Joe Kraynak

Doctors vs Health Insurance: Athens vs. Anthem

People who’ve grown up in Crawfordsville, Indiana like to refer to this small town in Central Indiana as “The Athens of the Midwest.” Perhaps it is, and from what’s been going on lately, this might just be the place where the battle lines are drawn between physicians and the health insurance companies, where debate over national health insurance finally gains enough momentum to make a difference.

Over the past couple months, I’ve heard some discussion about Anthem Health Insurance not covering treatment provided by St. Clare Medical Center - the only hospital in Crawfordsville. Apparently, the two parties settled whatever dispute they were having, and the issue kind of faded as a topic in the local gossip chains.

The other day, however, my wife received a letter from Athens Medical Group, where her primary care physician practices. (You can view a PDF version of the letter - 1 meg.) In his letter, CEO of Athens Medical Group, Brett Spencer, MD informs patients that Anthem Insurance Companies are dropping Athens as an “in network” provider. For anyone who’s dealt with health insurance, this is a biggie, because you pay a premium for “out of network” care.

The conflict could affect my family through my wife - forcing her to pay out-of-network if she wants to continue seeing her current providers or to drive a half hour or more out of town to obtain in-network care. My health insurance is even worse. I pay over $2,000 per year for a $10,000 deductible policy to a company (American Medical “Security”) that simply sends me statements explaining why it’s not paying any claims.

What I’m waiting for is the doctors to get totally fed up with the status quo and launch their own national health insurance company through the AMA (American Medical Association). Get rid of the middleman! They could standardize all the forms, so they wouldn’t have to deal with multiple insurance companies and forms, streamline operations, and increase efficiency. Who better to oversee what insurance companies should and should not pay for than the doctors themselves?

And if that doesn’t work, why don’t we just go back to paying cash - out of pocket? Require each doctor to do a set amount of pro-bono work, and get rid of health insurance altogether? What we have now just isn’t working.

Until this gets fixed, I’ve left strict orders with my family. If I have a serious illness and can’t get myself to the hospital, they’re to take the wallet out of my pocket, drive me up in front of the hospital emergency room, and roll me gently out onto the pavement. This is the only way I’ll be able to get the treatment I need without going bankrupt.

If anyone has any detailed information about what’s going on between Athens Medical Group and Anthem Health Insurance Companies or any other similar dispute, please leave a comment. Or just weigh in on the current state of health insurance in the United States.

My New Best Friend: Cortisone… for Allergies

Ever since I had a severe reaction to a combination of pink champagne and Alleve (don’t ask), I’ve had a growing problem with all sorts of allergy symptoms (not to foods, but to airborne allergens) - hives,  runny nose, nasal congestion, sneezing; post-nasal drip, cough, wheezing, and shortness of breath.

Usually, I can control the symptoms by popping Benadryl and shooting NasalCrom up my nose a couple times a day during peak pollen season. This year, my usual treatment regimen didn’t phase the allergies, so back in January, I saw my doctor to see if he could recommend anything. He gave me prescriptions for fexofenadine (generic Allegra) and fluticasone propionate (genric Flonase, a nasal spray). That seemed to do the trick, but I often had to add some Benadryl to the mix when things got bad, especially at night.

I eventually stopped taking the meds and was okay for several months, but a couple weeks ago, the allergies returned with a vengeance. I refilled my prescriptions, stocked up on Benadryl and NasalCrom and hit them with everything in my arsenal:

• Generic Flonase
• Generic Allegra
• NasalCrom
• Benadryl
• Afrin
• Sudafed
• My wife’s Albuterol inhaler or my over-the-counter Primateen Mist (for clearing my lungs)
• Mucinex
• Saline solution irrigation (2 cups water + 1/2 teaspoon sea salt + 1/4 teaspoon baking soda + capful hydrogen peroxide) warmed in the microwave for a minute on high and pumped through my WaterPik using a gadget I rigged for it

Eventually the congestion got so bad, I was tempted to snort a couple lit firecrackers to blast through the blockage, but on second thought realized that would probably be a bad idea. Instead, I visited my doctor. Here’s what he did:

• Added Singulair to my generic Allegra and Flonase (boy is Singulair expensive! With my whopping $18 insurance discount, it cost me $105 for 30 pills).
• Told me to reduce my use of Afrin because over the long-term the “rebound effect” could make me more congested. (I could still use it once a day before bed).
• Told me to lay off the Sudafed and Primateen Mist because it could boost my blood pressure into a range of concern.
• Gave me a shot of cortisone, telling me that it’ll clear me up for at least two weeks.

Soon after that shot, I felt much better. Woke up last night sneezing, but when I took the generic Allegra and the Singulair, the combination cleared me up. This morning, I feel like a champ. I’m even thinking of going jogging later.

Yes, I found a new best friend - Cortisone, I love you! Thanks, doc!

What Good Is a Privacy Policy?

My doctor has a privacy policy. My health insurance company has a privacy policy. When I see my doctor, however, he bills my insurance company for the services he provided and any tests he ordered. The insurance company has never actually paid a claim, because my medical bills never even come close to my $10,000 deductible.

Yet, whenever my doctor dutifully bills the insurance company (so those billing amounts can be applied to the deductible), he’s giving the insurance company personal information about me that they can use to increase my rates. They now have a complete record of any health issues I have… supplied directly by my doctor.

I rarely see the doctor, but over the course of the past few weeks, I had several doctor’s appointments, a chest x-ray, and a few prescriptions for allergy medications. Within a couple weeks of my most recent visit, I received a notice from my health insurance provider, American Medical Security, that the company was raising my premiums.

I suppose the only solution would be to tell the doctor that I don’t have insurance and just pay cash for everything, saving the receipts in the off-chance that my healthcare costs will exceed my deductible. My question remains, however – What good does a privacy policy do if the doctor has to inform the insurance company in order to get paid?

Sure, the privacy policy could help keep this information from others, including my employer or someone else I might not want to know about it, but the people who can use that information to do the most damage to me financially have ready access to it.

Fast Becoming a Minority in America

In a recent article entitled “U.S. to Grow Grayer, More Diverse,” Washington Post Staff Writer N.C. Aizenman calls attention to the fact that according to U.S. Census Bureau estimates, “minorities will be majority by 2042.”

I don’t know what to think of this. In a way, I became a minority as soon as I moved out of my heavily Polish neighborhood on Chicago’s South Side in 1978. I quickly became one of the few students of Polish-Ruthenian heritage attending Purdue University in West Lafayette, Indiana. (I did meet one other Pole from “Da Region.”) When I moved to Indianapolis, Indiana in 1984, I felt even more like a minority. In my 20 years of living in Indianapolis, I met only a half dozen Poles (none of whom was very Pole-ish) and not a single Ruthenian. And Crawfordsville, Indiana? Fugget-about-it… I have yet to meet anyone who’s even sampled a perogi.

Personally, I enjoy my minority status. It makes me feel special. When I mention perogi or kapusta, I feel like a traveler from some long-forgotten land. When I speak the few words or phrases I know of Polish, like dziekuje (pronounced jen-ku-ya, meaning thank you) or idz do domu i spac (pronounced eez-dough-dome-oh-spotch meaning go home and go to bed), I feel bilingual. I don’t even mind the fact that people commonly mispronounce my name as Kray-nee-ack (Ruthenian, not Polish), although for the life of me, I can’t imagine how they came up with that mispronunciation.

As a minority, I can blame everything on the majority. After all, if the Polish-Ruthenians were running this country, we’d all have high-paying jobs, low taxes, the best schools in the world, free universal health care, and other perks too numerous to mention. And since my ancestors arrived long after “The White Man” stole the land from the Native Americans and some time after slavery was abolished in the United States, I feel none of the guilt that the majority of Americans often suffer.

So, when I read about “becoming” a minority in America by 2042, it really doesn’t bother me. I’m already there… and loving it.

Beautiful Women

I read somewhere recently that 95-99% of what men find most attractive in women is in the neck up. We’re initially attracted to women and ultimately adore them not primarily for their “from the neck down” bodies but for the intelligence, grace, and sheer joy of life that beams forth from their faces.

This struck me as true and an important lesson to teach our daughters and the other young ladies whose minds we influence. With all the magazines and TV shows and ads constantly reinforcing the message that beauty means being thin - usually overly thin -and showing as much flesh as possible, we need to counterbalance these messages with the truth that most men find beauty not in the breasts and hips, but in the eyes and smile - in confidence, joy, intelligence, and individual expression.

The media’s message of what female beauty consists of is actually counterproductive to cultivating true beauty. It simply makes women, especially young ladies, overly self-conscious, not confident, and perhaps even bitter and unhappy. There’s nothing sexy in that.