Thursday, November 13, 2008

Happy surgeversary to me!

At the risk of whining even more about my stupid health, I guess I want to note that today is Surgeversary, the second anniversary of my first brain surgery. Woohoo!

I went back and read last year's post about the day and was struck again by how chill I was on the morning of the surgery -- and struck even more by how cool I was last year when blogging about it. Maybe I'm catching myself at a bad time, but it seems the farther I get from the original grim diagnosis -- and despite my generally improving health -- the less sanguine I am about the whole deal.

Part of it is stress. My health insurance (the federally guaranteed 18-month extension of my old work benefits) is expiring at the end of this month, so I've been shopping around for an individual health insurance plan. Man, what a racket. And confusing, even for people with a full-size brain, I'll bet. Not to mention expensive. There were so many options, each with so many variables, that it was impossible to tell by eyeballing the plans which was the best deal.

Timing the switch is critical. Normally when you buy an individual health plan you have to complete a comprehensive health screening and wait nine months, to make sure you have no pre-existing medical conditions, before receiving coverage. That would screw me, of course, but fortunately there is an exception for people like me who are exhausting their Cobra (extended work) benefits. In that case, there is no pre-condition screening and coverage begins right away. The catch is that there is a one-day window to make the insurance switch. If the Cobra benefits expire on Nov. 30 as mine do, the new plan must start on Dec. 1. Any earlier or later, even by a day, and the nine-month waiting period becomes active again. I get sweaty just thinking about it.

Eventually I decided to approach the problem as if it were a newspaper assignment. I broke out a spreadsheet to analyze the coverage options like a state budget plan, creating Excel formulas to account for various premiums, deductibles, co-pays and benefit maximums, being sure to double-check the insurance company formularies to see if my drugs were covered (yes here, no there), reporting at the source to determine the full cost of all the prescriptions plus the MRI scans and weekly blood draws, and charting it all out for the rest of this year and all of the next.

It's the kind of reporting I always liked. But I have to say it's more fun when the bottom line shows merely the tens of millions of taxpayer dollars about to be wasted and not the tens of thousands about to come directly out of my own pocket.

Complicating the calculation further was that some of my doctors are part of one plan's preferred network of providers but not the other's, and vice versa. More potential charges to account for.

In the end the spreadsheet was a big help. I determined, to my surprise, that a local HMO, Group Health Cooperative, was a better deal for me than the seemingly richer plans offered elsewhere. So I mailed off my application last week, confident that it would be approved in time to take effect on Dec. 1.

A few days later a Group Health packet came in the mail. It wasn't my new coverage packet, as I expected, though, but a notice informing me that without an official letter from my previous insurer certifying that I was exhausting my Cobra benefits I wasn't eligible for the waiting-period exemption.

Damn! I had the official letter but had neglected to include it with my app.

Michelle, equally nervous (or more) about the upcoming deadline, persuaded me to drop off the application at Group Health in person rather than relying on the mail. OK, good thought, so off I drove on Tuesday to Group Health's campus in Seattle's Capitol Hill neighborhood.

After paying for parking and being misdirected three times I found the business office, where a woman informed me that she "can't process the application manually" and she instead would have to mail it to the co-op's processing center. Argh! Furthermore, since it was Veteran's Day there was no mail service and my packet wouldn't go out until Wednesday. Double argh!

So now I'm waiting to see what piece of red tape I overlooked or what fine print the insurance company can unearth to justify denying my claim.

I'm sure that if they took my photo and vital signs today as they did on Nov. 13, 2006, I'd look nothing like that cheery dip in the above picture.

6 comments:

Jason Bellamy said...

Well, this certainly is the day that Hallmark doesn't make a card for. So, you know, happy surgeversary. Now it's time for the airing of grievances and the feats of strength, right?

I'm hesitant to write anything even leaning toward profound, because I know you'd fucking hate that. But, dude, gotta say, you nailed it in your post a year ago when you wrote about "brilliant short-sightedness."

"Somehow I managed (and some of the time still do) not to think about the big picture, but to concentrate on the moment just ahead."

I don't think your attitude is the problem here. It's a heck of a lot easier to concentrate on the moment when the OTHER guys are monitoring the spreadsheet bullshit.

You've traded a drill to the skull for health insurance red tape. I'm not sure that's an upgrade. And I'm not joking.

Hang in, brother. Cheery or not, you're still our dip.

freda said...

have you looked into the possibility that you may be eligible for medicaid? I checked their site and found the following quote, "Medically needy persons who would be categorically eligible except for income or assets may become eligible for Medicaid solely because of excessive medical expenses."

Mark said...

Thanks for the nice supportive feedback.

Freda: Yes, I've looked into it but unfortunately do not qualify. That's another whole story about the impenetrable bureaucracy of the Social Security Administration. Ugh, I can't even bear to go into it. Thanks though.

Jason: You always say such smart things. Thank you.

Rita said...

I'll have a double martini and a cigarillo!

Cheery dip pictures or not, hang on to concentrating on that moment just ahead.

This blog is priceless!

kateco said...

I am making burnt offerings to the bureaucracy gods.

And Jason always does say smart things and this blog is priceless. (as is Rita)

Happy surgeversary.

Ronelle said...

I think if they took your picture and your vital signs today they would find that you have a heart that beats with resiliency and determination and bravery and humor and intelligence and... You are entitled to get a bit down once in a while - but don't sell yourself short. I am always in awe of both you and Michelle and your ability to face the good and bad in life as a team!
Happy Surgeversary!