Healthcare responses

Please contact me with any stories, comments or questions… how does the healthcare system work for you?

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2 Responses to Healthcare responses

  1. Claire Huttlinger says:

    Ana Grimaldi

    Ana Grimaldi defies her 50 years with her spry gestures and youthful features. Her wisdom and experience are evident, however, as she relates her story.

    When her husband, Thomas, was awarded an internship in New York City in 1994, Ana left her job as a social worker in Boston, and with it her insurance benefits, to join him. Although Thomas was covered through his internship, Ana was unemployed and had no coverage. Shortly after this move, she discovers she is pregnant.

    The couple moved back to the Boston area where Thomas began building a small business, and Ana stayed at home to care for their child, now five months. While Thomas had health insurance through an organization for the self-employed, and the baby had Mass Health, their wife and Mom has no access to health insurance. Furthermore, even the child’s healthcare was up for yearly re-valuation and rejection if Thomas’s income went up too much.

    Shortly before her son’s first birthday, and sooner than she would have preferred, Ana re-entered the work force with the sole goal of acquiring health insurance. Despite her Master’s degree, she earned barely enough to cover the 35 hours of child care per week, and her healthcare premiums. Ironically, she worked at an employee assistance program that provided resources for people who worked who worked for private companies.

    Both Ana and her husband had limited plans with high deductibles. Inevitably, costs accrued: Thomas became ill and needed hospitalization and the family was slapped with the $500.00 deductible; later Ana incurred over $6,000 in dental bills for oral surgery to save a tooth, not covered by her plan. They put these expenses on a credit card and avoided the high interest rates by flipping cards and looking for the best deals. Ana moved into a full-time job, and soon discovered that she was pregnant with her second baby.

    This time she had Mass Health coverage for her as well has her children, as her husband’s self-employed insurance group did not extend feasibly to her. They lived with the insecurity that they might lose their health insurance from one year to the next due to a change in either Thomas’s income or the state requirements for eligibility.

    The family moved to Western Mass, and Ana went back to work part time when their daughter was 7 months, again, with the sole goal of getting stable health insurance. This time, of course, the childcare was double, and the commute to and from work added an hour to the time the children are in care. As a clinician, Ana needed to see patients for twenty hours weekly at least in order to be eligible for the health insurance.

    Nevertheless, the couple had a load of yearly paperwork. They would sign their names to cryptic legal statements, despite being educated, they did not fully understand. They assumed that if they answered everything honestly and accurately, that they would be safe from any accusation of fraud. They were never entirely sure their children are eligible for Mass Health. Although Ana and Thomas later divorced, the family’s finances survived a heavy healthcare burden because they were educated, savvy, and were willing to take some calculated risks. They were never faced with a catastrophic illness, and most fortunately, there were no serious health incidents while Ana chose to stay home with her baby rather than go to work.

    The kids, now 18 and 16, will eventually age out of Mass Health program (sooner if they don’t go to college), at a time in our country’s history when the prospect of getting a job that offers insurance is lower than it has been in a 2 generations.

    Ana now has a private practice as a mental health clinician. She bills health insurance companies, including the state-funded Mass Health and its affiliates. After barely being able to afford healthcare as a young mother, she now sees much of her hard-earned income flowing back to the insurance companies.

    Of her yearly earnings of about $60,000, some $2,400 a year goes to pay a bookeeper just to manage insurance payments. The cost in time is also considerable:
    of a 90 patient session, 15 min estimated is spent discussing insurance, acquiring and documenting information required by the insurance companies, calling the companies to get authorizations for medications and visits. These authorizations must be resubmitted every so many months, 3 or 6, depending on the plan, even in cases of chronic illnesses. Like most clinicians, Ana’s works outside patient visits, known as “billable hours” is devoted to paperwork, consultations, etc. Of every 20 billable hours, Ana estimates that five of them are devoted to processing ever-increasing demands of insurance companies for patient data and justifications for care.

    These dollars and hours are siphoned off from providers’ pay and patient treatment time as tribute to insurance companies. The cost in time to mental health providers and patients has been documented by Harvard researchers and reported in the PNHP news (http://www.pnhp.org/news/2013/april/1-million-hours-of-psychiatrist-time-wasted-yearly-on-phone-approvals-for-hospitaliz).

    Thanks to the system in the Commonwealth of Massachusetts (recently labeled “Romneycare”) all children in financial need are covered by the state. Parents like Ana and Thomas don’t need to make any painful choices between their professional lives and keeping care available to their children. Since Thomas always worked, the rent and food bills were not in jeopardy. It was Ana’s own health insurance that hinged on her life choices. She risked living without healthcare in order to stay home with her first child while he was small, and later returned to work gradually, balancing her need to have healthcare with the need to take care of her family. Her employment options were enhanced by the fact that she had a Master’s degree and was fluent in Spanish and English. She was savvy enough to manage credit cards and navigate a sea of documents each year to keep the healthcare in place. Compared to many, this family had a great deal of support.
    Ana’s story is one of a capable mother and professional starting her adult life a modest income, but with a few advantages such as a good education, bilingual ability and, for a time, spousal support. We all know the financial dangers that are lurking hard by the less fortunate: the risk of losing a job because of taking time off for children, sickness, or family emergencies; the legal risks to the less-literate of filling out forms erroneously or not at all; the management of debts frequently faced by families such a high deductible for care after an accident, or an unexpected automobile malfunction.

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