Editor's note: The following letter was sent to Indiana Congressman Baron Hill, via his aides John Zody and Trent Deckard, simultaneous with its publication here. The Bloomington Alternative will publish any response the congressman sends, in full and unedited.
Dear Congressman Hill:
Before I get to the point of this letter, I want to thank you for your vote to support health care reform. And I want to say I hope you were sincere and not just tailoring your message when you told Dr. Rob Stone and other Indiana citizens that the ultimate solution to America's health-care crisis will be a single-payer system.
It seems to me that you may understand that this first step, so-called ObamaCare, will do little more than further enable and enrich those who have destroyed what at one time was a health-care system to be proud of. So, as both a journalist and a registered, Ninth District constituent, I am going to share with you my personal experience with these people.
And, Congressman, as I've told anyone in the health-care system who would listen over the past two years, you really need to hang around with a better class of people. Seriously.
"I have been self-insured since 2000."
In terms of who I am and where I might fit in your Blue Dog concept of the "American people," there are a couple descriptors we can agree on for the purposes of this communication.
The first is "self-insured." I earn my living as a freelance writer and adjunct lecturer at the IU School of Journalism. I pay for my health insurance myself, "out of pocket," as they say in the trade.
The second is "good risk." I have never smoked a cigarette in my life, have been a lifelong bicyclist and at 59 weigh the same I did in high school -- 170 pounds at 6'1". To my knowledge, the insurance companies that have covered me my entire adult life had never spent a dime out of their pockets on me until 17 months ago.
I have been self-insured since 2000, when I left the Indiana Department of Environmental Management, but this tale begins in the summer of 2006, when I was contacted by an insurance agent who told me he could get me a better deal on my health insurance, which he did, seemingly.
"I tailored this policy to my ability to pay on my modest, working-class salary. And that was what I felt I could afford -- no more than $6,056 a year on health care."
I didn't date my notes from the meeting we had at my home office, but I recorded the gist of our agreement on yellow notepaper. In part they read: "deductible ... 1,000; 50-50 coinsurance; max 2,500 out of pocket; 3,500 max."
I tailored this policy to my ability to pay on my modest, working-class salary. And that was what I felt I could afford -- no more than $6,056 a year on health care and premiums until the company had spent $6 million on me. That included the $1,000 deductible, $2,500 in annual copayments and $2,556 in premiums, at $213 a month.
Honestly, I couldn't really afford that deal, but I knew that at my age I could ill afford to not protect my body and what little I have of monetary value. So I signed up, and on Aug. 23, 2006, the company sent me a welcome letter.
I had made an excellent choice to "protect" me and my family "from the annual effects of unforeseen illness or injury," the letter from "Individual Medical Underwriting" said.
Included with that letter was 90-plus pages that comprised my "Certificate of Medical Insurance."
I'll confess right here, Congressman, that I did not read it. I don't think anyone except a lawyer would or could. I bought the best policy I could afford, based on what I was told.
In 2008, I started having problems with my right knee, and I went to see Dr. Tim Alward in Nashville, who recommended an orthopedic surgeon in Indianapolis named Charles Van Meter, who practices at Methodist Sports Medicine/The Orthopedic Specialists.
"My premiums, deductible and out-of-pocket expenses for 2009 was $9,212."
At my first appointment, Dr. Van Meter diagnosed the problem as a torn meniscus, a determination that was affirmed by an MRI. The meniscus is like a gel-pad that cushions the space between the femur and tibia bones.
My condition required a fairly simple, arthroscopic procedure to snip away the torn tissue, though the tear turned out to be more extensive than what I thought it was. After the surgery, Dr. V told my daughter he was surprised I could walk on it.
My recovery initially progressed according to script, but a few weeks in, for reasons I don't yet understand, I developed a bad place on my femur. Dr. Van Meter said it most likely was a bone bruise and that the best option was a course of benign neglect for a while. He told me to come back if the situation didn't improve.
Dr. Van Meter, Chuck, is an IU graduate with an autistic son, and I featured the two of them in a story about autism I wrote in the November-December 2009 issue of the IU Alumni Magazine. After I interviewed him at his son's group home in Mooresville in the spring and told him about my ongoing knee issues, Dr. V. urged me to come in for an office visit.
I chose not to go back, Congressman, in part because I had already been victimized by a system that emphasizes profits over human health.
I should mention that over the past four years, my monthly premium has more than doubled, from $213 a month to $454, and I expect another increase this summer.
Since no one can fill in for me in the classroom, and my condition wasn't critical, I scheduled my surgery at the Beltway Surgery Center in Carmel for December 2008, after the fall semester ended. Meniscus repair is an outpatient procedure with a fast recovery, and by the time the spring semester arrived, I was back in the classroom.
"When I told her I was going to spend two days in the hospital, she added, 'You have an inpatient access fee of $750 per day that we would not cover.'"
And I must say the process was at first quite impressive. The insurance company promptly paid the bills and sent me understandable explanations of benefits that comported with my understanding of our agreement. I paid the deductible and my half of the coinsurance.
While I knew I was getting ripped off, it didn't really feel like it.
Then Beltway informed me that it wouldn't accept the company's and my co-pays of $2,333 each for the few hours I spent in its facility. I spoke to a young man there who was personable and understanding. He said I could take 12 months to pay them off. I recall he pleasantly scoffed when I asked if they charged interest. No, he said.
The upshot is I spent the next year paying Beltway Surgery Center $240 a month. (The insurance company has subsequently told me that Beltway should not have charged me anything beyond my co-pay, but I have yet to follow up on that.)
As a consequence of my pre-surgery tests, I also had a stress test done at Bloomington Hospital and some blood work done locally, the upshot of which was mild high blood pressure.
My total out-of-pocket expense last year for all of this, Congressman, was $3,800, which is obviously more that what I was told I could be held responsible for.
While I really did hope my knee would heal on its own, the real reason I decided not to go back to Dr. Van Meter was that the whole money game with the insurance company started over on Jan. 1, 2009, two weeks after my surgery -- new deductibles, new co-pays, new out-of-pocket maximums.
The truth is, I couldn't afford to go back to the surgeon. My premiums, deductible and out-of-pocket expenses for 2009 was $9,212. That's $3,156 more in annual expense, Congressman Hill, than I was told it could possibly cost me in when I purchased this policy just four years earlier.
My knee never got back to 100 percent, though it reached an equilibrium that I could live with short-term. I couldn't ride my bike, but I could walk without my cane, and I could climb the one to three dozen steps to the Indiana Memorial Union, my office in the journalism annex and my house in downtown Bloomington. I could walk my Border Collie Zoe a mile or so each night.
"This fee clearly means my 'maximum out-of-pocket' for this second surgery will be $5,000, not $3,500."
My plan had been to wait until I paid off Beltway and return to see Dr. Van Meter if I wasn't back on the bike at that time. And while that would have happened, a bout with pneumonia in January knocked my knee out of kilter, landed me back on my cane and accelerated the timetable.
When I did go back to Dr. V after I recovered, he told me that any sort of assault to the body, like pneumonia or a gallbladder attack, can knock a joint that is in precarious balance, like my knee was, out of whack. He ordered another MRI, which showed a dead spot on my femur, and we scheduled a partial knee replacement for May 10.
Before surgery, I contacted my agent, who was surprised I had paid more than $3,500 out of pocket in 2009 and urged me to contact the company to verify that my providers are in the company's network, which I did, and they are.
I spoke with a helpful and friendly woman, who reiterated the terms of my policy -- the insurance company pays 50 percent in "covered charges until the out-of-pocket of $3,500 is satisfied and 100 percent thereafter to your lifetime maximum of $6 million," she said. I didn't ask what "covered charges" means.
When I told her I was going to spend two days in the hospital, she added, "You have an inpatient access fee of $750 per day that we would not cover, which means it would not go toward your deductible or your out-of-pocket. If you're there two days, it's going to be $1,500."
I'd never been told anything about an access fee, so I pulled out my "Certificate of Insurance" and looked it up. "An access fee is the dollar amount that a Covered Person must pay each time certain services are received," it says, going on to define two types, including a "Facility Fee," which is "the dollar amount that must be paid directly to the facility for each surgical procedure and each Inpatient stay."
I haven't gotten all my bills for my hospitalization yet, Congressman Hill, but this fee clearly means my "maximum out-of-pocket" for this second surgery will be $5,000, not $3,500.
"What kind of people do business like that? Why are you and President Obama enabling them rather than protecting us against them?"Congresman Hill, let's redo the math and think about this. Four years ago I signed onto a health insurance policy that I was told verbally and in writing set my out-of-pocket maximum at $6,056 for premiums and care.
In the past 12 months, I spent $9,212. And assuming no rate increase next year, I am looking at more than $10,000 this year.
I've lived in southern Indiana for the past 40 years and have traveled and written about the place for the past 30. I have a pretty good idea how people in Seymour and the rest of your district think. On their behalf, I ask you:
What kind of people do business like that? Why are you and President Obama enabling them rather than protecting us against them?
I'll speak for myself when I say that this lifelong Hoosier sees this kind of business dealing as misleading and dishonest, and those who do business this way liars and thieves.
I ask you again, Congressman Hill, whose side are you on?
I look forward to your reply,
cc: The Bloomington Alternative