Why we need comprehensive health care reform NOW

$415. That is the amount that I am being told I owe on two physical therapy sessions in December because the payee is listed on the insurance issued "EOB" (explanation of benefits) as an "out of network" provider and it says I therefore had "unauthorized service" resulting in owing this outrageous amount of money. The trouble is that I have been using the same "in network" PT provider for two years now and I did not exceed my yearly allowed total PT sessions for 2007 because I kept a careful count so as not to go over my allowed limit of 30 visits per year. Making a copy of my EOB for the PT office, I took it down to them to show them that there may have been a simple insurance coding error or something like that, but what this will result in is that Amy at the PT office will have to re-submit my claim to the insurance company, who will then have to re-issue the EOB, sending a copy on to me and then sending it on to their billing company for verification so that everyone can get paid their allowed amount. Is it any wonder that health care costs are so high, then? With all of this administrative overhead, it's no wonder we're all paying such high premiums, co-pays and deductibles. And with our patchwork system of private health care providers, doctor's offices must hire numerous personnel to deal with all of the paperwork for all of their myriad patients and their insurance providers. Doctors are often left to consult with insurance people to find out what kinds of treatments the insurance companies will allow them to offer their patients, meaning that insurance company people are often the ones making the actual medical decisions, not the patients, not the doctors. For example, my orthopaedic surgeon cannot do any kind of expensive diagnostic services like an MRI or a CAT scan or anything else like that without consulting the insurance company for approval. If my doctor feels that an MRI is in my best interest, then why does he have to clear it with insurance providers first? That, in turn, delays my ability to receive the proper treatment while the insurance company and the doctor talk to each other about what my doctor wants to do for me.

This coming week, I am to be fitted for a knee brace to help my chronic left knee problems due to osteoarthritis. Looking up the kind of brace I am to be fitted with online (and I assume the one shown here is what I will be fitted with, although there is another model that is listed as a "lite" style brace which may be what they want to give me), I see that it costs about $550. I called my insurance provider to see if they'd pay for it, but they'll only do so if my PT consults an in-network "DME" (durable medical equipment) provider, and even then, I will probably still have to shoulder at least 50% of the cost myself, because "DME's" are not covered by my insurance. None of this crap makes any sense whatsoever and I have to hope that the incoming Obama administration will act quickly to do something about all of this, because my medical bills are mounting and I haven't the money to pay for them all. However, I am enough of a realist to understand that they'll probably want to cover the uninsured and children first and will probably expect those of us who are insured to continue using our private, employer provided health care plans, even though most plans out there ask the patient to shoulder more and more of his or her own costs. With the economy being so badly in the dumps, I can understand why Obama will probably have to radically scale back his recovery plan, but it seems like I've waited long enough for help to arrive that I want results as soon as possible. But I know that patience will be asked of all of us, and it may take years to clean up the mess that the Bush administration has left for Obama to clean up. In the meantime, I'm just going to have to save money for unforeseen medical expenses, just like I used to have to do with my old car before I finally got rid of it. So I traded in one old used model, but I'm stuck inside a body that is requiring more and more maintenance as it accumulates more miles on it (and it's not the age, it's the miles!). I dream of an administration that values wellness and prevention over focusing on treating illness once it's taken hold. Of course, it's going to take all of us to change our mindset about how we treat our bodies and how we go about dealing with health care. As our grandmothers and moms always told us growing up (and you doubtless heard this, too, from various people): "An ounce of prevention is worth a pound of cure." An old aphorism, to be sure, but one that has more truth to it than most people would like to admit.