During a recent discussion with my family doctor about health insurance, one of us lamented the lack of decent coverage — and it wasn’t the one you might expect.
OK, I was the one who started it. My primary care provider, who’s wonderfully thorough, asked if there had been any changes to my family medical history in the last year. I mentioned that a relative had both knees replaced due to deterioration from arthritis, something that unfortunately runs in our family.
(I’m not naming the relative because my family grumbles about my tell-all columns.) Anyway, this person turned 65 last year and hadn’t planned to retire, but was going to use Medicare as the primary insurance for the surgery and let the work insurance pick up the difference.
No can do, said the insurance overlords.
I didn’t get all the particulars, but basically, the work insurance would be the primary payer. In that equation, the patient would be responsible for about $8,000.
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Not willing to pay that, my relative retired and let Medicare, and the supplemental insurance later acquired, pick up the bill.
In other words, insurance was the biggest factor in determining when my relative stopped working. And that just doesn’t seem right.
My doctor agreed. Years ago, when my annual deductible was about $3,000, she mentioned that hers was $10,000, and I about fell off the examining table. At my recent appointment, she said her insurance overlords had decided that her family’s plan had been grandfathered in for too long and would no longer be offered.
As of the end of this year, the physician may have to heal herself because she won’t have health insurance, at least through her current company. She’s married to a doctor, so I’m guessing that between the two of them, they can diagnose routine bugs and strep throat, but need insurance for more serious issues.
The patient she’d seen before me was the granddaughter of the family doctor of old — think house calls and little black bags. When commercial insurance came along, as well as the federal government’s coverage for seniors, the doctor warned his fellow practitioners that they would be sorry in the long run because the paperwork — and procedures for pre-authorizations and proper billing codes — would take over their lives.
His peek into the crystal ball seemed right on the ball.
Insurance dictates when we can see health providers or if we can have surgery to treat conditions that both patients and doctors deem necessary. Recent surveys suggest at least half of employees keep their jobs, even if they aren’t necessarily happy in their work, because of their health coverage.
When people reach their 60s and are eligible for Social Security or job pensions, they tend to keep working, not only for the immense satisfaction, but also because they’re waiting to turn 65 and qualify for Medicare.
A number of co-workers have walked out the door once they got their golden ticket, aka their Medicare card. I’m not faulting any of them. Someone asked me the other day how long before I qualified for a pension, and I said the same thing my slightly older colleagues probably said before me: “I’m just working for the health insurance.”
Cathy Dyson: 540/374-5425