Tuesday, September 24, 2013

Things That Piss Me Off Tuesday - the health insurance, mercy rule and new normal edition

The Bizarre World of Insurance Coverage
I struggle to make sense of many things in this world, not the least of which is the logic with which health insurance companies operate.

It seems that with each passing year, we are made to pay more for less coverage and our deductibles go up with every opportunity. Navigating any changes in plans requires something akin to a circus act - you're in the middle of it all, with the ring of what you need over here and the ring of what they will cover over there, wondering where and how often the two shall meet, trying to figure it all out backwards and upside down while wrangling a lion with one hand.

Many years ago, when my oldest was a little guy, we pursued speech therapy at the recommendation of his pediatrician. He had a frontal lisp/tongue projection that took only a few months to correct, though it still squeaks out at times when he isn't feeling good or is tired. At the time, we had fabulous insurance that covered everything with only a small co-payment.

Fast forward to many years later, when my youngest is unintelligible in his speech. Again, we sought private speech therapy due to the reality of what happened a few years ago when another of our children was screened for early intervention by the school district. Then, we were told that she absolutely needed help, but that we didn't qualify because we were married, spoke English, lived in the same household. Simply because we weren't receiving government assistance for anything else, she was ineligible for help that they knew she needed. They literally handed me a diagnosis and a pile of paperwork and told me to work with her at home because their hands were tied.

I didn't bother even going through that frustrating process with the youngest. We just went for a private evaluation, first ensuring that speech was a covered benefit by our insurance company. He has articulation issues, and started to benefit from therapy almost immediately. He can already pronounce many things correctly now after only a short time of work.

Our insurance company is refusing to cover what they told us was covered now, saying that because his diagnosis is a developmental speech delay, it's not covered even though other forms of speech therapy are. So, we now are looking at a huge bill for services we were told were covered, to treat a correctable condition that has already manifested benefits to the patient. He would, at most, require six months of therapy, but they won't cover it.

In a world where insurance covers all sorts of medications, office visits, procedures and surgeries for adults who make bad decisions, why isn't something that could change the life of a child included, especially when benefits are almost immediate and treatment will be short term???

I could appeal it, sure. I know it will do no good. We'll end up on a payment plan.

NCAA football - today's David and Goliath
It's football season, y'all. I love college football, truly, like all the way down to my core...but I've been increasingly frustrated at the blatant unfairness in it all.

First you have the NCAA picking and choosing who and what to sanction, slapping some players and teams on the wrist, but handing out sanctions of five years or more to others. There is no rhyme or reason to it, no fairness, no transparency. Nothing.

Second, you have a system that wants to believe that a $100,000+ scholarship/housing/food/travel/expenses arrangement in exchange for playing a game isn't paying players, but if that same kid takes a $1,000 for signing autographs, they are to be condemned for soiling the sport. It's asinine.

Third, you have a system that hands out basic, minor scholarships to almost every kid on the field, if they are even scholarship eligible, and throws a few kids up on a gold plated pedestal. Those kids up there on the pedestal? For the most part, they come from privileged backgrounds, have been groomed to be football players since they were six years old, played at private high schools and have been catered to and told how awesome they are since birth. Then we wonder why kids like Johnny Manziel think they are invincible....because the entire system encourages it. Don't worry, the 99% of other football players will go out with some kind of major injury, or just use up their years of eligibility, or lose their position and figure out how to live life in the shadow of the pillar standers.

Fourth, we refuse to push for an actual playoff for a National Championship, and instead rely on this bizarre BCS system that is biased towards the schools we decide in advance were worthy of attention. Now, all that matters is the team's record, so you have the best schools padding their schedules whenever they can, playing against opponents that never have a chance against them. Coaches allow their teams to run up the scores in these games, to make a statement somehow. Because shutting out an opponent 21-0 isn't good enough if you can score 76.

So, now the smaller schools are left with a choice - refuse the games and miss out on national television coverage and the money it brings, or agree and get their asses kicked. Getting annihilated in front of a few million people is always a confidence booster for an 18 year old kid, right? Oh, that's right....no one actually cares about the players. Football isn't about the sport anymore, it's just about money.....just don't say that to the NCAA. They seem to be the only ones who haven't figured that out yet.

The Massacre We Already Forgot About
12 people were killed in yet another shooting this month. It was the lead story on the news for a couple days, then we collectively shrugged our shoulders and went on with life.

It seems like with each of these shootings that occurs, we get a little less outraged. A little more complacent. A little less affected.

We've accepted this as normal.

We spend more time arguing about gun rights versus gun control than we do analyzing actual data about gun ownership in this country, or the consequences of it. We ignore statistics about guns that tell us that owning a gun increases the chances of it being used against someone in your home, whether through homicide, accidental discharge, assault or suicide. We'd rather believe it will only ever be used for self defense because that gives us a false sense of security.

We go round and round and round about the gun issues, ignoring the mental health component that seems to run through most of these situations. We look back at the suspects and can often see red flags waving in the past, chances when something could have been done, times when a system should have caught something being off.  Red flags that were ignored, or red flags that we couldn't do anything about.

If all we do is make half-hearted arguments that get us nowhere, get outraged less and less with each occurrence, become totally desensitized to it, this WILL become our new reality.

You could make the argument that it already is.

1 comment:

  1. Went through something similar with our oldest. Ended up not even trying to take to insurance because their cure was worse than just figuring it out ourselves.

    Makes you wonder what we are paying for...


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