Jul 25, 2008

The Costs of Being a Girl... Without Health Insurance

(First of all, I want to apologize for being so behind on updating this blog. My life has gotten quite busy, which is a good thing, but I definitely haven't updated this site as often as I should, or as often as I've wanted to. I do hope you'll bare with me until I can make more frequent updates.)

Today's post is brought to you by The American Health Care System. Due to failures in the system, this post is vastly underfunded, but luckily I've got plastic to pay it off...

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One you've started bleeding (down there) or having sex (down there) - if you're a girl - which I am - you're supposed to go to the gynecologist once a year to get the basic test. Swab in, swab out. Needle prick. No sir you have no STDs, thanks for coming. The whole nine.

Prior to getting super-high deductible health insurance (with a $3000 deductible, so I count that as no insurance at all), I didn't think twice about scheduling my yearly paps. The co-pays for the appointment, tests and pills were a bit annoying, but nothing that set me back any large sums. I barely went to the doctor anyway, so this wasn't a huge deal.

Then came contract life. It took me forever to get accepted for any health insurance at all. Finally, I got accepted to a high deductible program. That sounded like a good idea. I'm young. Somewhat healthy. Well, I know what's wrong with me, PCOS - ie, polycystic ovary syndrome - and the likelihood of my falling to the floor in pain due to anything other than a ruptured cyst is near zilch. That's what the high-risk insurance is for. Accidents. Not day to day, or year to year stuff. That's all out of pocket.

So my yearly health insurance, which covers nothing except a hospital visit (after I pay $3000), costs me, oh, $1600 or something like that. $1600 in case I fall down and break myself. That's important to have.

But it's not going to help me make sure I don't have cancer or any other life-threatening illness. It's not at all about prevention. It's about post-intervention.

Ok, so I'm really sensitive to screening before things happen right now because my dad was just diagnosed with prostate cancer. And while I know that I'll never have prostate cancer, I'm still very concerned about being at high risk for ovarian and uterian cancers due to PCOS and having, like, 2-3 periods a year (sans bc pills).

I want to be "good" and get tested yearly. I'm 24, nothing should be wrong, but it's good to be safe. Plus, I like to have STD screenings every once in a while, just in case an earlier one was wrong. It takes like 6 months for some of those diseases to show up on tests. And sometimes tests lie.

Anyway, today I was scheduled for my annual pap and checkup with a gynocologyst I had seen about a year ago when my cyst ruptured and I felt like death. She did an ultrasound on me then, and perscribed me - tylenol. At the time, it was cheaper to perscribe me it because I had good health insurance and I got a cheaper price to buy it under the cover as opposed to over. Those days are, apparently, long gone.

Although a few weeks ago I had a very, very painful period and pre-period period, and felt little alien slugs were attacking my innerds, I opted to avoid spending $200 on another ultrasound that would likely end with the words "take tylenol." Instead, I figured it made sense to schedule my annual pap with the doc, and then to ask her what was wrong with me then, or at least inquire as to what could be wrong with me given my symptoms, and go from there.

When I called up the gyno's office, they told me the annual appointment, sans insurance, would be $180. Ok, so $180 isn't a big deal. I mean, it is, but when you consider the cost to get better insurance that would actually cover that sort of thing would cost me about $180 A MONTH more, it wasn't so bad.

But when I got to the office today - I was running late - it turned out I missed the appointment with the doc. Which actually was a good thing, because I was soon informed that the $180 for the appointment did not include any costs of labwork. Umm... isn't that THE POINT of having a pap? Let's just scrape my cervix for fun, why don't we? Use the swabby stick as a paintbrush and have a little creative fun on the wax paper I'd be sitting on, sounds like a plan. Totally worth $180.

No one could really tell me how much the tests would cost. I guess they're not used to seeing people without insurance. Or with crappy insurance, like my insurance. I got such mixed answers today. The lady at the front desk said 100s, and then the nurse pratictioner who I finally went in to see said the basic pap test would be only like $35 - $50. I don't trust ranges.

What I really needed today, urgently, was treatment for my likely UTI. Yup, I have and have had a full-blown, painful urinary tract infection for over two weeks now. (TMI? Sorry.) I knew I needed antibiotics. I know when I have UTI. I get them all the time. This one was caused by drinking about 6 large glasses of iced tea and promptly getting on public transportation for about an hour. Lets just say my bladder was not a happy camper, and it made me pay for what I did to it.

At the doctor's office, I ended up getting a "talking" appointment with the nurse practicioner because she happened to have a cancellation. They had me pee in a cup to test my urine for the UTI. Again, no one told me how much this would cost me. I was told - well, the doctor will look at your pee, then decide if we need to send it out. And sending it out - would be a lab fee. Ok, how much am I looking at? $50? $100? More? Can't someone just give me antibiotics? I've been having UTIs all my life, I know I have a god damn UTI, I can tell you exactly how it happened. I can even reproduce the situation. Got any iced tea???

Well, I went into the examining room, and the nurse practioner came in to talk. She was really nice, but I could tell that she didn't exactly love that I was wasting her time. Well, I wasn't wasting her time, because she ended up charging me $65 for the appointment, but at least I left with a perscription for some generic antibiotics. Not sure how much those will cost me, but she said they're and old brand and should be cheap. Right now I'll pay anything for antibiotics, as that's what I really, really need.

However, this doc told me that it prob makes sense for me to go to Planned Parenthood for my pap and checkup, since it'll likely be cheaper. I was thinking of calling Planned Parenthood but I figured my income bracket would prob be too high for getting treated there. But this nurse gyno lady convinced me it might be best, and since I've never had an abnormal pap before, she didn't seem to think there was any urgent need for me to get the test done.

Maybe she's right. I'm 24, I have cysts on my ovaries, I get a period once in a blue polka-dotted moon and a UTI when the moon is full and white. What else is there to know?

Still, I want to get tested. So I left the doctor's office $65 poorer with perscription in hand.

... a few minutes ago I called up Planned Parenthood to schedule an appointment. I was told by a friend that it's better to tell them you have no insurance if you have high deductible insurance so they will see you. As, again, my insurance has such a high deductible it's pretty much no insurance, I didn't feel like that was much of a lie.

So I called and asked for the appointment. They proceeded to survey me about my age, ethnicity, and income. When they asked how much I make, I didn't know what to say. The truth would surely be too high for any sort of affordable care. But I kind of did tell the truth. I told them I'm a contractor. Which is true. They asked how much I make per month. I said, well it ranges. She asked what the low end was. I picked a number out of the air. $2500, I said. The truth is the low end is like $400 when I don't have a job and the high end is like $5000 when I do have a job. So I averaged it. What's $2500 a month? $30k a year? Not quite poverty, I guess, but the only way to get reasonably costed checkups in this country is to be poor, apparently. Not that I'd wish for that, but when I was making less than $30k, I had health insurance, like real health insurance. And now... well, you know... not so much.

So I figured on a sliding scale, $2500 a month income might get me some discount on all the tests. I was told, by someone else, that she basically got free care at planned parenthood. And she had money, it's just that she wasn't making any money. She was a grad student, but she had money, somehow. Anyway...

I was told I didn't qualify for a discount. So their pap would cost $300 (which, I think, includes lab services) which is MORE than what I was going to pay at the doctor's office this morning... she was going to do the exam for $165 plus lab fees. Well, she said the lab fees were "$35-50" - whatever that means. Maybe it'd be about the same. Still, so much for finding cheaper care.

Meanwhile, I found out that at Planned Parenthood, you could get birth control pills without a full exam. It'd just be $30 for an appointment and $22+ for the pills, depending on which ones you want. I guess most of planned parenthood's funding is really about not making babies, not, not having cancer (which makes sense. It's not Planned Ovarian Health Org). And the cost of a full STD screening at my "level of income?" $150.

I think all of this has me rethinking my career. I love my job. It's wonderful. But I just need REAL health insurance. So maybe I'll start looking for a job that provides that. I hate to do that. My company seems to have health insurance for "full time employees" (not contractors who work 40 hours a week) but even their health insurance, I think, is high deductible. I'm not sure, I haven't really looked into it, but it sounds like they all have HSA plans which means they must be high deductibles, I think. They're a small 8ish person startup, so they can't afford good health insurance. Can't blame them for that. But I don't even get that. Everything comes out of pocket. And my pretty good contract rate starts looking less and less good...

It's just hard to figure out the total cost of everything when it comes to healthcare. And in this case, the comparision between a year of being on crappy healthcare at $140 a month and having to pay for all health costs out of pocket and working as a contractor where I can work from home on some days and save on gas money, versus getting a "real job" with a salary and benefits, and having to go in every day and spend money on gas and extra travel time and being miserable and needing to spend money on a therapist.

It's impossible to really compare that. Maybe I should just pay $300 something a month for an HMO. I can't decifer if it's worth it. I have an HSA plan but haven't even opened an HSA account yet because that kind of seems like a joke. They charge you a fee to open the account, and to maintain it. It's basically another RothIRA, but I go for index funds, and then I have limited choice in investments, and - the kicker is it's not even tax-free in California. So...

blah.



11 comments:

Sallie's Niece said...

Wait, yikes, $300 for your annual? I got to Planned Parenthood and I think I pay like $50 for the annual and $15 a month for my pills.

They did say they wanted me to bring in my paystub next time though so I'm worried about it increasing.

I DO have health insurance but getting my pills at Planned Parenthood is cheaper.

I also have very very few periods a year when I'm off the pill. All doctors I've spoken to have assured me it's okay though.

For UTIs my suggestion is to keep some of the antibiotics for next time - usually two of those things will knock it out of my system.

Or when I have no antibiotics I will just drink a gallon of cranberry juice.

A friend of mine takes a cranberry vitamin once a day to keep them away.

Hope this helps!

her every cent counts said...

sallie's niece:

Thanks for your comment.

I was surprised about the planned parenthood thing too! everyone says they are so cheap, but I guess not when you make more than minimum wage!

I usually do keep pills around when i get antibiotics around. :)

Juggler314 said...

First off - you don't mention having an HSA (health savings account). If not you need to open one - this is basically a healthcare IRA. You contribute pre-tax and you get to use your funds for any health related expenses (doctor's visits, prescriptions, even over the counter stuff - think contact lens solution, regular tylenol, etc). Second you should still be paying less for healthcare even with a high deductible plan - you still have healthcare - this means your doctor will have to charge you the "negotiated" rate - much the same as if you had healthcare your insurance company is probably not reimbursing him $180 for the visit - might be only $105. You have insurance thus you should be paying that $105 - even if you have what, effectively, is a 100% co-pay.

And for sallie - always take the full course of antibiotics - the reason we have things like multi-drug-resistant TB now is that people don't take full courses of antibiotics. Even though you might feel better and pretty much be cured at that point, you need to keep taking them so that you don't encourage the growth of super bugs (what happens is the bugs in your system that need the full 2 weeks to get killed off, they don't die, but there are so few you aren't "sick" anymore, but if you get the same thing again, those are going to thrive and will be harder to kill off next time - eventually your antibiotics wont work at all - bad for the earth).

Amphritrite said...

I fully understand, and it's REALLY sad that there are people in this country -- one of the most powerful and richest countries in the world -- who have to avoid going to the doc because they can't afford it.

I grew up without insurance, and, with the stupid 90-day waiting period many jobs require to actually GET the insurance, I've found myself quite often without any help paying medical bills.

I'm also prone to UTIs - YES I know what it feels like. I can even tell you the three different prescriptions that I've used in the last three years. I can tell you why it happens, how it happens, and how often it happens. And I can tell you I'm in pain when it happens.

Do I really want to pay the doc $150-$200 so that he'll let me pee in a cup, give me a prescription I already know the name and dosage of, and so that he'll tell me to be more careful next time (as though I could prevent it. Geesh.)?

Heck. No.

Ugh.

For what it's worth, you have my sympathies.

KC said...

Ditto what Juggler314 said, please, please, take all your antibiotics. It really is important. I have decent insurance but for my last annual, they sent the pap out to a lab that was not on the approved list (I didn't even think to ask since the doctor was listed as approved) and the pap test cost me $75. Not huge, but not great. The co-pay was only $20 to see the nurse practitioner.

Juggler314 said...

FYI here's a nice authoritative source on why misusing antibiotics is bad:

http://www.mayoclinic.com/health/antibiotics/FL00075

note that it also points out overusing them is bad, which is why you should also strive to take them only when absolutely necessary.

Kati said...

I have PCOS. Doctors can't do anything for you on this one. Except give you a BC like seasonale/seasonique so you ovulate 4 times a year. Or you could do depo which should keep you from ovulating all together. I went 5 years without health insurance, with this pain in the butt pcos.

Sallie's Niece said...

I didn't mean to give bad medical advice really!

And sure I realize you should take the full course of your antibiotics.

But really, if you are having the extreme pain of a UTI and you know what you have why should you have to worry about getting an emergency appointment to see your doc, just so they can prescribe you the same thing? It's a racket if you ask me.

I can verify, however, that the gallon of cranberry juice works.

Emily said...

I had a very similar health care "plan" at my old job, with the same high deductible. Even though I contributed money pre-tax to an HSA, it went fast, as some specialists can be anywhere from $200-300. I wouldn't go to the doctor when I probably should have because I felt I should save my money in case of an "emergency." Not good.

That was a huge factor in me deciding to get a new job. As a PF blogger, you probably know the importance of adequate insurance of every type. If you got seriously sick, the bills can really derail any financial goals you may have.

I didn't particularly love my old job anyway, but having such terrible insurance didn't help, and having a job now that pays 75% of it makes me very grateful. Looking for a new job may not be such a terrible idea in your case. Or you can check out ehealthinsurance.com, they might have something better.

Juggler314 said...

yeah I have yet to spend money on anythin but contact lenses over the last two years or so from my HSA. Also I work for a great company, not only does my boss pay 100% of the actual health care cost, he deposits the $1500 deductible into our HSA every year (between the cost and the "free" money it's still cheape for the company than a traditional healthcare plan).

Cristina said...

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