Monday, February 8, 2016

A Self-Sufficient Life in 2016: Phase 5: Health

"Hi, Mrs. Ludwigsen? This is the school nurse. Can you come pick up your daughter? She hit her head and requires stitches."

I went from working-from-home pj's to jeans and a t-shirt in 2 seconds flat. I don't think I've ever buckled my youngest in her car seat that fast. Together we flew to the school where my big girl was lying in the nurse's office...and definitely in need of stitches.

Don't panic, Jen, I said to myself. Don't panic.

I swept her up and got both girls in the car. I started the engine, buckled my seat belt, and then froze. What now? This was my first real emergency on the new insurance policy. I knew only two things right at that moment: (1) - an ER visit was an automatic $500, plus whatever we owed out of our $6,500 deductible and (2) - if I didn't go to the "right" immediate care center, I could end up paying the entire bill altogether.

So I did what any mom would do while her toddler is watching her big sister bleed from a gaping wound on her head. I sat in the school parking lot and called my insurance.

As anyone knows who's needed to call his or her insurance before, there is no such thing as a "quick" eligibility check. First you've got the automated maniac. Then you're got to press buttons and read tiny numbers off a plastic card. Then you get a representative who transfers you or gives you another number to call. Then when you finally get the person who has the unfortunate pleasure of speaking with you today, they can't spell your name right. Or find the immediate care center you're asking about. Or confirm you have immediate/urgent care benefits at all. Or they confirm the benefits, but then tell you the nearest immediate care center that is in-network is over yonder at the good old hospital...which has an emergency room, not an immediate care center.

So after throwing my phone into a lake I decided screw it, my kid is bleeding, I tried to do the right thing by my insurance, but they are morons. It's go time. I drove to the nearest facility, one that is so closely associated with the hospital the representative recommended that the hospital name is actually written on the building, and hoped for the best.

We had to go there twice. And the charges from the first visit (when we had the stitches put in) hadn't processed through insurance by the time we had to go back (to have the stitches removed). But don't worry, I, thinking like the good, smart medic I am, decided continuity of care (meaning, obtaining follow up appointments at the same place that originally treated you because it's typically better to see the same doctor for the repeat visits than to see a physician who is treating this injury/illness for the first time) was valued in America and it made sense to just go back to the center.

Of course, six weeks later I was punching myself. We received the explanation of benefits showing the facility charges were covered, but the actual physicians within the immediate care clinic were not contracted with my insurance plan. They were out of network. So 9 stitches, $650 left after insurance for facility fees, and $500 in non-covered physician fees, and my big girl's lil' forehead is all healed up with the faintest scar. 

Now this is a side note: I applied for financial assistance. The doctors didn't have any programs, but let me pay off my medical bill per month with no interest. The facility, I knew, had a fantastic financial assistance program. I sent in close to 30 pages of materials documenting the changes I'd made in my career and the amount of money we had coming in VS going out (hint: they are not equal numbers - paycheck to paycheck is a good way to describe my current influx of currency). Another 6 weeks passes and glory be to heaven, I received an approval letter. I owed $32. $32 after assistance! I danced! I called the customer service line immediately to pay my $32 and celebrated and laughed at the grumpy lady on the other end of the line.

But then, two weeks ago, a letter. Another charge for $650....and I owe $450 of it? I dialed the hospital billing line with a shaky hand and after much back and forth about whether or not I was ever approved, the representative finally admitted one of the charges had been overlooked because it was pending with insurance when I applied for assistance. "That can't be right," I told her. "I had an explanation of benefits showing they'd processed that charge. I included it in the application I sent you...so you had a copy, too, when you considered me for assistance!" Many ma'am's later and a few discreet cuss words and I'm currently back at square one. They are reviewing my account and it's very possible I will need to either re-apply and gather all new, updated materials or pay the $450. 

And this, ladies and gentleman, is why taking charge of your own health is important. I am a healthcare professional with a Bachelor's in Healthcare Administration and over 5 years of experience in the healthcare billing world. I know insurance....and I am tripped up by the red tape, the representatives who don't understand what they're looking at, the insurance regulations, and the high cost of healthcare. 

Now I'm not crazy. I know stitches cannot be avoided when your kid biffs her face. But outside of emergencies and chronic conditions, many human ailments can be treated without spending your entire savings account. 


Preventive Visits
Almost all insurance policies cover preventative care at 100%. Use these benefits, people. Go to as many preventative visits as your policy allows. Get the physicals. Get the labwork. Get the vaccinations. Let the doctor check you out because more often than not, early detection saves lives. And money. 

Know Insurance Terms
I wrote a little blog post about health insurance a few months ago. Understanding health insurance is critical, people. I know it's intimidating....but can you really trust your doctor's office or insurance company to handle your medical billing affairs? They see hundreds of thousands of patients, all with different medical policies...whereas you have one. Just one. Learn some of the basics so you can keep up!

Read Your Policy Now, Not Later
Read your policy. No, I'm serious. You can do it. Get a paper copy and a cool highlighter. Check for things like "visit frequency" and "limitations." Do not assume your doctor's office knows when you can get another flu shot or well-baby exam. You need to track those dates yourself and compare them to the limits of your policy. Some insurance companies only allow physicals up to certain age. Others only cover labwork every 5 years. Still others set limitations on what types of services are considered medically necessary. Read and if you can't figure it out, call and ask. If I'd done this step prior to little-miss-stitches-time, I would've known ahead of time the doctors at my nearest immediate care facility were out of network. Likely would've saved me a couple hundred dollars. 

Shop Around
Did you know patients without insurance can sometimes receive a self-pay discount? 25% of the bill written off right then and there. Sometimes that 25% discount is more cost-effective than actually submitting your charges through insurance. All doctors set a "fee schedule" each year. This fee schedule determines how much they charge for each procedure or office visit. These fee schedules change and of course, each insurance company has their own fee (also called reimbursement) allowances. When your doctors sign a contract with your insurance company's patients (and are therefore considered in-network), they essentially agree to give their services to the insurance company at a discounted rate. And lemmie tell you, some doctors charge more than others for the exact same procedure. If you don't have insurance (and even if you do), price the doctors in your area and take the costs into consideration before seeing anyone for an appointment. Sometimes it's worth the extra $30 for plush chairs and mood lighting....but sometimes, I just want to pee in the cup and go home.

Exercise and Eat Right
Nope, not going to tell you how much to exercise. Or when. Or how. Just make time to move your body. And no, grocery shopping doesn't count. You've gotta actually be focused on raising your heart rate a little. You can walk around. You can dance with your kids while dinner cooks. You can even watch TV while you do it. You know the drill. Just do it. 

And we talked about the importance of healthy, sustainable food a few weeks ago. Food is a delicious, delectable component of life. Choose your food (and therefore, quality of life) wisely.

Herbal Medicine
I once thought herbs were strictly for cooking and smoking. I've come to realize herbal remedies, while sometimes thought of as "too hippy' for the general population, are actually quite effective.

I created some cough syrup, immunity-booster, and depression-fighter this fall using stuff from my backyard. Next year I hope to make more - I didn't realize how awesome homemade immunity booster is as a gift! 

Part of my main motivation behind becoming self-sufficient was due in large part to my continual struggles with my mood swings, weight management, skincare, and chronic strep throat. Traditional medicine wasn't working for me. I would take antibiotics, Accutane, face washes, expensive face washes, diet foods....I mean I did all the All-American things they say to do when you have trouble with hormones. I was still getting breakouts...I was still starving while overweight....I was tired all the time.....and I was still getting sick. The very first green smoothie I ever made was blended because I was sick of being sick. And guess what - I haven't gotten strep throat since I started drinking green smoothies. My skin looks pretty dang good, too, and I've found if I drink one when I start to feel a cold coming on, the cold doesn't last as long and I don't spend as much time wishing I were in bed surrounded by empty Kleenex boxes. 

Do yourself a favor and just check it out. You don't need to change out every medicine in your closet, but if you can save a trip to the doctor by simply smooshin some yard weeds in a jar of honey, it's worth a try, right?

Clean Out the Chemicals
In addition to decreasing my reliance on a Walgreens-like medicine cabinet, I've switched a whole slew of personal care products from store-bought to homemade in an effort to avoid chemicals. Chemicals suck, plain and simple. 

The toothpaste recipe is perhaps my favorite. I was a dental assistant for years and never thought I would stoop to brushing my teeth with clay and coconut oil....but can I please tell you, it's freaking awesome. I love it and so do my kids. I also use clay on my armpits. It's true. Best deodorant ever. I wash my face with an oil blend. It is also quite fantastic. The lotion (which is actually a salve, one very sweet lotion-salve-expert told me) is awesome and I sell it to people and give it to new moms. I've washed my hair with homemade shampoo, baking soda and apple cider vinegar, eggs, and most recently, homemade shampoo bars from my favorite lady ever. I've even gone as far as replacing my female products with reusable, sustainable options (which, to be completely honest, is way easier than I thought it would be, super affordable, and definitely something I will eventually need to post about. Maybe....).

I also make my own laundry detergent because it's cheap and not filled with weird substances that seep into the fibers of the clothes and pillowcases that surround my babes. I use wool dryer balls instead of sheets. I've started making my own glass cleaner and all-purpose spray. I am kinda obsessed with un-paper towels. Clean the chemicals out of your home and you reduce getting them into your body....and you save some serious cash when you stop buying disposable, pre-made everything. 

Go Outside
I mean it. Sitting in your house all day, or behind a desk, or behind the wheel is enough to make you insane. Go outside for 5 minutes, just 5 minutes. Just to check the weather. Or see the stars. Or get your mail. Step outside and if you like it, stay out longer. It nourishes your body and your mind to be outside. Create a little oasis for yourself somewhere outside (this can even be a stair with a bit of sunlight slanting on it and a magazine...or a park tree.....or heck a chair outside of Starbucks). Enjoy the air for a minute, or 10, or 30, if you can. 

Health is a combination of nature, nurture, and chance. Sometimes you come from the best genetics and best habits and still get sacked with chronic disease. Sometimes you come from a family filled with lung cancer and smoke 2 packs a day and you live until you're 90. Everyone's definition of health is slightly different, but one thing holds true: If you feel unhealthy, you can take steps toward improving your quality of life. You don't need to live like a sick person. You can improve your health one small step a time...start by loving your body and committing to taking charge of your health, be it in the heart, mind, or soul.

What about you, dear readers? Do you have any health tips and tricks that you fall back on when the going gets tough? What areas can you improve? Which ones do you rock? I'd love to hear about it in the comments down below and as always, thank you so much for reading :)

Did you miss a Self-Sufficient Life series post? Don't worry! Here's what we've covered so far:


2 comments:

  1. I could probably improve at actually going to the doctor once in a while...but my method is just to stay healthy and stay far away from the doctor. I'm thankful that strategy has largely worked for us! Health is something I'm continually grateful for. Our odd international insurance (when you don't have job that provides insurance and you don't live in your native country, affordable options are limited) has 0 coverage of preventative health. It's mostly a policy that protects us in case of terrible tragedy/emergency. We have yet to ever use it or even spend anything toward the deductible. Last time I went to the doctor was about a year ago for a Japanese Encephalitis vaccination. (Wanna have lots of cool and obscure vaccinations? Live in SE Asia!)
    My parents are still bitter about the time I fell and split my chin and had to go to the emergency room and they had to pay $700 for them to glue it back together. Problem is, if you have to go to the emergency room, is probably an emergency, and there's no 'preventing' about it...

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    1. I am with you, Rach, especially if prevention isn't covered. When that is the case, avoiding the doctor is exactly what I do, too. I am also huge on homeopathic medicine and herbal remedies, mainly because they are free and take little to no skill to make. I always wondered how international health insurance worked! I mean, I assume everyone is "out of network"?? It's interesting to hear about....particularly because insurance initially started as a tragedy/emergency-only type of thing, like car insurance. It slowly morphed into taking over every element of our healthcare and I honestly think if we kinda went back to where things were, we might be better off in the long run. Short-term, though, people would be very sick, I think. And mad!! Thanks for stopping by Rach! :)

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