Ow, ow, ouch!

OUCH - one teeny, tiny, little bitty tube of Denavir cream for the ugly, painful cold sores which I still get = $45.00 at the pharmacy this a.m. I don't remember it costing that much last refill but maybe my old insurance had it in a lower tier. Who knows? I'll try thinking of it as a beauty product, maybe that'll be better. Let's see, my moisturizer is $12.00 for 40 grams and that lasts me about 3 months. So, $48.00 per year. And if I have 3 cold sore outbreaks per year, then the Denavir will last 16 months for $45.00. Hah, better already. But the moisturizer is only .30 cents per gram and the Denavir is $30.00 per gram. Holy cow. $12.00 vs $1,200.00 for equal amounts. Like I'm going to care the next time I start feeling the burning, itching, swelling, blistering outbreak?

But what else could I have done with $45?
Gotten 4 months of DVD's from Netflix or,
Downloaded 45 cool tunes from iTunes or,
Bought 5 yards of cotton quilting fabric or,
Had 4.75 "Back Bar" margueritas at the bar & grill and
Stocked up on Tylenol to deal the with the back-bar hangover or,
Got that red leather purse which was 50% off at Macy's last weekend or,
Picked up 18 6-packs of annual at my favorite nursery or,
Spent it all at the Oprah store in Chicago this weekend.

Oh well, I'll just admire my teensy tiny tube and hope the airline doesn't confiscate it tomorrow. That would hurt.

Use It/Lose It

Have I mentioned yet that I work in Human Resources for a small company on the west coast? Well, I do. And that includes overseeing the employee benefit package - which means, of course, the medical insurance plan. Like most small employers we've been watching our premiums climb and climb and climb over the past 10 years. We've tried all the cost control measures: converting to a Preferred Provider Plan, raising deductibles, increasing co-pays, decreasing coverage - all of which worked for very short periods of time. But the rates still increased 85% between 2001 and 2006. At renewal time in 2007, the projected annual premiums were going to be over $600,000 to cover 35 families - an average $17,142 per year per family. We actually had entry level employees whose health coverage was going to be higher than their annual earnings! It wasn't do-able.

So we switched companies, restructured the benefits, and signed on with a High Deductible Health Plan (HDHP) and a Health Reimbursement Account (HRA). The savings were substantial, enough for the company to fully fund the HRA for each employee and still leave operating funds for the business! It seems to have worked well - the employees have been relatively happy with new coverage (but have given me lots of blog material for the future), the expenses have been kept in line, and the paperwork has been manageable.

Now it's time for renewal. And guess what? The premiums will be increasing 20% for the upcoming year, because we fully funded the HRA rather than leaving our employees responsible for a portion of the deductible. As it's been explained to me, the insurance company has found that when deductibles are fully covered thru the HRA, the employees "over utilize the system". In other words, they make doctor's appointments and get health care! If the HRA is not fully funded and the employees have to come up with an additional $500 or $1000 per family, then they "tend to make better consumer decisions and utilize the system more appropriately." In other words, when they can't afford to pay the doctor bills, they tend not to make appointments.

But the thing is, we're not over-utilizing. The reports show that 75% of the employees had a medical claim in the last 9 months. 25% have not seen a doctor during that time. Of the 75%, 6 people had reached their annual deductible and maxed out their HRA. That worked out to 20% of the covered employees. So 80% did not fulfill the deductible. In addition, the HRA usage is running about 48% of projected expenditures, which is well below the 60% industry average. That's great for the company because we can keep 52% of the funds in the operating budget for next year. Except that now a portion of the savings will be sucked into the gigantic insurance vacuum when they raise our premiums. Again. Year after year after, there is only one winner and it's never the employer or the employees.

Although technically I'm not supposed to have access to employees medical information, I pretty much know what's going on with everyone because they tell me! I've helped them select in-network "providers", decipher insurance statements, file reimbursement claims, set up their internet passwords, send in the pharmacy-by-mail forms, and more. I know what's up with each person and I know how they're getting their health care. No one is using the ER inappropriately, no one is making appmts. just to get out of work for a few hours, no one is running to the MD for sniffles or dishpan hands. We have a couple of diabetics, some baby-boomers with the standard high cholesterol/bp problems, cancer survivors who need periodic checks, teen sports injuries, young moms and want-to-be-moms, etc. etc. etc. It's a boringly normal slice of middle-income Americans, who are now footing the bill for the true system abusers and for the insurance company shareholders. Providing health care for their own families is coming in a distant 3rd in the list of priorities.

So, my company won't be fully funding the HRA's in the next 12 month period, which will keep the insurance company happy and will keep our overall increase in the 5% range rather than 20%. The employees will have to factor another $500 to $1000 into their annual budget and "make better choices as health care consumers." When I meet with them in June to explain the decreased funding, the only thing I'll be able to say is "Don't use it and you won't lose it."

Xscape Part 2

In order to finish this tale, I’m skipping ahead 6 weeks. During that 6 weeks, I had the office consultation, a blood draw for CA125 testing (normal limits), got advice from friends about how to get the best post-surgery drugs (always say 3 or higher), and made tentative arrangements to be off work for 6 weeks. At the very last check-up, my feet slipped into the stirrups and YEEHAW, the funky looking ovarian cyst was nowhere to be found. It had spontaneously resolved and, like a condemned prisoner I was given a reprieve! I still had 3 out of the 4 issues, but Dr. Z felt those could be dealt with by an “oscopy” instead of an “ectomy” and we had a deal.
He took time to explain the new plan but I was so pleased that all I heard was “outpatient procedure” blah blah, “dilation” blah blah, “little crampy” blah blah, “surgical center” blah blah. I wasn’t being rude, just relieved. There seemed to me to be a huge difference between a procedure and a surgery – I work with procedure manuals and policies & procedures all the time. This was much more familiar territory -much easier to handle.

So the date was set and I showed up bright, early, clean, and hungry at the brand new outpatient surgical center attached to our local hospital. The lobby looked more like a spa than a medical facility – granite counters, floor to ceiling windows, flat screen tv’s, landscaped gardens, and a large stone fireplace. It’s very beautiful and creates an immediate image of success, progress, and oh,OK – money. Thank God for insurance.

I was snugly watching TV by the burning fire when the nurse came to get me and we walked through the double doors on the right. From that point on, it was like visiting a foreign country where the citizens spoke a different language, wore different clothing, had a different culture and different customs. I was the outsider coming in on a temporary VISA, assigned a guide and expected to follow directions. I got into the ridiculously ugly gown (open2theback) and climbed into bed. The IV went in easily and I was ready. Ready to wait, that is. Apparently surgery is like installing cable - the appointment time is only an estimate. Just as I was starting to get fidgety, Dr. Z came in and I experienced proof that the brain can actually think of two different things at the exact same time: 1) Damn, he looks hot in blue scrubs, and 2) Please, please God don’t let me actually say that out loud no matter how many drugs I get! (Prayer must work ‘cause I’m still his patient. As far as I know he does not read or write blogs. I hope.)

Compared to my distress 6 weeks prior, I was feeling fairly calm and confident. The first reality check/qualm came when the anesthesiologist mentioned a potential sore throat from removing the breathing tube. A breathing tube? They think I’m going to stop breathing during this “procedure”? Maybe I should have paid a little more attention during the blah,blah sections in the office. Too late, I had already signed the consent form and I was wheeled off to the OR.

The pre-op area had seemed like a foreign country, but entering the OR was like landing on a different planet. It was fascinating but very scary and intimidating. I would have loved walking in and having a look around before getting onto the table, but the meter was running and tours were not available. I managed to slide over without either pulling a "Britney" or pulling out the IV, and that was the last thing I had to do for myself.

The NASCAR pit crew went to work attaching wires, cuffs, clips and monitors. I tried counting number of staff but kept losing track because I couldn’t see well (no contacts or glasses) and they kept appearing and disappearing from different directions. Each team member had an assignment, did it fast, and did it well. We all had a laugh when someone asked if I was comfortable because that was such an impossibility. I had the uncanny sensation of not being in the least bit necessary to the process, except that it was my body which was the center of attention. But that elusive element which makes me Me, wasn’t needed at all. I could have left the body there and gone across the street to Starbuck’s and everything would have gone just as smoothly.

OK, if you're still with me, we're finally reaching the conclusion of this epic tale. The anesthesiologist gave the nod and said "All set". Those two little words triggered a reaction I'd kept on hold all morning and I felt a cold electric shock of fear travel the pathway down my spine to my navel. It was a "fight or flight" reaction to giving up control and I panicked, wanting to stop the drugs which were already coming through the IV line into my bloodstream. Then Dr. Z stepped over, picked up my hand, held on tight and said "Think a happy thought and I'll see you in about an hour." Blink...and out.

So it was not being in the center of a team of highly educated, competent professionals, or the precision instruments, or the sci-fi, beyond-state-of-the-art technology that banished the fear, as thankful as I am for the all of the above. It was a warm human hand and the sound of a human voice. Simple, basic, and incredibly effective. Everything leading up to and following those 5 seconds were medical procedures for my health. The 5 seconds of hand-holding was for me. End of story. : -))

Xcaping a SurgeXperience

For the SurgeXperience Carnaval: My Medblog Ho post was about my recent addiction to medblogs. In this one I’ll try to explain the start of my fascination with medical procedures. Or, to be more accurate, my fascination with medical procedures performed on other people!

Last fall, during a routine gyn exam, it became apparent that I had some things growing where they shouldn’t have been. (Sorry, providing a complete description would require not only a gown-open-2-the-back, but everything-off-below-waist, and this is not that kind of blog! ) My trusted GYN takes a conservative approach to my healthcare because my mother died from ovarian cancer at 59, only two years older than I am now. So when 4 separate, unrelated issues showed up at the same time he suggested that I consider an elective, preventative hysterectomy. I was not happy. It’s not that I wanted to take chances with my health but I’d managed to go 57 years without any hospitalizations, broken bones, incisions, or scars. Except for 4 useless, impacted wisdom teeth which were chiseled out in the 1970’s, I still had all my body parts and wanted to keep it that way for as long as possible. So the walls of resistance starting building even as we scheduled an office visit for further discussion, and kept on building during the drive home and evening.

Like most responsible patients, I consulted 3 very credible sources for 2nd, 3rd, and 4th opinions: 1) the internet, 2) my friends, and 3) my sibling, who happens to be a newly graduated nurse working in labor & delivery. The internet sources informed me that most hysterectomies in the US are unnecessary procedures inflicted upon women by uncaring, money-hungry, techno-reliant male physicians. That was helpful. Five friends informed me that“it was the best thing I ever did and my only regret is that I didn’t go in sooner.” Obviously, they’d been brainwashed. My younger sister, The Nurse, recommended, “Listen to your doctor, it sounds like he knows what he’s doing. And besides, at your age, it’s not like you need any of those parts.” Gee, thanks, that made me feel better.

Of course my sister was right – physically I didn’t need those parts. The ovaries have only been working part time for awhile now, and they may have even taken full retirement - which means the uterus no longer has to stay on call. And the cervix is just holding the other parts in, so yes, the whole apparatus could come out and not be physically missed. But emotionally – that was a different story! We weren’t talking about removing a gall bladder or appendix or some neutral organ, whose function I might not really understand. We were talking about removing the very organs which make me female, which distinguish me from the other half of the population, which once had the miraculous ability to create and nurture life itself and whose cycles have dominated my life for the past 45 years. I found myself wondering, irrationally, how they would be disposed of….would my womb just be plopped in with all the other surgical debris from the day, mixed with appendices(had to look up the plural), stinky kidneys and broken-down bowels? That was disturbing, as if it were a mixing of the sacred and profane. I wanted a ceremony or blessing or at least a tiny prayer of forgiveness as the tissues were carried away, saying “I’m sorry, I didn’t let you do your job and now it’s too late. Thank you for the potential, rest in peace.”

I tried imagining having that conversation with my rational, western science educated, male doctor. He’s worked with women and their screwball bodies (my words, not his!) for 20+ years, and has probably heard just about everything. But not from me. I was suddenly thinking like a crystal wearing, sage burning, lavender inhaling, new age earth mother and not my pragmatic, stoical self. This whole experience was taking me by surprise.

OK, it's obvious this post has taken on a life of its' own and will have to be written in 2 parts. I'll post this, and write the 2nd half a bit later. To be continued.......

Healthy but Hurting

After about the 48th ab crunch tonight in fitness class, I wondered: "If exercise is so great for the human body, then why the frick does it hurt so much?" Personally, I think a lot more people would do it on a regular basis if pain wasn't involved. Seems like yet another design flaw in the human system. Gosh, high blood pressure doesn' t hurt a bit but 60 second wall squats and floor planks hurt a lot. Hmmm, which one should I choose? Gaining weight from sitting on the couch with a bowl of ice cream watching a rerun of Scrubs for the 5th time doesn't hurt either but doing my bicep curls and tricep lifts does. And it doesn't hurt at all to have my bones lose density but walking up & down the hills around my house does. Being in bad shape = no pain. Trying to be in good shape = pain. That's just WRONG!

Well, stripes are always more slimming....

MedBlog Ho

Hi, my name is Spynster57 and I have a Medblog addiction. I didn't mean for it to happen. It started very innocently, suggested by my morning commute friend NPR. Some friend. "Go ahead", NPR said, "you might find it interesting and you can always hit the Escape button at any time. It's not like you'll get hooked or anything." Within hours, I was on my first blog. Within days, I had an uncontrolled compulsion to start my own blog. Within a week, I was a goner - hiding my habit from friends and family, losing interest in work and household chores, neglecting my pets, and forgetting to water the garden. Those things were all so PMB - pre-med-blog. Now it's all blog, all the time. The first few visits were fine - to seemingly harmless, interesting sites like Musings of a Dinosaur and Kevin M.D. But I visited every day, sometimes twice a day, just to stay connected and see what they were up to... almost like a stalker, but that's SO not the old me! Discovering the blogrolls was like being handed a rock of crack cocaine - I can't stop, clicking, clicking, clicking, getting deeper into the blog world and pretending like I understand the topics. This weekend I found myself enthralled by a 10 part posting on bowel surgery (oh, the seduction of Surgeon'sblog!) and I realized the extent of the problem. It's not like I know anything about a colon - other than the fact that I have one and that I should be very, very thankful that it actually functions properly! It's not likely that I will ever see a jejunum or duodenum and if I do, I probably won't eat for a week afterward. But that didn't stop me from reading - no way.

I see problems in the future, unless I get this addiction under control. If my employer finds out I'm spending 45 minutes reading medblogs for every 15 minutes of work, it could mean trouble. Then I'll probably start crying on the drive home, get into a car crash on the frightening highway I drive every day. But that means I could be rescued by Ambulance Driver, admitted by EM Physician, cared for by Emergiblog, operated on by Surgeonsblog, turned over to the Happy Hospitalist, and finally released to my own PCP who's a little like Dr. Dino actually. OMG.... I need a psych consult. Can someone please call Dr. Deb?

Cute Ho Story:
Last fall my friend, who operates a commercial nursery with her husband, took her 5 yr. old for the final interview before starting Catholic preschool.
Sister Margaret: "So Maddy, what does your daddy do?"
Maddy; "He works hard all day long."
Sister Margaret: "Yes, and I'll bet your mommy works hard too."
Maddy: "No, she's just a hoer."
True story......

A Pain in the B*tt

Feb. 2008: "Aetna Inc. said it will delay a proposed policy that would stop covering the cost of using anesthesiologists during colonsocopies." Wall Street Journal

April 2008: "Under stewardship, Aetna achieved one of the more remarkable turnarounds in business history. Today ...Aetna's valuation has grown nearly nine-fold (since 2001) to $29 billion. Net earnings for 2006, were $1.7 billion." HR Magazine

Interesting. If the company earned $1.7 billion while covering safe, effective anesthesia for their over-50 clients, how much more will they earn by discontinuing coverage? Is $1.7 billion not enough to guarantee long term success of the company? Are greedy anesthesiologists gouging the struggling insurance company for unnecessary drugs and fees, just because they can? Maybe. I notice the proposed policy has only been delayed, not discarded. Aetna must still be analyzing the risk/benefit factors, including the long term coverage costs for late - diagnosed colon cancer patients. Geez, health care management is such a pain in the b*tt!

Have You Recently Changed Laundry Detergent?

Female Clerk: "My nipples itch...someone must be thinking of me."
Male Doctor: "What?!?"
Female Clerk: "Isn't that what they say? When your nipples itch, someone is thinking of you?"
Male Doctor: "Nooooooo..."

From Overhead at the Office, attyahoo.com

HB Exam continued....

I'm still pondering the 6 minute exam. It was not an unpleasant doctor's visit, just disconcerting. I made the appmt. initially because 3 friends have been diagnosed with melanoma and a business acquaintance recently died from it, after a tragic oversite at her HMO. (Her "spot" was removed 3 times before they decided to send it to the lab.) In all fairness, the MD I saw asked if I had specific areas I wanted checked. And fortunately for me, that answer was no - I haven't noticed anything suspicious or unusual. But my friend Rosalie actually went in with a "suspicious" complaint, and that mole turned out normal - while the one on her shoulder was most definitely not. She had surgery a week after her first appmt. and now has to be scutinized every 6 months. So, what if I had had a "spot" under my bra, or along the pubic line, or on the inner thigh or armpit or top of the ear? It would still be there unnoticed and untreated.

That leaves me with this question. As a "health care consumer", which is the new paradigm, (and I hate that phrase) did I receive the product which my insurance company purchased for me? I would have to say no. It was partly my mistake in not realizing that the practice focused on cosmetic treatments rather than clinical, but as the consumer how can I make that determination? I did the research, as much as possible, and picked the doctor based on her degrees and internship at prestigious schools and facilities. Should I be sceptical of busy practices, knowing that the doctors are overscheduled? Should I rely on only word of mouth, and ingnore the PPO lists and PPO background info? Perhaps we need more accuracy in medical advertising or more access to useful background information. Otherwise, it's a roll of the medical dice. Sometimes I hit a 7 or 11, sometimes not!

Exam by a Hummingbird

Being a conscientous health care "consumer" I recently scheduled my yearly skin check. But my insurance has changed, so I either had to pay out of network rate - ouch - or pick a new doc. After researching the PPO list, I made an appmt., set the alarm, scrubbed up (after all, this new doctor would be seeing my skin for the first time) and drove 20 miles in commute traffic. For, alas, none of our local dermatologist are in the PPO. So, I had a 30 minute drive and a 30 minute wait before my name was called. The nurse took a brief history, said "Gown Open 2 The Back" and left me in an exam room with the ambiance and temperature of the Arctic National Wildlife Refuge. Minus the caribou and oil company engineers - too bad. I could have wrapped my feet in caribou skin and discussed the Bush administration with an engineer or two. As it was, I just watched my skin turn blue and finally huddled up on the exam table with my toes tucked under the thin cotton gown. Maybe that's why those gowns are always blue & white - color coordinated to lips and feet! Finally, the doctor flew in the door - young, petite, energetic, with alabaster skin and awesome suede heels. She looked at my arms, legs, back, scalp, and very briefly at the areas covered by the thin gown. The entire encounter took not more than 6 minutes. But, could that really have been comprehensive? The exams I had before (different doctor) generally took about 20 min. as she carefully examined every blemish, mole, bump, and crevice. What happened yesterday felt more like an exam by a hummingbird! I realized later that the practice specializes in cosmetic treatments, but still? Guess I'll go review the PPO list again. Maybe by next year my local doc will have joined the insurance PPO.