement of "reasonable and customary" fees are a fraction of what the doctors actually charge. and what, it seems, the general public is willing to pay out-of-pocket.

so, just what is fucked up? is it that insurance companies can dictate what medical procedures should cost? is it that doctors will charge the very limit of what the market will bear? or that they can, because like it or not, we need medical care? is it that insurance premiums are too high for the services (or lack thereof) provided? that's probably what pisses me off the most. i've been paying my insurance company $600 a year for the past 5 years (just for the dental coverage, mind) - a total of $3000 for those math-handicapped - and now i need $500 worth of credit from those assholes, that i apparently can't use.

even if the doctor did "accept the plan," i would still need to pay a deductible, and then 50% of the costs. so in essence, Blue Cross Blue Shield of NC has turned my $3000 of premiums into $6000 for them (or $1500 for me, depending on how you look at it - either way i'm getting bent over). i give you $50, but when it comes time to pay it back, you only have to give me $25, and only after i give you another $75. again, how is that not broken?

i have some amount of sympathy for the doctors. i know their malpractice premiums are ridiculous, because the law allows no limits on monetary damages. it is important to note here, however, that the companies getting money from us for health insurance are also getting money from the doctors just in case they screw up, in essence getting paid twice for every medical procedure ever performed in this country. of course, the one time a huge judgement is levied against the doctor or dentist or hospital and the insurance company has to shell out a hundred million dollars, they're going to be writing a check using money they made off their investment of my premiums. you just know they'll raise premiums again in response to the current legal climate, though, and make that back fairly quickly.

i also understand that at some level, a person can never be fully compensated for a loss of health or life from a doctor's negligence, however rarely that might happen. tort reform will aways be a sticky quagmire to wade through, as no lawmaker or judge wants to be the one to set a precedent regarding limited compensation for the one isolated incident where the doctor shows up drunk and removes the wrong half of the patient's brain. doctors are, after all, human just like me. they simply make (a minimum of) ten times what i do. i'm cognizant of the fact that eight (or more) years of medical school ain't cheap.

i can walk these circles in my head for days, and still not be real clear about anything except that at some level i always end up back at the unpleasant reality that i'm the end user, and i'm getting screwed. and i hate that feeling. moreso, i hate that i'm absolutely powerless over it. my options are seriously limited. i ruptured my spleen one time, and it nearly cost me $30,000. that was for 3 days in the hospital and an angioscopic procedure. luckily, i was uninsured and below the poverty level at the time, so the hospital took a charitable write-off. so yeah, it was free.

taking that into consideration, canceling all my health insurance and taking my chances in the E.R. when i seriously jack myself up is starting to look pretty good. even if the current "healthcare reform" bill somehow does get pushed through our horribly ineffective Legislative Branch and signed into law, the proposed legal penalty for not carrying health insurance ($750, i believe) is roughly 1/6th of what i'm paying in health insurance premiums right now.

and as i understand it, i would be able to purchase insurance any time i needed it, regardless of whether my spleen is already ruptured or not.

thanks a bunch, Blue Cross Blue Shield of NC - you will no longer be getting any money from me for that "dental plan."

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please set me straight -