Episode 2 -- Private Health Insurance...The Offer

It finally came after another e-mail to my insurance agent this morning. This was the offer that would free my wife from her work-for-insurance situation...just $100/month. BUT...there's some fine print. For myself:

• 2 year rider excluding any illness, disease or physical disorder of the wrists including, but not limited to, Carpal Tunnel Syndrome.
  
  
• 3 year rider excluding any injury, illness, disease, or physical disorder of the spine, its muscles, ligaments, joints, discs, nerves and spinal cord.
  

And for my 1 year old son:

• 1 year rider excluding esophagitis, reflux esophagitis, heartburn, indigestion, gastroesophageal reflux disease, duodenitis or hiatal hernia, including but not limited to any diagnostic procedures, treatment, surgery or complications thereof.
  
  
• 2 year rider excluding Otitis Media, including any diagnostic procedures treatment, surgery or complications thereof.
  

So let's look at each of these exclusions individually related to our medical history. Both of my exclusions deal with a precautionary visit to the Doctor regarding numbness in my arms while sleeping. As it was, I had let the problem go on for about half a year without visiting a Doctor and finally went because the episodes were so severe that I couldn't move the arm from the shoulder down, and it was taking 5-10 minutes to get feeling back in the arm.

The orthapaedist ordered X-Rays, an EMG, and an MRI. As a side note, I have never met a more arrogant Doctor. The X-Rays showed basically nothing. The Doctor was a little concerned about the position of one vertebrae which prompted the MRI. My profession, computer programming, led him to order the EMG.

The MRI was a piece of cake and resulted in a statement from the reviewing physician of "Negative cervical spine MRI." Of course, the EMG, that was a different story. I can imagine a lot of people live with the pain of carpal tunnel syndrome instead of completing one of these tests. Basically, the test consists of electric shock to the nerves in your arms and hands and stabbing the muscles with needles.

My test took around 2 hours as the Doctor wanted to be very thorough given the unusual nature of my symptoms. He even went so far as to check my neck (not part of the normal routine). I don't know if you've ever had a needle inserted into the back of your neck, but it's not the most comfortable thing in the world. The fun part about the needles in the EMG, though, is that the Doctor moves it slightly inward 3 times after the initial stick. Big fun if you ask me...

Anyway, I ended up with the same result as the MRI...normal study. In fact, the Doctor told me during the test that he'd never done such a test where the nerves fired as well as mine did.

The Doctors explained my symptoms as a combination of injury and bad sleeping position.

So, I took a precautionary visit to the Doctor, ruled out any problems, and the insurance company penalized me for it.

With respect to my son, he had some minor reflux problems in his first 3 months of life, but since then, he's been fine. At the time of the insurance application, he had been through a rough period with ear infections, but the Doctors were not (and still are not) talking about tubes. Both of these are things that a lots of babies experience and the majority outgrow.

I don't mind the exclusion about carpal tunnel. I know from the EMG that it will be a long time before I have to deal with it, but excluding everything related to my spine. That's a bit scary. With respect to my son, again, I'm fine without having a safety net for reflux issues, but otitis media? I have no idea how much tubes would cost and what kind of complications could go along with them. Granted, there's a very low chance that he'll have tubes, but it's an issue that has to be addressed due to the exclusion.

The problem here is the mindset of the insurance company. For each patient, they want to make money (in the private market) regardless of what happens to your health along the way. As a result, they try to find the most likely near-term problems and exclude them from coverage.

How is insurance "insurance" when they only cover things that you don't have? It's great that I can have cancer coverage, but what good does insurance do me if, by some off chance, I have a problem with my spinal cord? I thought the whole idea behind insurance was sharing risk across a larger group. When did the insurance companies decide that each and every patient had to be profitable?

Something in the health insurance market has to change in this country...this system is hopelessly broken. Being far, far right in the political spectrum, I refuse to believe that means socialized medicine. Maybe I just need to start my own insurance company...