For Better or Worse

A week ago, July 1, our health insurance policy changed. I don’t know if it’s for better or worse, but it’s certainly going to be more expensive. The hospital where Al serves as a social worker changed corporate owners, and belt-tightening is their M.O. So now we have somewhat lower monthly premiums, but much higher out-of-pocket expenses.

As in a four-figure “deductible”—read, you have to pay this total for your health care appointments and treatments before the plan’s coverage kicks in. Then, once you hit that threshold, you pay a set percentage of the allowable cost (defined by the insurance company, as opposed to the medical provider) of care. But you have to pay close attention to who’s in the approved network, or your share goes from 20 percent of allowable cost to a whopping 75 percent.

Are you following me?

I have been reading through the online summaries, at least five pages of dense tables, that explain what you owe for which kind of service—regular appointments, preventive care, emergency care, in-hospital, out-patient procedures, on and on. But I’m going to have to call Member Services before my next appointment to be sure I understand what I’m supposed to do and not incur unnecessary expenses because I forgot to get pre-authorization or picked the wrong place to have a test.

Basically, I’ve concluded, we’ll be paying a lot up front within a few months, because I have a lot of expensive appointments. It may be fall or winter, even, before we begin to see the benefits of the insurance coverage. And that also depends on when the deductible year starts. Is it in July, when our new coverage began? Or is it in January, as the online tables states? In which case, we’ll be, basically, screwed.

And how do we cover that, I wonder? Work harder? Get more contracts? Al’s salary is fixed for the year. So it’s up to me to find additional income to pay for this up-front expense. Or we’ll have to borrow from our equity line. Or something.

I understand the drive to create incentives for medical consumers (i.e., patients) to choose doctors wisely and to be sure that any procedures are necessary and cost-effective. That’s good business and good medicine. I get it.

But it would be nice if the new, more expensive health insurance plan that is saving the employer plenty of dough would also be accompanied by some significant financial assistance for employees and their families to make the transition. Plans with large up-front deductibles penalize individuals like me, with complex, chronic medical conditions not of our own making or choosing, who may or may not have the ability to earn enough extra income to fill the gap.

I realize that I’m still fortunate to have comprehensive medical insurance through Al’s employer. I have not checked the Massachusetts health care exchange to see how much it would cost for my coverage if he didn’t have access to a good plan. I’m hoping and praying he has the energy and good health to keep working (not to mention, a good job) until I’m eligible for Medicare in a few years.

A friend who is an expert in health insurance, whom I consulted when we first learned about our options, tells me this kind of medical reimbursement insurance plan is just the latest trend. We’re catching up here in Massachusetts to what the rest of the country’s employers are already offering.

But it’s going to get more complicated, she says: Next up, narrow networks. That means, regardless of who your docs are, your health insurance carrier will limit the physicians they will reimburse to ones that they deem are providing the highest quality care for the least cost, based on a raft of comparative data. Again, from a global perspective, this makes sense. But if the physician you know and trust doesn’t make the cut, you’ll have some difficult choices to make.

For me, right now, no choice but to stay informed, ask a lot of questions ahead of time and keep close track of those invoices. One way or another, we’ll make this work. I just wish it were simpler to understand—and that I didn’t feel treated like it’s somehow my fault that I have this expensive-to-manage disease and have to shell out, regardless of ability to pay.

Photo Credit: Images_of_Money via Compfight cc

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at



  1. Pat Bizzell says:

    So sorry this nightmare has come true, Ev–like you are being punished for having that chronic, complex illness. And what in the world do people do who don’t have access to knowledgeable friends, or experience dealing with complicated written material to puzzle out for themselves?

    I fear you are the canary-in-the-coal-mine for all of us aging Boomers.

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