First time diarist, so please be gentle.
I hope my experiences navigating the healthcare maze as an uninsured, relatively young adult with a mild chronic condition might be helpful to others facing a similar situation.
I was diagnosed with hypothyroidism right after I graduated from college back in 1999. My Mom had recently been diagnosed and she insisted I go see her endocrinologist in Houston, which she paid for. That particular doc was in such high demand he didn't even bother with insurance. Office visits and labs were a few hundred cash, but Mom just knew I had hypothyroidism and loved me enough to pay for it. For years, I couldn't lose weight no matter how much I exercised or dieted, had dry hair full of split ends, was chronically constipated, lethargic, all the classic symptoms. Sure enough, the labs and the neck exam indicated hypothyroidism. I was put on Synthroid 100 mcg.
As an aside, the only reason my Mother took me to that doc was because she called on him as a pharmaceutical rep. I won't go into the extravagances I heard about, but suffice it to say money just fell off trees from Big Pharma.
As it happens, Synthroid is a relatively inexpensive daily maintenance medication. Back then, it cost about $17/month cash for my prescription. It's risen over the years, of course, and I can save a few dollars ordering online from drugstore.com or eckerd.com rather than getting it from the brick and mortar CVS.
After temping for most of 1999, and having only a catastrophic insurance policy my Father bought me, I landed a good job at a telecom company in Dallas (no small feat for an English major back then). Great, I thought! Now I have health insurance and I need a refill on my Synthroid. The doc in Houston referred me to an internist in the North Dallas area (Richardson) and I saw him for years.
In the meantime, my company went through all kinds of problems, as the Dallas telecom industry was in a bit of flux after the crash. Divestitures, mergers, and constantly changing insurance plans. I think we went back and forth from Aetna and Cigna about four times. Still, my doc in Dallas kept taking whatever insurance I had at the time for my yearly visit.
In the middle of all this, my company's insurance plan introduced a mail order only policy for maintenance medications. I had been doing mail order anyway, but from eckerd.com, which was now forbidden. The company's mail order pharmacy would ship 3 months of pills at a time for 2 copays instead of 3. Oh, and the copay went way up when this policy was implemented. I messed around with that for a few times, but the customer service was abysmal, shipments were late, and the paperwork was a nightmare. Eventually I priced it out and realized that the cash price of three months of Synthroid was the same or cheaper than using insurance, so I just quit fooling with that headache and started paying cash to either eckerd.com or drugstore.com, whichever quote was cheapest.
One year I was visiting my doc for my annual bloodwork and med check and he happened to mention that my insurance company hadn't paid him yet for my last year's visit. I was absolutely horrified. Here I am, a young healthy person in my twenties, trying to stay healthy, and they balk at paying for my annual checkup? The doc doesn't work for free, nor should he be expected to. And that was my only utilization of resources - that single yearly checkup. Between my employer and me, the premiums were over $400 a month.
The year after that, I decided to move back home to Birmingham, AL, and went to see my doc in Dallas one last time while I was still covered, as I knew I wouldn't have health insurance for a while. However, my insurance company had been so crappy he decided to just drop them. Uh, oh. I'm about to leave the state and don't have a doc in Alabama yet and still need my Synthroid script. So I asked how much it would be to pay cash for my appointment. We negotiated $150 for a full physical and labs. I got my Synthroid script, which I'd been paying cash for anyway, and moved to Birmingham.
A year later, and I'm doing contract work with no benefits. I made an appointment with a doc I used to see when I was in high school and let his office know I didn't have insurance and needed a Synthroid script. That doc had a policy of charging his uninsured patients $40 a visit and, probably because I'm not a complicated patient, he accepted me into his practice again.
I've been seeing the doc here in Birmingham for three years, still paying cash, still doing contract work with no benefits. His office policy is a visit every six months instead of yearly, which can be kind of inconvenient, but he's seeing me for $40 a pop, so I can't really complain.
One thing I learned after my first visit to the lab in Birmingham - negotiate labs through your doctor's office if you can. I paid Qwest Diagnostics $400 for bloodwork the first time. I mentioned it to the nurse at the doc's office and she said that their office has a huge discount if I go through them. No kiddding, it was a massive discount. Cash price for labs ends up being a little under $50 through the doctor's office. Qwest was charging me like they would charge an insurance company.
It's strange how not having insurance changes things. The last time I went up to get my labs done, I went into the doc's office to pay first. The receptionist said, "Oh, you don't have to pay for labs, it's covered under your insurance." Um, I don't have insurance. The office manager walked by and recognized me, pulled out a clipboard with my information, ran my credit card, and gave me a paper to take upstairs to the lab.
There's a neon pink post-it note taped on my chart: UNINSURED
I know this sounds like a big Republican wet dream that I'm "taking responsibility for my own healthcare" and that I've managed to navigate the system thus far. The system must be working, right? Um, no. I've looked into crap individual policies from BCBS, which even President Obama pointed out is a monopoly in Alabama, and they all look like junk. Why would I pay a bunch of premiums for no benefit? I basically did that before with employer sponsored insurance. I can pay cash for what I need now, but if something else were to happen, I couldn't do it. Years ago, I was a temp receptionist at the Austin office of the American Cancer Society for a few weeks, and heard a few folks come in saying, "I was diagnosed with cancer and don't have insurance (or my insurance company denied the claims). Am I just supposed to go home and die?" I hope that's not me one day.
Yes, I do want the public option, but that's not what this diary is about, as there are far more well written stories and diaries on the subject.
Just my experiences with cash for healthcare as a younger person, or should I say consumer, with a relatively mild and inexpensive condition.