Defining Health Insurance Irony in TN

Today’s local paper has two front-page (dead-wood version), different sections, articles on health care insurance. In the Health section is Sherry Wilcox who is uninsured and had to go to Thailand for a hysterectomy because the same procedure was unaffordable here.

Wilcox, a real-estate agent, works on contract and thus isn’t eligible for group insurance through her employer. She’s had individual insurance plans before, most recently through a large national company that dropped her after, she said, combing through past medical records and finding a passing notation by a physician that she felt “depressed” about some financial setbacks a few years ago. Wilcox said her insurer called this “depression” an undisclosed pre-existing condition and canceled her policy retroactive to almost two years, an increasingly common practice that has resulted in legal ramifications in other states for insurance companies.

Wilcox made a fruitless search for an affordable policy, considering her age – 45 – and past health problems that included a pulmonary embolism, a blood clot blocking the artery to the heart.

“It was unaffordable,” she said.

Then, in April, she began feeling unwell. Primary among her problems was rapid weight gain and a swollen, sore stomach.

“I only go to the doctor if I absolutely have to,” Wilcox said. This was one such case. Wilcox visited a gynecologist and told him she had a history of uterine fibroids; he deduced that was causing her current problems and forwent an ultrasound, which would have cost her more money out of pocket.

Turns out the cost here in east TN would run Sherry more than $22,000.

The physicians’ fee for the surgery was around $6,000, but since Wilcox was paying out of pocket instead of filing insurance, she learned she could negotiate it down to about $3,000. That left hospital expenses.

“Just for the surgery room and two nights in the hospital, not including medications, not including anesthesia, not including all the pre-op stuff you have to go through … was $16,000,” Wilcox said. “I was just blown away. And they would need whatever amount of money up front unless the doctor said it was a medical emergency.”

Turns out that the problem was not uterine fibroids, but a benign tumor that the doctor in Thailand caught. Meanwhile, later in the article, you are warned about going overseas for medical care, even though Sherry did her research for the best doctor and hospital, got wonderful care, and the cost was less than half (including travel and hotel) of what it would have cost her here in the US.

Now, for our wonderful care [/sarcasim] here at home, the front page of the local section has this article on TennCare cutting back on nursing services.

In an effort to curb what it says are skyrocketing costs, TennCare is reducing coverage for private-duty and home-health nursing services for adults as of Sept. 8, according to bureau officials.

TennCare is the managed-care program that provides health coverage for 1.2 million low-income children, pregnant women and disabled Tennesseans. Officials say that about 10,800 TennCare patients received some type of home nursing care in 2007. The new limits will affect about 1,000 of those patients.

Now, far be it for me to tell the state how to manage TennCare, but the increase from $60 million per year in 2005 to $163 million per year in 2007 is astounding. No one from the state of TN is reigning in the MCO’s that are taking money from TennCare for the care of patients, whether or not that patient uses their alloted amount of monies. Shorter version: MCO’s are taking money for no services in some cases.

Wouldn’t it be more cost effecctive for TennCare to pay for a patient’s actual care instead of handing over money?

It’s no wonder that the uninsured are globetrotting for medical and dental care. For those that stay at home, they are dying younger and receiving less care for more money. I’d say this is the sickest kind of ironies there is.