Saturday, May 30, 2009

They're Penetrating the Bureaucracy!

Anyone remember this well-written scene from The Incredibles? It begins with Bob Parr being pulled in to see his boss. Bob works for Insuricare, a medical insurance company.

Mr. Huph: I'm not happy, Bob. Not. Happy. Ask me why.
Bob Parr: Okay. Why?
Mr. Huph: Why what? Be specific, Bob.
Bob Parr: Why are you unhappy?
Mr. Huph: Your customers make me unhappy.
Bob Parr: What, you've gotten complaints?
Mr. Huph: Complaints I can handle. What I can't handle is your customers' inexplicable knowledge of lnsuricare's inner workings! These people are experts! Experts, Bob! Exploiting every loophole, dodging every obstacle! They're penetrating the bureaucracy!
Bob Parr: Did I do something illegal?
Mr. Huph: [reluctantly] No.
Bob Parr: Are you saying we shouldn't help our customers?
Mr. Huph: The law requires that I answer no.

Well, Brent and I have penetrated the bureaucracy of United Health Care. We've learned it's all about knowing "the inner workings" or the secret passwords and handshakes, as it were.

The birth center I am going to found a letter in their insurance files for me that makes quite nice ammunition. Apparently earlier this year another client of theirs had beaten UHC into submission and got them to pay at in-network levels for both the birth center and the midwife that attends there. They reluctantly agreed to this after admitting that there were no other providers in the client's geographical area that offered the same services.


Anyway, the letter was from UHC to the birth center giving notification of their intention to pay in full.


So armed with this information Brent called the insurance company. It only took about an hour on the phone and talking to three different people, but we think we will soon be victorious. At first it was "I'm sorry, sir, I just don't know what the procedure would be for that", or "Oh, I think it's this other department that you need to talk to". So after going back and forth between Care Coordination and Benefits someone happened to slip out the phrase coverage gap exception.

Eureka! We discovered the secret password that would allow us to at least start the process of what it is we want. Since people working in such large organizations aren't allowed to think for themselves and can only read from a script, you have to use their special vernacular for them to get to understand you.

So Brent went back to Care Coordination and asked for a "coverage gap exception". Suddenly they knew what he was talking about. They explained that this meant that in order to qualify there had to be no in-network providers that provided the same service. Yes, he agreed to that. The process was begun.

Then he was asked for my diagnosis. Umm. Isn't that kind of obvious considering he was requesting to go to a birth center? Anyway, he said "my wife is having a baby". Long pause on the other side of the phone. Brent could hear the woman rolling her eyes as if to say "Yeah right, there's nowhere within 30 miles of your residence for you to give birth."

So Brent said "You'll find there are lots of hospitals in the surrounding area in-network, but there are no birth centers."

Long pause.

"Huh." Again do we hear the rolling of eyes and the passing of judgment?

"Oh, yeah. You're right. Okay."

So, long story (sorry about that) short: we think they're gonna cave. They said the request had to be processed and they'd send a letter to us and the birth center in a week or two.

The moral of the story? It's a pain in the arse, but it is possible to "penetrate the bureaucracy" if you are dogged enough to learn the secret passwords.

Go forth and conquer.

Wednesday, May 27, 2009

Turn Down the Dial

A month or so ago I was in a church meeting where the concluding speaker gave a thought that has swirled around in my brain ever since. I'll summarize his remarks.

Think about your dial of negative emotion. Call it a rating system if you like. Imagine that you're driving to work in the morning, you are rushed, running late for an important meeting, traffic is terrible, and you blow a tire. There you are on the side of the freeway, cars zooming past. It's hot and windy and you're late and you don't have time for this. Not to mention the expense of getting a new tire. ARGH!!!!! What's your rating out of 10? A 6? A 7? An 11? How often do you feel like you are beyond the highest rating of frustration? Keep in mind that the dial only goes to 10, and yet you rate yourself beyond it.

What if instead of blowing a tire you were in a car crash that killed your loved ones. If that's a 10 (sorry, I'm not giving you more than 10; the dial stops there) then what does your tire blowing incident become. A 2, maybe?

His point was that we need to turn down the dial of negative emotion in our lives. We need to have proper perspective when dealing with life's inevitable frustrations and troubles. Our society has become so stressful that we operate on a higher level of tension all the time. It also has become so self-centered that we think that everything should go our way all the time. When it doesn't we feel put upon, cheated, mistreated, etc. We complain about the sense of entitlement that people seem to have nowadays, but fail to recognize it in ourselves.

If we could turn the dial down and consciously choose to interpret our struggles as something to be dealt with rather than a catastrophe sent to ruin us, then we would have much greater happiness in our lives. Don't we all want that? It is up to us to choose to live after the manner of happiness. We must choose to act, rather than be acted upon.

So that's become my mantra lately:

"Turn down the dial of negative emotion."

Monday, May 18, 2009

I Need to Vent

So I hate the medical institution in this country. I'm not saying that national health care is necessarily the way to go, but AAARGH!!

With Brent's new job comes new insurance. This new insurance company will not pay for me to go to the birth center I've been planning on. I understand that they have their network and want their clients to receive service within the network, yadda yadda yadda. I'm good with all that.

However, I think that all alternatives should be considered when building a network. They tout one of the largest networks in America, so I will have my choice of the best physicians and hospitals in the nation. Well that's just fine and dandy if I need a physician or a hospital. However, I need neither. What I need is a midwife and a birth center.

So even though the birth I am planning on will only cost about $2000 total and the average unmedicated and complication-free hospital birth costs about $6000-$7000 (we're not even talking about the "what if" scenarios that are so much more likely to take place in a hospital anyway, which up the cost significantly), the insurance company isn't interested. Why save money when you have political relationships to maintain?

When is America going to learn that pregnancy and birth are natural and normal and healthy events, not illnesses that the woman needs rescuing from? If a pregnant woman is high-risk then OF COURSE she should go to a hospital to deliver her baby. But for the 80% of us who are perfectly fine and healthy, we should have more options.

I realize that most women think I'm crazy and wonder why on earth I would even consider birthing without an epidural. Well, I'm not here to convince you, though believe me, I have my reasons. I think that choosing a hospital birth and anesthesia is a perfectly valid option for many women. However, I also think women are nuts who don't bother to educate themselves about the potential risks of even the most common of obstetrical interventions. How can you claim to be giving informed consent if your doctor doesn't inform you of the risks as well as the benefits? Only when you know both sides of the story do you really have a choice.

In this country of wealth and education we should have better options. We should have true informed consent. We should have people who are empowered to take control of their own medical care. We should not have insurance companies and politicians deciding what is best for us or what care we should receive!

Of course we are all free to pursue our own care outside of the insurance world, but at a steep price. Ancient remedies that have been proven over centuries to be effective (acupuncture, herbal medicine, etc.) are not covered by most insurance policies. If traditional western medicine has failed a person, they are left alone to suffer or seek expensive alternative care that they usually cannot afford.

There is something wrong with this picture.

Rant over.

Sunday, May 17, 2009

Pregnancy Update

As of today I am 33 weeks +3 days pregnant. Where did my time go? I'm not complaining, oh no, not at all. I'm thrilled to be so close to meeting my little JJ. I am, however, starting to hit that point in pregnancy where there is more discomfort than delight.

I can't sleep well, though that's not really a change. It's just that now the poor sleeping is accompanied by aching hips and reflux. As my pelvis loosens at the seams I feel very unsteady whenever I get up from sitting or reclining. Plus the pressure of my uterus and all it contains makes whichever hip I'm laying on HURT!

I'm able to walk less, carry less, accomplish less, etc. I can't hold Jenny like she wants me too, and I feel bad about that. Poor little girl. Her world is going to be rocked when James arrives. Hopefully she'll be excited about the prospect of being a helpful big sister rather than feeling totally displaced.

I went for a hike with Brent and Jenny a week or two ago. I went maybe three miles and the first half was pretty steep switch-backs. I went slow, took it easy, and was able to just make it.

Today I went for a walk on a flat, paved path and could hardly hold my own body up. We went maybe one mile. I need to get back into my prenatal yoga; it helps so so so much with energy and discomfort.

The positive aspects of pregnancy are significant enough that I don't really mind the uncomfortable bits too much. For one thing, pregnancy completely eliminates my chronic migraines. Hallelujah, praise the Lord!!!! I do occasionally have a tension headache, but it is always much milder than when I'm not pregnant. Also, the normal back pain and other fibromyalgia related junk I have to put up with is also greatly minimized. I figure God realizes that pregnancy is enough to deal with and he blesses me by temporarily removing my other physical obstacles. I am grateful.

As an aside, I think that all parking lots should not only have handicapped spaces, but senior citizen and expectant mommy spaces reserved as well. Anyone want to sign a petition?