Surfacing After Silence

Life. After.

Controversial Insurance Post


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So this is the mandatory controversial insurance post.  I’ll throw it out there: I support Obama’s health plan.  I don’t think he has any intention of socializing health care, or the country.  No smart president would attempt to do so, and no smart congressman would vote a plan into effect.  But since we do like to jump to black and white conclusions in this country as of late, it’s much easier for people to say, “He’s a socialist” than say, “He’s willing to look at other options.”

Okay.  That’s my political vent for the day.  My main concern today is health insurance and the beef that some people have with Medicare and Medicaid.  And who deserves to be on those plans.  And the injustice of the common citizen paying for the people on Medicare.  People on Medicare who can supposedly work but don’t and take advantage of the system, robbing our country of money that should be spent elsewhere.  On people who need it.  People on Medicare who are lazy and just won’t work.  People on Medicare who should be working.  People on Medicare who spend too much time in treatment and just need to be in the real world and pay for their own treatment.

Let’s break some myths:
A) it’s not easy to get Medicare.  You have to successfully apply for Social Security Disability.  This is not an easy task.  Most people get denied their first or second times applying.  They are told they aren’t sick enough.  (Oh wait, people with eating disorders get told that, too, and we say that’s a bad thing to hear.  Well, it’s a horrible thing to hear in this case, too.)

B) People on Disability have to wait two years to get Medicare.  Generally, they will have Medicaid in the meantime.  Have you tried getting adequate care on Medicaid?  Getting prescriptions covered?  Getting to see a doctor who doesn’t make you wait multiple weeks for an appointment?  And forget about dental and optical coverage.  You don’t need to eat or see.  Mental health coverage is a joke.  In PA at one point, they limited you to 20  thirty-minute sessions a year.

C) Medicare.  Oh the Great and Glorious Medicare that covers everything.  Except a whole list of medications, including psychiatric medications that aren’t “necessary.”  Because unmedicated Bipolar people and Schizophrenics don’t ever end up causing harm to self or others, and they never end up in the hospital needing more intensive (and more expensive) care because they couldn’t get their prescriptions.  Ever try to find a therapist or psychiatrist who accepts Medicare?  Good for you.  But you’ll still have to pay half of the bill.  And there will be a limit as to how many times you can go per year.

D) Who gets to have Disability and Medicare?  People who are Disabled.  I know, that’s an interesting concept.  But here’s where the controversy rears it’s ugly head.  Guess what?  The average joe walking around, paying taxes, doesn’t get to decide who is worthy and who isn’t and whether or not they are using their services in an appropriate fashion.  A team of medical doctors does that.  And they review each individual case, which requires medical documentation, on a regular schedule.

E)  The ease of life people who get disability checks live.  Once a month, money magically appears in their checking accounts.  WOW!  Shopping spree time.  Except the yearly amount is below the poverty level.  And generally, people have to pay rent, utilities, and bills, and med co-pays.  And if you want to have a part time job?  They cap how much you can earn per month.  So if you decide “I need to work full time and get better benefits” then you get a full time job, right?  Except that puts you over the monthly limit, and you don’t get new insurance for another three months (at most employers) and unless Medicare decides to continue coverage in that meantime, you will have a preexisting illness for a year and won’t get any coverage at all from your new employer.  That’s fun.

Wait a second?  How do I have knowledge of this Medicare business?  I mean, I’m a well-educated adult who doesn’t have any close relatives on disability or medicare.

But I am. That’s right.  I’m on disability and medicare.  I should be working.  I should be paying my own way through treatment.  The consequences my actions cause should come out of my own pocket and I should be the one suffering for them, not anyone else.  (But really, are you suffering?)

Did I break my back?  Am I in End Stage Renal Failure?  I mean, these are acceptable reasons to be on disability, right?  Depression and anorexia aren’t, though, are they?  That’s the general idea people toss around.  People like me just need to toughen up, stop using up resources, stop going into treatment centers when we could be working, and stop making people like you pay for our treatment.

I tried to.  Believe me.  I gave it my damn best shot.  If you don’t think depression and anorexia can be crippling enough where you can’t work full time, then you haven’t seen them at their worst.  I worked until I couldn’t.  Until my boss noticed.  Until I got fired.  Until I stared at walls for hours on end because moving hurt too much.  My doctor suggested disability. I applied.  Was accepted.  Lived on food stamps and Medicaid for two years and had to rely on county housing for a place to live.  Living on the boundary of the two worst gang districts in your town is not fun.

Yes, I now have Medicare.  Yes, it paid for multiple hospitalizations.  Psychiatric hospitalizations.

I am alive because of it.

I’m sorry if you feel that you’ve been financially burdened because of this.  But it’s the truth.  If I hadn’t had Medicare, I would not have been able to get treatment.  And if you think I wasn’t in debt after treatment you are wrong.  Medicare doesn’t pay for everything.  Medicare barely covers anything at all.  I’ve had to appeal and fight and make phone calls just to get routine medical care.  Medicare initially denied my claim for a Cardiac MRI saying it was “above and beyond average medical expenses.”  This was the same MRI that diagnosed me with ARVD, which led to the ICD implant, which will, hopefully, keep me alive.

Do I always plan to stay on Disability?  Absolutely not.  I want a career.  But I need to make sure I have insurance in line, because if I don’t, I’m pretty much screwed.

You don’t get to decide who is using it appropriately or not.  Because you don’t know what is going on with that person.  It may seem like they are “living the live” in some treatment center, but I’ve been there, and treatment is some of the hardest work you’ll ever do in your life, regardless of whether it’s termed “residential,” “inpatient,” “partial” or “outpatient.”  And the last thing “people like us” need is judgment from “people like you.”

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October 15, 2009 - Posted by | Eating Disorders, health, heart, recovery, therapy | , , , , , , , , , , , , , , , , , , , , ,

9 Comments »

  1. I too am on disability and medicare. And like you, I am alive today b/c medicare/medicaid paid for the numerous inpatient treatments for anorxia and depression and countless more medical hospitalizations while I was refusing inpatient treatment.
    But some of my experiences have been different from the ones you describe and have had to deal with.
    I went back to work, part time, about 4 years ago and for 9 months, I was able to keep the disability and medicare. I also had ins through my employer so medicare became my secondary ins. I was laid off from that job 3 years ago and medicare then became my primary ins again. I was never uninsured so the pre-exisitng condition was never an issue with me.
    When I lost the disability medicare didn’t end. Is that unusual? Did I slip through a crack in the system? I don’t know. Then I relapsed and went back into treatment. My disabilty was re-instated. My social worker at the hospital I was in made a phone call and that was it, at least until my next evaluaton, which won’t be for at least 2 years, or until I start making more money than I’m allowed under the medicare system.
    I’ve never been denied medications by medicare. I’ve been on a lot of different meds and although I’m not bipolar, I’ve been on many meds for my depression that people who are bipolar take. Neither have I ever been denied tests my doctor has ordered. Ever.
    Medicare has paid 80% of all my hospitalizations and when I was on medicaid, they picked up the other 20%, even across state lines.
    There are a lot of things wrong in the world of medicare/medicaid and I don’t mean to say it’s been easy. It hasn’t. Going back to work and trying to support myself has been the hardest part. When I lose the disability, and I will, I have no idea what I will do.
    But I’m sitting here thinking–Have I just had it easy? So far, my answer is yes.

    Comment by unknownperson | October 15, 2009 | Reply

    • I’m glad your experience with Medicare and Medicare have been different. Maybe you did slip through the cracks somehow, or maybe it’s your geographical state, or maybe it’s your case manager. Who knows. But I’m glad you’ve had a better experience. I’m glad you haven’t had to fight them as much as I have. Tomorrow I have another appointment and it’s to discuss a med change and I’m dreading it, because I know Medicare is so freaking picky about the meds I’m on. They’ve even said, “You can be on X med, but you can’t be above a certain dosage,” even though below that dosage, my blood level was below therapeutic level. My doctors have had to fight all the way.

      I’m currently a student and have student insurance, but they are always secondary, so everything has to go through Medicare first.

      Comment by surfacingaftersilence | October 15, 2009 | Reply

  2. Ahh, gotta love the healthcare system in our country. When I graduated from college, I was dropped from my parents’ insurance, so for two years, I had to pay for everything out of pocket. I had to dip into my dad’s retirement fund and my savings for treatment, when I could’ve bought a new car – with cash – for the same amount of money!

    Luckily, I have MHIP now, insurance for those who can’t get it otherwise (like pre-existing conditions). It’s great insurance and pays for 70% of everything until I meet my deductible, and then they pay 100%. But, I’m only eligible to get this insurance because I have no job. I won’t be eligible once I do get a job and they offer me health insurance (even if it doesn’t cover pre-existing conditions). Or, if my income is more than a certain amount, I won’t qualify anymore, either.

    So, I need a job for money, yet I need to find one that won’t give me health insurance so I can stay with my current plan. I can’t afford not to have the coverage that I have at the moment. I can either get a great paying job and lose coverage, or continue to have great coverage with no job. The choice is obvious when you absolutely need treatment. People shouldn’t have to chose between a job and their health.

    Comment by Jen | October 15, 2009 | Reply

  3. I love this. Absolutely love it. I go to a pretty conservative school in which I am a social work major and in full support of medicaid, medicare, and Obama’s healthcare plan-and I’m one of few. I regularly hear it being bashed and it makes me angry-I’d like to read some of your points in class sometime and see if any of these great, hardworking, bootstrap pulling, would be swayed.
    I am thankful you are alive. And I wish you could get BETTER healthcare.You deserve it.

    Comment by Melinda | October 15, 2009 | Reply

  4. I’m on SSDI, was approved the first time, at age 22. Put off applying for a couple years bc I didn’t think my case was ‘severe’ enough, I didn’t deserve it, I could work harder in OP, go back to IP for the umpteenth time, try to work, again. Try not to get fired this time.

    I applied, and 4 months later, was told what medications I could get and at what dosage. What therapists I could see (and in this state, there is already an extreme lack of ED tx professionals) and for how long.

    I now have Medicare. There are no EDUs for 4 hours/one state away, so when I am routinely hospitalized for various ED related ailments (hypokalemia, seizures, etc), I end up with a massive bill. My last 48 hr stay cost me over $8,000, AFTER Medicare and Medicaid were billed.

    The people who say that Medicare is so great and they are tired of working to pay for others health insurance…well, try needing to go to the doctor, but your co-pay is $30 and you can’t afford that. Or if you manage to get the money together, your prescription is more than your SSDI check, because it is not one of the ones that Medicare covers.

    Comment by ohreallyhealthcare | October 18, 2009 | Reply

  5. Hey Alexis, hope you’re okay, I haven’t seen you on facebook or here or anything.

    Thinking of you..
    Amanda

    Comment by happyjoyousfree | October 22, 2009 | Reply

  6. This is beautiful. I couldn’t believe last week in my social work class, that almost everyone was opposed to universal healthcare and felt that people on medicare and disability were unworthy. I had a few choice words before the professor calmed the class down. Thanks for posting this. If you don’t mind, I may print it out and bring it in..

    Comment by Jess K | October 27, 2009 | Reply

    • absolutely, Jess. Feel free to share it. Just give them the web address for it.

      Comment by surfacingaftersilence | October 27, 2009 | Reply

  7. I loved the last sentence of your post, hit the nail on the head. I think alot of us would be better off not worry so damn much about what other people think, just learn not to care anymore. I myself have always held my own insurance policy by working full time, and now I work and go to school full time. Both sides are difficult to walk. Allthough I am against the new healthcare movement for the exact reasons you mentioned above, I am begining to see where “people like you” are coming from.

    Comment by mylifemywishfulthinking | April 4, 2010 | Reply


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