Friday, November 14, 2008

The force will be with you, always

Wandering through the hallowed halls of my place of employment yesterday I noticed the wonderful people who are kind enough to supply us with Health Insurance had set up tables. It was obvious by their supply of free pens that glow iridescent when you click them and neon green change purses that were admittedly empty but open for the filling, that their warehouses had filled to the point of bursting. And instead of paying an extra storage fee, which they would have undoubtedly been charged, they showed up here to share the wealth. Then I thought maybe I am just being cynical. Maybe they had come simply for a smile, a handshake, a chuck on the shoulder just to let us know we were appreciated. I’ll bet if I asked I could have gotten a back scratch.

While the back scratch had seemed enticing, I tipped my hat and moved on, there was no reason for me to stop, the support that I had received, while not the top coverage I have ever had, was working out okay. Obviously the representatives of one of the largest health care conglomerates were there to let the good people know that all was okay. I mean in these times of economic turmoil it could lead one to question the solvency of those stead fast institutions that help us rest easy at night. I put it from my mind and set to work.

I had a busy morning. First I completed payroll, then off to a production meeting where we discussed the shows coming up in the next week (nothing of note. It’s close to Christmas. Tours start to pack it up at this point. Even the famous like to eat a turkey or hope for Santa.). I then busied myself on the arduous task of music blog updates. I have a few sites that I dig into that keeps me hip to the scenes that I was once a big part of. It helps me forget that I am over thirty and not to be trusted. Which honestly I understand, I don’t even trust myself most days.

“Dude, did you see that old bald guy hanging around? He looks like a NARC.” At this point my wife, disgusted, sticks her head in and says, “Dude,” her sarcasm biting, “you’re talking to yourself in the mirror again.”

Then of course I wander onto many of the MS blogs that I dig on. Let me just say there has been some really amazing stuff filtering though cyber space as of late. I have added a new blog over there on the right. Living life with sarcasm, kids and MS is a pretty great read. Take a look, and for that matter the rest of the blogs that I have had the good taste to include are well worth your time. Turns out over at No Empire they celebrate my wife’s birthday as well. Who knew? Although truth be told it’s not necessarily for my wife as much as they happen to share a birthday. Nevertheless, happy birthday to one and all, mine is in May. See you then.

It was about here that I got down to my real work of the day: Star Wars clips on YouTube. This can get a guy pretty hype, I mean take a look….

Then of course is the classic…

Luke was so whiney…

Anyway, while digging deep into the ‘ol YouTube archives (And I mean digging, oddly enough, there are very few bounty hunter clips. The balls on these people not to upload copyrighted Boba Fett clips. Although, I had enough to chew on with the Star Wars Holiday Special, come on, cooking with a Wookie? It’s a classic.) A co-worker came up to the cube behind me and began to rant and rave about the health insurance changes and how we have to take a survey or our rates go up.

Wait, wait, wait….She’s not talking about my health insurance. She can’t be talking about those nice people out in the lounge area that brought us all those free pens and glossy folders with tons of useless information inside. She has to be talking about another health insurance, right? She’s talking about another company. Right? Would these people be so friendly with their pens and such while they are sticking it you? Well after a few exasperated moments, a couple of, “are you serious.” A few, “are you sure?” an emphatic, “who told you that?” and a handful of “that’s gotta be illegal.” I figured I had better go get the answer myself, straight from the mouth of the good people who had pens to give out.

“Ehmmm…excuse me sir, one of my co-workers here….honestly I, ah…I think she’s a bit…well you know…soft, well she said, and please excuse me, I feel a bit funny for even asking you this, but the thing is, she said that there is some sort of survey we need to take in order for our rates to stay the same. I know it’s silly, sorry for…..”

“Yeah, but their’s no guarantee that the rates will stay the same. It’s a “risk assessment” test. It gives your employer an aggregate tally of all the employees here, and how much of a “risk” they are in. Here take this glossy folder there are bunch of changes that you should be aware of.”

I stumbled back. My world shook. Everywhere I looked it was as if people were laughing at me. Everything was spinning, the very foundation of that which I believed was crumbling around me, and I had no where to turn, just a glossy folder and an iridescent pen. In this new paradigm were cats and dogs still mortal enemies? Did Pepsi really win the Pepsi challenge? Where in fact was the beef?

Well, I suppose I am being dramatic and this isn’t entirely true. I did step back but only so I was far enough away from the dude so I didn’t jump over the table and make him wish he had different health insurance. Did the guy really just say, “how much of risk my employer's in?" Apparently he isn't aware that the multi-billion dollar company I work for doesn’t have MS. Yes, while their profits have been a bit necrotic as of late, I think they're gonna be just fine. My legs however, well the jury is still out on that one. Yeah I got your risk right here, buddy..

So it turns out if I don’t take this Risk Assessment test my rates jump $30.00 a pay period. What makes this even more insidious is that no one in the company has been made aware of this test unless you went up and asked specifically about it. Furthermore, they are pushing one of my hospitals out of their plan. Apparently it is no longer financial sound to use one of the premier hospitals in the region and the country. Allow me to quote from the literature…..

Our Insurance has an obligation to you to try and keep health care costs in check while providing you with access to high quality care. For more than 75 years, we have taken that obligation very seriously when negotiating with hospitals. We understand that we are negotiating on your behalf. After all, your premium dollars are used to pay for the services of said great hospital.

We also want you to know that for some time we have tried to negotiate reasonable rates with your hospital, but we were unsuccessful. After our termination letter was sent, the hospital responded by sending us a proposal with lower rates.

I don’t remember getting a call when they were negotiating. I would be the first to tell you that what ever premiums that might rise I would be more than happy to pay if I am able to see the doctors and go to the facilities of my choice as it was when I began the plan. Furthermore, the last sentence is infuriating. It turns out the insurance company is really just playing some sort of half assed game of chicken with the hospital. Well, I’m blinking, look at me I’m blinking, Uncle or whatever the hell you want me to say, let’s put on the breaks here before somebody gets hurt or losses an eye to optic neuritis.

Of course it really only gets worse from here: co-pays change, what facilities I can and can not get my MRIs in change, the formulary on the prescription plan is changing and my copaxone, while still covered, suddenly will cost me $100.00 more out of pocket for a total of $200.00

An aside here…..
I realize that I am bitching about something that many Americans do not have the liberty to bitch about. I am being a bit of a dilettante here. I was in fact one of those 47 million Americans without health care when I was diagnosed, and understand what a blessing it is to have some sort of coverage. However it is painfully apparent that something needs to done and done quickly in order to heal people that can be healed, and care for those that need the care. Everyday the country proves that as Bono wrote, “the rich stay healthy and the sick stay poor.” Health care is a business and we are just the cogs that feed the machine. Cures are bad for business.

Well for those of you who have been reading you know that I am very rarely at a loss for words, but this new info and the way it was so nonchalantly handed to me really took the wind out of my sails. I slunk back to my desk, feeling a bit sorry for myself. Yet the words of Yoda rang through my head, “do or do not. There is no try.” So, as if the force itself was lighting up my bald head I took a stroll back out to the tables. I formed a series of thoughtful questions and I wanted satisfaction, nay, I demanded satisfaction.

“excuse me sir, could you tell me….”

“it’s all right there in your packet.”

“Yes, but I was hoping for something a little more specific.”

“Oh right, well you can see here on the bottom of the first sheet the 800 number. They will have all the answers you need.”

“You can’t answer my question?”

“No sir. I’m sorry. We’re not qualified.”

Remember that speechless thing before….Color me dumbfounded.

Health Insurance is really the reason I work where I do, at least in the field that I do. I went to college and studied photography and film. I worked as a photographer and film maker for a few years out of college. I loved every second of it. Unfortunately being self employed does not come with health insurance. Yet I was relatively healthy, and starving for my “art” was perfectly acceptable. It actually helped. Pangs of hunger really help the creative process.

However I had to do some other work to supplement my income. I got involved with being a go-for in concert production (called a runner. Cause you’re running back and forth looking for the most inane things that nobody actually needs. That’s a different story.) and before you knew it I was offered a full time position. Now this is where many of you reading might start to say, “Bald Ben you’re a sell out”. Well, I’ll kindly tell you to shove it and shut the hell up.

I had been getting knocked on my ass by cluster headaches at that point for at least six years. (I haven’t talked much about the cluster headaches. There will be a post at some point. However I have been headache free for a year for the first time since I am 17. I am afraid of tempting the devil.) The only medication that worked cost $150.00 per shot (at the time). There were many days I was only making $150.00 for whatever work I was doing. There were more times then I care to count that I woke up had to take a shot and then go to work. Essentially to work for nothing, just the medicine I had put into my arm that morning. Sadly I knew that I would most likely need it again that day. Talk about deflating.

It was around the year 2002 that I had all but depleted my savings and knew that the headaches would soon return. So when someone offered me a steady paycheck and pretty sweet benefits I really had no choice. You see this goes back into an earlier post where I knew there was some sort of problem, bigger than the headaches, but everyone else just kept on telling me I was delusional and all I needed was to chill out. Guess I showed them. So I got involved in the world of concert production which I soon found out is a load of crap and for the most part completely against most of my moral code. Yet somehow I guess I’m half way decent at my job because I keep getting offers for other positions, but as they say beggars can’t be choosers.

Another aside:
Again I realize that I am bitching about things that many people don’t have the ability to bitch about. Everyday we hear of more and more lay offs, unemployment is insane. These are the people that should be bitching, and I bet a lot of them are, and rightfully so. So please do not think that I am not aware of just how fortunate I am. Truth be told most people would think that I have a pretty neat job, if they knew the truth they wouldn’t, but I digress. If I had my druthers I would be somewhere else, making movies, taking pictures, flexing a creative muscle from time to time, MS free. Like I said beggars can’t be choosers.

Long story short: They are changing my insurance on me. Remind me why I do this again?




Sorry about the insurance hikes. My rates have risen 40% over the past two years alone. After they went up in Sept (birthday time), I received a notice that the insurance company had "made an error" - a calculation error. The actual new rate would be another $25 higher. Whoops.

Health insurance and health policy is a topic I've written quite a bit about on (an MS-related blog which really SHOULD be on your special list, just sayin').

You might appreciate this: I'm self-employed, a musician, buy my own insurance (an underwritten, individual policy purchased pre-MS), and have really sucky prescription coverage. My policy stops paying after $1500 each year.

Yep, that's right. Copaxone's not covered. Four months worth of Provigil would almost take it all. Not to mention the other symptomatic drugs or the ones for RA, depression, low thyroid, etc.

And if I worked a regular job, I'd have been put on SSDI long ago. Can't work a 40-hour schedule anymore. Ok, I'll stop right there.

Just saying that I understand your shock, dismay, and disappointment. Oh and - “Dude, did you see that old bald guy hanging around? He looks like a NARC.” At this point my wife, disgusted, sticks her head in and says, “Dude,” her sarcasm biting, “you’re talking to yourself in the mirror again.” - is hilarious.

Tracys Ramblings said...

Hey! Where did my comment go?
I'll give you a recap:
I'm a member of an MS group through Yahoo and one of the people were complaining about their insurance copays going up. Then another lady wrote in saying that Copaxone has this program where they will help you pay your copay up to 100 bucks. I guess you would just call their number from the website. It's worth looking in too.
I'm in rush mode right now because until the new year, we've met our deductible (thank you MS) and don't have any out of pocket charges so I'm trying to get everything before then. The super Scooter will be delivered on Tuesday. For some reason, I'm just not that excited about it.
And you're not a sell out. You're a man with a family to support. It's great to have the "starving artist" days but when you've got a family, you need to know there's a check coming.
And it's never good when the insurance people show up giving you free stuff. And if they have food too then you're really in trouble!

Bald Ben said...

One thing I left out here (I know that's hard to believe as it is the longest post ever) is that the company I worked for before my current company had the greatest benefits ever. I could do, eat, drink, contract incurable diseases at will and they paid for it. Over the course of my wife's twin pregnancy we only paid $25.00! More doctor visits than an MS patients, ultrasounds once a month, c-section, 4 days in the hospital $25.00. All the while I was still in need of MS care. So then I get a new job and the pay is better but the benefits are nowhere near as good. That's why this is so hard to stomach. Anyway....


Please forgive the omission of Brass and Ivory. I had Carnival of MS blogers linked and due to the scar tissue on my brain somehow thought that they were the same thing. I apologize, problem has been solved.

As to your insurance, how do you survive? I should say, how do you get through? Do you actually pay out of pocket for your meds? Do you just forgo meds and go a more holistic approach? This is all very interesting.

Oh and thanks for the "hilarious" most of the time my wife sees my musings about our life together and just rolls her eyes. Needless to say I can feel her thinking," please don't encourage him."


The copaxone thing only works with certain companies that supply patients. Of course the company that they use here is not one of them. Figures.

I appreciate that you feel I am not a sell out. It's hard to rectify with myself most days. I just have to not work in a casino when my boys are old enough to understand what it is that happens here. I've said too much... Thanks for reading.



In a nutshell, here's what I have done/ and do:

1. Insurance wouldn't pay so Shared Solutions referred my case to NORD. I applied and received 50% assistance.

2. This left me with 50% responsibility and I appealed but was denied....twice (with AGI of ~ $27,000 I earned too much). I spent $15,000 on out-of-pocket medical costs that year.

3. Worked less and tax-planned better and following year earned AGI < 200% FPL (which is the magic number). NORD awarded me 100% assistance this time.

4. Next year, again earned < 200% FPL and, voile, received assistance again.

That's the key, voluntarily and drastically limit earnings to qualify for help. Really sucks!!! I would have to earn more than $40,000 extra just to pay taxes and drug costs, leaving nothing extra for me.

pUNKrOCKfairy said...

Didn't your mama teach you that NOTHING in life is free? Even blinky pens and dayglo change purses; especially anything provided by a company that may be associated with health "Care." I'm sure that "care" is a euphemism to these companies because whether you try the honey approach OR the vinegar tactic, they do not CARE about you, only about your money. Insurance companies trade in FEAR. How caring is that? They also seem to specialize in keeping the people with the information you need locked up behind phone trees and bound with red tape. Every day I am bound legally to tell patients they have to wait to get their results from their MD, even though I have just seen their giant tumor with my own two eyes. Nobody WANTS to be the bearer of bad news and few people get paid enough to do it well. Still, it's one of the things that makes me feel morally compromised in my job.

And here's the icing on my shitcake: The health "care" company I work for owns their own HMO and most of the hospitals and diagnostic centers in the county. They have just drastically cut everyone's work hours and instituted a hiring freeze. They're about to announce that there will be no bonuses or incentives this year, which sucks bad 'coz they don't give "merit-based" raises, just company-wide annual bonuses that can be earned by the employees by making the company work harder for cheaper. AND, our "benefits" packages for 2009 just came out announcing increases in co-pays and premiums!

Damn, I think my comment's as long as your post, but it's easy to get me riled up about this. WE are getting the shaft, my friend.

Anonymous said...

Just FWIW:
It pays to be prepared.

You don't need insurance for the treatment either ;-)

Bald Ben said...

Well I hate anymous posts, however I have to say I have been to clusterbusters, and it is the reason that I have been headache free for the last year. I will go in greater detail one day soon.


I say we start a revolution. You start in FlA and I'll start here in Philly. We'll meet somewhere in the middle and change the world. Burn it to the ground.

Brian Baughan said...

"If I had my druthers I would be somewhere else, making movies, taking pictures, flexing a creative muscle from time to time, MS free."

Well said. And I'd be cheering you on, brother.

Kelley said...

Sorry to be so late to the bitchfest. I am new to the MS blogosphere.

I am Kelley and I was diagnosed with RRMS in May. I've been on Copaxone and am faring well. However, I just found out that my copay for Copaxone will go from $50 per month to $150 in January. I was so thrilled, NOT! Anyway, I was able to get $50 of the copay covered by Shared Solutions. Sorry that's not an option for you. :(

Anyway, come check out my blog sometime; I'm still in the fledgling stages. I think you are very humorous!