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Note:  This is a repost of an article I originally wrote on Christmas Eve, which few people read (it being Christmas Eve and all), but I received several personal messages urging me to post it again, so I am.  Hope that's okay...

The Illness

As some of you know, I am a Type 1 Diabetic.  Also called "Juvenile Diabetes", Type 1 Diabetes actually has nothing in common with the far more prevalent Type 2 Diabetes -- they're completely separate illnesses, and in a way, opposites.  Type 1 Diabetes isn't so much a "disease" as it is an event -- organ failure of the pancreas.  That means that, although my cells can process insulin correctly, my body isn't making any.  You could become a Type 1 Diabetic in a motorcycle accident, for example (which happened to a family friend).  Type 2 Diabetics, on the other hand, usually have a functioning pancreas, but the body's cells have forgotten what to do with insulin being produced.

While it's possible (for some) to prevent or even reverse Type 2 Diabetes, Type 1 Diabetes can never be prevented nor cured for anyone -- those of us who are preprogrammed to have their pancreas fail have to inject ourselves with insulin multiple times daily, in order to approximate what a functional pancreas would do.  To know how much insulin to give ourselves, we count carbs, and take 7-10 finger-poke blood sugar tests throughout the day, especially before meals.  It's not an exact science, but if I'm really diligent about it, and don't make too many life-threatening mistakes, my doctor says I could have another 30 years or so.  (I'm 32, now.)

The Good Old Days

Now, back when I was working for a larger company, my health care needs were more or less met.  My co-pays for insulin, syringes, and testing strips worked out to be around $120/month out of pocket.  Three years ago, however, I decided to try branching out on my own, and founded a web and graphic design firm as a sole proprietorship.  I used Cobra for a while, but when that was about to run out, I had to purchase my own insurance, which I had been dreading.  Even though I had heard horror stories, I didn't know how truly terrible health insurance was for a Michigan resident with a pre-existing condition.  Now, I do.

Michigan does not allow "groups of one" policies for self-employed individuals.  They do not allow people with pre-existing conditions to join group plans, such as would be offered by Sam's Club Business Association, or my Graphics Artist Guild membership.  Private insurance companies do not have to offer insurance to those with pre-existing conditions, and so none do -- not one, not in the entire state.  The only option that someone in my position has is to purchase Blue Cross Blue Shield's Individual Plan.  That's it.  

The Insurer of Last Resort

Because Blue Cross is a non-profit, the state requires them to accept everyone, earning them the name "the insurer of last resort."  That does not mean they have to offer very good coverage, nor be particularly competent in doing so.  (They have made an almost unbelievable amount of mistakes in my coverage just in the past two years.)  My premiums are quite low (only $250/month), but consider what little this is covering:

I am allowed only one doctor's visit (any type of doctor) per year.

I have a 30% Copay on all medications and doctors visits.

I have a $5,000 total cap on all services and benefits for each calendar year.

As you can imagine, being a Type 1 Diabetic on this plan is nearly impossible.  I'm supposed to see my endocrinologist four times a year, as all Type 1 Diabetics are required to do, but either can't, or have to pay $200 each non-covered visit, when I can afford it.  I'd like to be on a modern therapy, such as an insulin pump which could add 8-10 years to my life expectancy, but it's not covered by Blue Cross and it would be impossible to pay by myself.  I'd like to be testing my sugar as many times a day as my doctor recommends, but at $1 per test, that adds up too quickly.  And, a 30% copay for insulin works out to be hundreds and hundreds of dollars out-of-pocket just by itself -- per month.  Just for this one condition.  God forbid I ever get any other disease, or get into a car accident or something -- I would literally, instantly go bankrupt, even though I have insurance.

Which brings me to today's adventure.

Please Sir, Could You Spare a Syringe?

My health care premium check bounced earlier in the month, because a client check to me had bounced that week as well, and I didn't catch it in time.  Unfortunately, Blue Cross does not allow you to make a payment by phone.  There is no way to use a credit card.  You cannot pay online.  The only way you can pay is by sending a physical check through the mail, or driving more than 100 miles to the one and only payment center in the entire state.  During the time when you're waiting for a check to make its way through the mail, get lost, get found again, and eventually (hopefully) get processed, you have no coverage.

All this week, I've seen my remaining insulin supply dwindle away.  I've done my best to eat only low-carb foods, to help make the remaining units last, but I eventually ran out yesterday.  (I even tried calling other friends, or friends of friends, to see if anyone knew someone I could "bum" some insulin off of, but most Type 1 Diabetics have better insurance and are on incompatible modern therapy.)  Every morning this week, I would check my bank to see if the check had been cashed, or call Blue Cross to see if my coverage had turned back on.  Finally, yesterday, the money had indeed left my checking account, so I tried to get my insulin refilled.  No dice -- although they had apparently cashed the check, they still needed another day to "process".  But, they assured me if I could just hang in until this afternoon, everything should go through.

Uh-huh.

A Not-Unexpected Surprise

I waited as long as I could today, as they recommended, but finally had to try the pharmacy and see.  Predictably, I had still not been switched back on.  Blue Cross staff left at noon for the holidays, so there was no one to call, and Rite Aid's hands were tied.  They couldn't just sell me one insulin pen from the pack -- I'd have to buy the whole pack.  Unfortunately, that would cost me $525, which I simply didn't have, even if I emptied every penny from both my accounts and filled up my one remaining credit card.  What's worst, they couldn't just let me buy a singular bottle of insulin either, because I don't have a prescription for a single bottle, I only have a prescription for the packs of pens.  Even though it's the exact same medication (Humalog).  

So, the pharmacists told me I'd have to go to the emergency room, to get an on call physician to write a script for a single bottle, which I could then afford.  I went to our local hospital, Sparrow, and explained the situation.  They said they'd be happy to help, but recommended I try a redi-care center first instead, as it would be cheaper.  They gave me a list of all the local redi-care centers, but being Christmas Eve, they were all either closed, or had closed hours earlier.  I drove around frantically for a while, and almost made it to the last one that closed at 5:00pm, but they were already locking the doors when I pulled up.

Defeated, I drove back to Sparrow hospital to talk to their physician on-call.  They were very quick and efficient, and since all I needed was to talk to someone for a minute and get a script, they didn't even bother with the standard intake tests (i.e. no forms, no taking my temperature, no stepping on a scale, etc.)  I just sat with a nurse practitioner, explained the medication I needed, he wrote me a script, and that was that.  After all the hours driving around today and talking to people on the phone and trying to get help, the Sparrow Hospital solution took only five or six minutes.

But What Will it Cost?

So I walked to the hospital's pharmacy (my normal pharmacy had already closed early for the holiday) and bought the bottle I needed, now that I had a prescription.  It's only a seven-day supply, but it was also "only" $125 -- which I could afford.  Finally, for the first time in two days, I could eat something other than lunchmeat and water.

Then I go to check out.  Explaining the insurance glitch to the receptionist, she assured me it would be no problem -- she'd just bill Blue Cross the "old fashioned" way, which would take a few days, and surely the insurance would be turned back on by then.  So, she said I'd only have to pay my normal 30% copay for the visit today.  

"Great!" I replied, since I had very little money left and guessed I couldn't possibly afford the full bill, even though I just met with an n.p. for five minutes.  "How much?"

"Well, it looks like the total bill is $624."

My jaw dropped to the floor, as I started doing the math in my head.  30% of $624 is, what, $180?  $190?  I didn't have that anymore, because I had already bought the insulin.  

"It costs $624 to talk to a nurse for five minutes?" I said, astonished.  "So what's my portion?"

"No, no, you misunderstand," she explained.  "The full cost of your visit is $2,080.  $624 is your copay."

Blink.

Yes, that's what she said.  That's what the receipt says.  $2,080, and $624 for my copay.  For five minutes with a nurse practitioner, just so I could get a script for an amount of insulin to stay alive a few days, so I wouldn't go into a ketoacidosis coma (which would have happened had I been without insulin for another 48 hours or so).  

I gave the receptionist the last $20 from my wallet, and sadly gave her my address to bill me for the rest.

The Future

Honestly, I don't know what to think of the health care reform compromise that they're working on.  I still can't get a good answer from anyone as to whether it will even help me or not.  Right now, I spend about 1/3rd of my total income solely on managing my one and only illness (an illness, I remind again, could not be caused nor prevented on my end.)  I already lost every penny of savings last year, and the bank is sadly due to repossess my car any day now.  Although I'm quite successful these days in terms of clients, awards, and national recognition in my field, to say I'm still struggling financially is a bit of an understatement.  I don't qualify for programs like Medicaid because I make "too much" based on their poverty level calculations.  But after you subtract 1/3rd of my income (which is what I spend on health care), then ironically I would qualify for Medicaid.  But that's not how they do the math, because then if I went on Medicaid, I would instantly be kicked off, because without the medical expenses, I'm making "too much" again.  So... yeah.  Like so many people caught in the working or lower middle class, I'm caught in a solution-less cycle: I make too much to get government assistance with my health care, but not enough to be able to afford health care without assistance.  As to what the Senate bill will do to help me, and how many year I have to wait for it to kick in... well, I've emailed my Senators but the form letter responses don't clarify a thing.

Anyway, at the end of the day, I was able to use the system to get the insulin I needed.  As Republicans would say, it's not like they just let me die or anything, right?  It's just amazing what kind of damage a single, tiny bounced check can do.  I'll be paying for this mistake all of the next year.  

But, hey at least I'm alive!  :)  

Originally posted to cartwrightdale on Sat Dec 26, 2009 at 12:11 PM PST.

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