Tag Archives: health insurance

Useless Financial Advice

The June 2012 issue of Smartmoney magazine featured two popular types of finance articles – a how-to piece about saving money on health care and an interview with a policy expert about rethinking retirement.  Both of these are big topics in the world of finance; after all rising health care costs and inadequate retirement savings are two things that affect each and every one of us at some point.

I admit that the health care article was thoroughly researched.  In addition to standard advice about negotiating with your doctor and finding cheaper meds via mail-order or getting generics, it has some tips for questioning tests ordered by your doctor, going to physical therapy and timing your dental work in one calendar year to save on your federal tax bill (provided your medical bills exceed 7.5% of your adjusted gross income).

The interview with psychologist Laura Carstensen, an expert on aging, focuses on making the most of retirement.  She offers several “solutions” for overburdened social security system, from increasing the retirement age to creating a “phased retirement” based upon a moderately paced career path with more flexible schedules (assuming this will cause less burn-out and allow us to enjoy work longer).

In my opinion, these types of advice articles, and there are many similar ones that periodically crop up in print and online, are practically worthless because they ignore real solutions that would actually help the majority of people. 

I understand that there are times you can negotiate with your doctors and hospitals.  However, when you’re really, really sick or your loved one is truly sick and facing astronomical costs, are you in a frame of mind to negotiate care and bills?  Most people are not and should not have to. When my European friends have to undergo major surgery or treatments, all they have to focus on is getting better or caring for their loved ones.  When you’re scared and facing new and complex medical terminology, the last thing you want to think about is how you’re going to pay for care.   These types of articles ignore the human side of things, as if it’s negotiating for medical care is the same as a cable bill!  You can throw all the great advice about getting a detailed bill and scanning for medical overcharges but who the hell wants to deal with that during a time of crisis? (And while I’m ranting, who the hell has the time to figure out if their anesthesiologist is also “in network” like their doctor or hospital?)

A friend had a child in intensive care, racking up hundreds of thousands in bills.  Although she had insurance, she still had to pay quite a lot out of pocket.  The worse part is that she did not bring home a completely healthy child.  As she received mysterious bill after bill, she also had to focus on caring for her sick child.  I’ve read similar stories of parents desperately fundraising for their child’s care.  I can’t believe that anyone should have to worry about finances at a time like that.  It’s fine that some people pay more for cable or airplane tickets because they’re bad at negotiating or comparison shopping.  However, this should not be a consideration when it comes to essentials like health care.

In the retirement article, one key point is that we must work longer to make our finances last longer.  The interview states that 88% of people 65 to 74 are healthy enough to work.  Great advice, in theory.  The reality is that the majority of older people who want to work longer simply can’t.  While some climb high enough up the ladder to enjoy respect or can jump into consulting, many more people face age discrimination and are the first to be laid off.  It’s great that 88% of older people could work; however, how many companies are eager to hire these people? The expert also states that longer careers would be possible if we all didn’t work so hard in the “middle” years.   While  I do know people who have opted out to go back to school, which is not really a break, or to travel, most people who ramp down or opt out of work do so to care for kids or parents.   The majority of these people don’t find great jobs after their “break”.  I’m not saying that we can keep the current retirement age or benefits as is, but the typical solutions given in money magazines are not very realistic either.

The lack of reality is what bothers me most about discussions addressing health care in the U.S. and retirement.  They seem to be made by the upper echelons who have little or much less to worry about in terms of finances, with little regard for how the majority of people will be affected.

I’m even more bothered that many regular middle-income people I know seem to feel the same way, especially if they haven’t been personally affected by serious health issues or reached retirement age.  I want to know if they will feel the same if/when they face a serious illness or if they have a sick child.  And when they reach age 70, I wonder if they will re-think how great or easy it will be to work longer….maybe they’ll get lucky and Walmart needs a greeter.

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My Idea Of Simple Living Doesn’t Exist

For some, simple living means leaving urban areas for rural farmland, preferably with a vineyard, animals, and fields of lavendar.   For some, it’s about staying home with the kids.  While I understand the appeal of these common dreams,  I’ve realized lately that all those fantasies have their complications.

A rural life can be back-breaking and tough financially. You trade suit and tie for mud-covered overalls.  You don’t clock in at 9 am to 5 pm  but you probably work dusk to dawn if you need money to survive.  Of course you can run a bed and breakfast in Tuscany or Provence or other more “rural” paradise, but you need a lot of money to buy into that dream (and it requires work also).  Less commuting and less office politics would be a welcomed bonus however! 

Staying home with kids holds obvious appeal for many exhausted working parents.  But it’s important for me to remember that I wouldn’t be spending hours and hours reading to them, walking in the park or just playing with them.  I would have to do a lot more laundry and house cleaning, too!  It’s not that I’m spared those chores now but I definitely can offload many chores and errands due to my work schedule.

So other than rural escape or quitting my job, what is my ideal simple life?  The answer: A life free from mounds of paperwork, bureaucracy and bills.  If only I could live life without having to call so-and-so about an incorrect charge on my bill, write letters to insurance companies, call my cable or phone company to renegotiate my rates, or fill out forms ever again.

This is probably at the top of my mind because I’ve had the pleasure of dealing with both the government and private insurance for a myriad of reasons.  I know the words government and bureaucracy go together while corporations are seen as more efficient.  That may be true if you compare the government with Walmart or Coca-Cola, but if you compare the Big Government with Blue Shield, Cigna or any private health insurer, you’ll soon get a huge headache with rude or inept customer service reps, overwhelming bills, billing errors and paperwork, too. 

I supposed I could simplify this area of adult life if my husband took care of everything but I don’t think it’s a good idea to step back that much or be that clueless about finances and other bills/paperwork that affect us both.   Maybe that’s why we cherish our childhoods so much. That’s when our parents scheduled doctor appointments and dealt with all our bills! 

Other than running off to a tropical paradise and living off the land, is there really a way to escape from paperwork?

Evil Health Insurance Company, Why Do You Bother Denying My Claims?

Over the past three years, I’ve gotten quite good at battling my health insurance company, or hereforth known as Evil Health Insurer, for their denial of office visits and diagnostic tests recommended by my doctors.  I have to thank the internet for my newfound expertise. When my insurer first denied a legitimate visit to a specialist, I did some research and found very helpful tips on letter writing and on navigating the process in general.  Using these tips, I wrote a letter and included documentation to back up my claims.  A month later, they said I was correct and paid for the visit.

Since that first victory, they’ve denied various claims (for the same medical condition) at least four times. I’ve lost count.  Each time, I pull up my letter template…yes, I now have a handy insurance letter template…fill in the blanks, and re-attach supporting documentation from my benefits manual.  I recently won my latest battle and I admit that I’m feeling cocky enough to post about this. I want to say or shout from the rooftops:

Dear Evil Health Insurer,

You may screw over millions of people just when they need healthcare the most but you’re not screwing me. In fact, the next you see a letter from me, why don’t you just approve the claim without re-reviewing the case because you know I’m right!!!

Or better yet, why don’t you stop denying legitimate claims in the hope that the victim is too illed, too uneducated, or too busy to fight back?  I truly cannot believe that each denial is an honest mistake. I saw Michael Moore’s “Sicko” and have read enough horror stories to know that this is simply how most insurers conduct business.

Hopefully this post will become irrelevant if healthcare reform actually goes through. In the meantime, here are my tips if you ever get denied:

1 ) Your letter should not be emotional.  Be as factual as possible. Throw in legal-ese if you can!

2 ) Send your letter via certified mail. Don’t bother calling more than once. A paper trail is critical.

3 ) Back it up! Copy pages from your benefits manual that support your claim.

4 ) Keep a copy of your letter and use it as a template if/when you are denied again in the future. This saves a lot of time and makes the process less of a headache.

You can also ask your HR department for help if you’re not able to resolve this on your own. Remember, most people don’t fight back and insurers know this. They are more likely to approve your claim if you’re one of the few who bother to fight back. I don’t know if fighting back counts in my “Just Ask! Negotiations” challenge.  After all, my company and I pay for health insurance and expect legitimate expenses to be part of the deal. It’s not the same as asking for a better deal on rugs or shoes.

I’ve left out the name of this Evil Health Insurer because they’re all pretty much the same so I don’t feel the need to single them out by name