Insurance
Ok. So here’s my rant about insurance.
Three years ago I weighed over 250 pounds. For my sex and height, that put my squarely in the Obese category. I was fat, unhappy, and unhealthy. But at that point I had not experienced any medical problems resulting directly from my weight. In general I would have said I was in good shape, not that round is exactly an optimal shape. I was resigned to the fact that I was just heavy thanks to genetics and other factors that I could not control. But in actuality I simply wasn’t eating right or being active. If I had continued down that path, I have no doubt in my mind that my health would have gotten worse and worse with every year that passed. Obesity is the number one growing problem in America. According to the JAMA (Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. Journal of the American Medical Association. 2002;288:1723-1727.) “Nearly one-third of U.S. adults are obese (BMI > 30).” And another third are overweight. So that means, for all you math majors, only one third of the American population is at their ideal body weight.
I don’t think I need to list all the diseases associated with obesity, but diabetes, heart disease, stroke, hypertension, gallbladder disease, osteoarthritis (degeneration of cartilage and bone of joints), sleep apnea and other breathing problems, and cancer (uterine, breast, colorectal, kidney, and gallbladder) immediately come to mind. All these obese people come with a price. “A recent study estimated annual medical spending due to overweight and obesity (BMI > 25) to be as much as $92.6 billion in 2002 dollars (9.1 percent of U.S. health expenditures). http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.219v1/DC1. ”
If I had continued on the path I was on, I would have been a financial burden to myself, my insurance company and my country. They would have to had treated me for any number of costly conditions. But instead, on my own, I decided to lose weight. And again, that expense was out of pocket. Supposedly you can now write off any Doctor recommended weight loss attempts on your taxes, but I missed that boat. If you figure I spent $10 a week at weight watchers, for 2 and a half years until I hit goal, you arrive at $1300. Now add to that all the weight loss accessories like clothes, cookbooks, gym memberships, bikes, sports teams fees, health food, and various other thing, that number could easily double or triple. The result was that I lost over 100 pounds, and I gladly would pay that money all over again for the results I achieved.
But I was left with, what I feel, is a medical condition of lose and hanging skin. So now I embark on a $5000 surgery. Elective surgery they say. For insurance to cover the procedure, I would need to have a long and documented history of severe rashes, back problems from the hanging skin, or some other serious medical condition. Nevermind that I’ve saved them thousands and thousands of dollars for my future treatments by losing my weight. Insurance is such a scam. I remember reading about one insurance company that covered the prescription Viagra for men, but would not cover one woman’s birth control pill. How messed up is that?
My point is that I feel in America we often wait until the last minute to solve our problems. We ignore the old adage of “An ounce of prevention is worth a pound of cure.” It’s too easy to wait until someone has a problem to solve it, instead of preventing it all together. We end up rewarding the people who don’t take care of themselves and punishing those who do. Insurance reform is long due in this country, and there are plenty of cases that are far, far worse than my minor gripe. I just hope in the future the power will shift from the big business of health care and prescription drugs and move back into the hands of the people.
April 21st, 2005 at 12:09 pm
I totally agree. Insurance has become such a money making business that we continue to work to treat instead of cure. Someone like you who takes their health care into their own hands is punished because you arn’t following what they deem to be the proper protocol. Only thing I have to say is, just think of how bad it is who have no insurance at all. In a country with our vast wealth (and waste) we should have a national healthcare system instead of the best treatment going to those with the money to afford it.
April 21st, 2005 at 12:43 pm
In principle I’m in favor of national healthcare for all citizens. What needs to be done is look at Canada, figure out why they suck, and do it right down here.
The current MinnesotaCare fiasco is a good example of the short sidedness of politicians. Mr. cheapo-lenty wants to cut state sponsored health care for the working poor to balance his budget. What he doesn’t talk about is that costs will GO UP in the long run, but those added costs will be shifted to the hospitals who will end up giving free care to people (and since no preventative health care was available, their illnesses will be that much more costly to treat) and to all consumers in the form of higher premiums.
But, since Pawlenty’s budget will be balanced, he’s a happy camper. Who cares if thousands of people will be unable to access reliable preventative health care and those costs will impact everyone… right?
April 22nd, 2005 at 12:13 pm
From Suzi on MakeMeHeal.com
Erica,
I admire you immensely for taking control of your life and losing the weight on your own. As an overweight person, I truly understand just how incredibly difficult weight loss can be. True, in this society, we punish those who take responsiblity for themselves and reward those who do not. It’s crazy, mixed up and not fair. With that being said, I had my abdominoplasty covered by my insurance. I had three kids in less than 2 years (twins, quickly followed by a 10 lb boy). Both of the births were by c-sect and both wounds opened up and I had to have packing for several weeks -this greatly undermined the integrity of my abdominal wall. My abd muscles were so lax that my insides were literally falling forward causing some back pain. I had a hernia the size of a cantelope originating from my old c-sect scars. I also had a couple of hernias in my upper abs. My skin on my stomach was so stretched out that it hung below my pubic area. With all that being said, my insurance company had the audacity to tell me that my abodminoplasty would be for cosmetic purposes only. Like I would not have any positive medical outcome other than looking better. OHHHH! I was so angry that I decided to fight. I did alot of research and found a paper written by accredited plastic surgeons from the American Society of Plastic Surgery that explains when an abdominoplasty is considered a reconstructive procedure vs a cosmetic one. They list certain criteria and you certainly fit a couple of the criteria. I used the paper as a reference in my insurance appeal letter and I think it was the reason that my appeal was successful. How can the insurance company argue with accredited plastic surgeons? I had the surgery 11 mos ago and it has been a total blessing. If I were you, I would try to fight the insurance company through their appeals process. It is so worth the fight. You will save thousands of dollars. Here is the link to the paper: http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZ8ZX32NAC&sub_cat=600 Click it, read it, and copy it. Use it to fight for your right to coverage. Find out what your insurance companies definitions for cosmetic surgery are and what their definitions for reconstructive surgery are and see where your situation lies. I live in CA and have an HMO (Blue Cross of CA). HMOs are known for being stingy but they are not above the law. You have rights. Let me know if you need any further information. Good luck!
Suzi in Sac