August 13, 2010

Health Care as a Human Right

I want to say right off the bat that this post is coming from a very emotional place, not a political one. I don't pay attention to politics much - I know, it's a bad habit - but politics depress and frustrate me. A lot. (Those of you who are politics-savvy should point me in the direction of good websites that will deliver the facts about issues. Please and thank you.)

Here's what's been going on behind the scenes here.

We have United Health Care as our insurance company (through Roy's work). $500 a month gets taken out of Roy's pay every month for this. And that's not even for top-of-the-line coverage. I think that's way excessive. So does everyone else who finds out how much we pay a month.

We are using a midwife at a birth center for the birth of our second baby. You guys know how I feel about the state of maternal health care within the medical model, so I will skip the soapbox on that and head straight for how we're paying for the birth of the baby.

The cost of all my prenatal care, the birth, and my and the baby's postpartum care is $5,500. Total. Unless you've been living under a rock, you know that is an amazing price for (quite frankly) wonderful, loving care from my midwife and her student midwives. You also probably know that it costs a lot more than that to give birth in a hospital, even if you give birth vaginally.

The birth center will file insurance claims on behalf of the families that birth with them, which is great, but they still require their families to be on a payment plan for the $5,500. The hope is that when all is said and done, each family who is insured will be reimbursed at least some of the money they have paid for their birth. This is possible because the birth center bills each insurance company the maximum allowed, knowing that the insurance company will chop that amount right in half.

When I found out I was pregnant with Burt Reynolds, I called the insurance company and set up a gap exception for midwifery care. To my understanding at that point, setting up that gap exception would be the most likely way we'd see any money back after the birth of the baby. It was very easy to set it up, and I was very pleased and hopeful that the rest of dealings with insurance would be smooth sailing.

But I was wrong. Just so completely wrong. There are way too many details to share here, but let's just say that the insurance company closed my gap exception case and has denied all claims from the birth center. Actually, they aren't denying all the claims - they are applying them to my out-of-network deductible, which, if I am understanding it correctly, wasn't supposed to happen if the gap exception was in place. My out-of-network deductible is $3000. So basically, even though we will end up paying $5,500 (and already have, actually, since we paid off our balance), almost all of the allowable charges will be applied to the deductible. Once the deductible is met, we are STILL responsible for 45% of the charges. WTF.

Every time I call to find out about the gap exception, no one has a clue what I'm talking about. I get bounced around from department to department, and no one knows what to do. The insurance people that the birth center have been in contact with apparently fall off the face of the earth after their conversations, because we haven't been able to reach any of them again.

We are facing the very real possibility that we will see no money back after the birth. From an insurance company that we pay $500 to EVERY SINGLE MONTH. And let me just say that every month we are actually going in the hole because we are paying out the ass so that we can continue to have health care coverage.

It is ridiculous and sad that we have to worry about something like this while preparing to bring our second child into the world. It is a sign that our health care system is one where people constantly fall through the cracks, even white, educated, middle-class people like us. And yet there are people out there who will deny the need for health care reform. There are people who will look at Obama's solution (which isn't perfect, I know) and shout "SOCIALISM!" There are people who will say, "Well, I guess you should have gone with an OB in a hospital for this birth."

I shouldn't be penalized for having the birth that I feel is safest for myself and our baby. Period. And yet that is exactly what's happening here.

One of my Facebook friends summed my feelings up pretty well:

And if you don't want the government to step in to provide welfare and health care, then start caring for your neighbors when they're down. If there was a strong social safety net, the entire discussion of welfare and universal health care would be moot. The fact is, such a safety net doesn't exist, *especially* in America. So instead of ranting on about "socialism" (which the vast majority of Americans have no idea what it is and isn't), do something in your own community to promote such a safety net so that the government wouldn't be inclined to do it for you.


Health care is a human right. It is my right to have a safe, empowering, healthy birth, so that perhaps this time around I can avoid a cesarean and I can breastfeed and bond with my baby the way I didn't get to with Charlie. It is my right to pick what I feel is best for me so that I don't end up with PPD again and so that I'm not completely traumatized by what is a completely natural event.

Why do I have to fight so hard for these rights?

The short answer is I shouldn't. No one should. But here we are fighting on the front lines for a just health care system that will take care of all of us. You can call it "socialism" all you want.

But I call it "empathy." I call it "compassion."


Amanda said...

I can't even begin to tell you how much I agree with you. Health care is a human right. We shouldn't have to fight corporations only interested in the bottom line to get medical care.

I am sorry you are having to go through this.

alejna said...

You must know I agree with you about this.

And while you say that this post is personal, and not political, I would say that this in one of those cases where the personal is very much political, and in an important way. It matters for people to speak out with real experiences.

I'm also sorry you have to deal with this. It's ridiculous what the insurance companies get away with.

amber said...

I'm so sorry you're having to deal with insurance company hell. I used to be an office manager at a doctor's office and spent a large part of my day fighting with them - both on behalf of the doctor and the patients. The whole system is all kinds of jacked up.