written on Aug 19, 2014
It’s been a lot of fun getting responses from people about my blogs. I’m getting quite a few questions about things I haven’t yet mentioned. One item that keeps coming up is insurance – does my insurance cover all of this?
Turns out it does. Since I started working in the union two years ago, I became eligible for Motion Picture Health Insurance (which is just Anthem Blue Cross PPO)– one of the benefits of being in the IATSE (International Association of Television and Stage Employees). I have to pay a monthly fee to have dependents (like the kids) and we have co-pays everytime we see a doctor, or one sees us, but it’s way better than when we had individual policies with Anthem Blue Cross.
According to Cedars, the total cost for the kidney transplant, including all of the donor’s costs, is approximately $300,000.
Wow. Yes, look at that number again.
$300,000.
So if you don’t have insurance, you’re most likely going to go bankrupt just to save your life. Craziness. (I know, if you don't have insurance, most hospitals and doctors will discount their rates - some even do the procedures for free. So you might not go bankrupt, but you'd get real close...)
But under Motion Picture, I’ll be paying $100, plus my wife’s remaining deductible. And according to MPI, that should be it. We got lucky - my wife just became eligible for her own Motion Picture insurance coverage, so now we'll both have dual insurance which will cover all the co-pays.
Unfortunately I have been told I will have to sign up for Medicaid (every thinks I mean Medicare, but Cedars told me directly it’s Medicaid). I need government insurance so my wife can be covered for the rest of her life, in case anything happens to her remaining kidney. If I don’t sign up for Medicaid, apparently my insurance will only cover her kidney-related medical bills (if there are any) for one year. So say she’s fine for 10 years, and then she contracts a kidney disease that they can relate back to the kidney donation – Motion Picture won’t cover those health care costs since it’s related to the donation and it’s more than a year after. How crazy is that?!? What kind of screwed up insurance system is it when someone who’s voluntarily donating an organ to save someone else’s life can’t then be covered for life under a private insurance plan?
Of course, if we had done this transplant prior to April of this year, she would never have been able to get her own private insurance because donating a kidney would have been considered a pre-existing condition, and one with a high risk factor, and insurance companies would have just denied her coverage (or charged her an outrageous monthly fee to be covered, except for kidney-related issues). So prior to Obamacare getting rid of the pre-existing condition clause in most insurance plans, donating a kidney would have made it near-impossible (or crazy expensive) to get a private, individual insurance plan.
Tangent time – in my opinion the whole idea of health insurance in America is clearly broken. I’ve heard repeatedly from doctors and nurses how insurance companies aren’t paying to keep you healthy – they actually go out of their way to not cover preventative care and to limit the amount of care they will pay for. And because of the limits that insurance companies pay to doctors with co-pays, a lot of doctors end up ordering tests that you may not need because they can charge your insurance more for the testing.
I had a nephrologist tell me this week that Medicare pays a flat rate, per month, for dialysis. So if you’re on Medicare and receiving dialysis, the center where you’re being dialyzed gets a flat rate for your care every month, regardless of how long you dialyze, what medications you’re given or how many nurses or doctors are taking care of you. He mentioned that some dialysis centers choose not to give the medications every week because they don’t get paid more from the government if they give you the meds you need – they just don’t give you the drugs, but it’s still “covered” in the payment from Medicare. Now the center is saving money because they don’t have to spend the money to buy the drugs to give you.
Health insurance should be about keeping people healthy and well so they don’t have to get sick and need to go to the hospital and have expensive tests and procedures performed. I know it’s an ideal to strive for, but I’m also a realist and know that capitalism is the main priority of insurance companies – the cynic in me thinks all they care about is the bottom line. Since we’re all numbers on a piece of paper, they really don’t care whether we’re alive, healthy or sick. In some instances they would prefer we get sick and die quickly so they no longer have to cover the costs of taking care of us.
I’ve read too many stories of where this is the actuality – health insurance companies really aren’t there to take care of us. They’re there to make money, any way they can. In my opinion, if we want to change health care in America, we need to either change or get rid of the insurance companies. They have far too much power and control over how and when we get treated. And why does a kidney transplant cost $300,000 anyway? Who determined that that would be the fair price? Clearly it’s a broken system when my cost is going to be $100. And how much would the transplant cost, before insurance, in say San Francisco? Or New York? Or Washington, D.C.? And if the cost is more or less, why the discrepancy?
I know that changing the way insurance companies work will never happen. Nor will standardizing the cost of health care. Too many people would lose too much money. So this is the best we’ve got. I’m just glad I have good private insurance right now. The unfortunate part for me is once I sign up for Medicaid, it will become my primary insurance in 2 years. And everything I’ve read about Medicaid, and even Medicare, because they’re government-run, my coverage won’t be nearly as good. I just hope I can keep my PPO as a secondary insurance and not be penalized for it. Guess we just have to wait and see.