Saturday, December 4, 2010

Saturday Story Fodder

Great writers pull story material from real life, right? I figure every once in a while I'll give you something to think about, something to remind you that our stories aren't as far off reality as we think.

Today—I'm talking about my insurance, baby.

No, I swear it'll be entertaining, because I have the MOST EVIL INSURANCE IN THE WORLD. I kid you not. Let's start with the basics.

To get decent coverage, they require you and your spouse to pass SIX tests. If you do not pass these tests, you are fined an amount of the premium (about 40 bucks per fail, which on our income is like half our groceries for a week).

The SIX Tests:
Weight: You must be under 29% body fat or lose 3lbs a month. (At 138lbs, I am still considered too fat, as I am an EPIC 32% body fat.)

Exercise: You must either 1) strap a pedometer (aka leash) to yourself every single day and get 10k steps (which is about 5 miles), 2) Exercise at home at least 12 times a month and keep a detailed log of how long and what you did, or 3) Join a gym and exercise 12+ times a month and make them print out proof that you went.

Cholesterol: You must be under a certain number or "show improvement" after each test.

Glucose: You must be under a certain number or "show improvement" after each test.

Blood Pressure: You must be under a certain number or "show improvement."

Vitamin D (newly added! because we weren't doing enough before!): You must have more than a certain amount or "show improvement."

Seriously. I am NOT making this up. Every month I get to drive to my husband's place of work, stand on a scale, and be told how much I weigh and how fatty my body is. Then they strap the blood pressure thing on, all the while smiling like they are doing me a favor...

Every quarter, we get the blood tests for cholesterol, glucose, and vitamin D. It's recommended that we fast...and I'm hypoglycemic, which makes that SUPER fun. And if we can't get an early appointment? Yeah, I have to eat, and then when they weigh me that day I'm FATTER because that's just what happens over the course of a day!

*deep breath*

Sorry, the rage was coming on. The number one thing people say to me when I tell them about our Evil Dictator Insurance is: "That's legal?"

To which I begrudgingly have to say yes. Why? Oh, this is where it gets really evil, guys. Be prepared. The reason it's legal is because this "Health Incentivised Plan" is technically optional. Except it's not really optional, because the "default" company insurance is a piece of crap. If we were not on this plan, our family deductible would be $3000 dollars a year. That means the insurance company would pay nothing until we racked up 3k in medical bills...and after that they would graciously pay 80/20.

For reals.

We're a healthy family. We rarely get sick. But I do have two young children who need shots and at least yearly health exams. I do have to go to the dermatologist yearly, because I have a large birthmark that needs to be watched closely. I do have to buy contacts. And visit the dentist. We can't afford to pay for all that out of pocket, even if it doesn't add up to 3k. We're, well, kind of poor.

So we have to do the "Health Incentivised Plan" to actually get insurance. And guess what? Even that coverage is not that great. You'd think we'd get the freaking moon for all that, but nope, we just get normal insurance a lot of people don't have to work for. Thirty-dollar co-pays on regular visits. One fifty on emergency room. 80/20. 5k deduct on maternity. Nothing full coverage, and let's not forget the fines if we fail...

Here I am, being appraised and poked and tested like an animal just so I can earn the right to affordable doctor visits. Every time I go in there, I feel like a big part of my privacy has been invaded. I feel like this company has put a security camera in my home, my fridge, hell, in my body. I feel trapped and angry, because they've cleverly made it so I can't fight back and cry foul. All they'll say to that is, "Well, you don't have to do the program. Just pay the 3k deductible."

Which I can't afford. Which is basically like having no insurance at all.

To the people who say America doesn't need health care reform, I say wear my damn pedometer for a month, stand on a scale to be told you are fat (when I AM NOT), have your blood taken just so a company that's supposed to help you can find a reason to fine you instead. Then tell me how you feel.

I am not saying I am for a government health plan—I'm just saying there IS a problem. I'm tired of this company running my life. For me? So far the choice has been between one dictator or another. And that, for this country, is just plain sad.

Also, if that's not dystopian book fodder, I don't know what is. Go forth. Write.


  1. So sorry that you have to go through all that, but I'm actually really excited you shared this info. I am already working on a dystopian that this information is perfect for.
    Now back to you - *hugs*

  2. Wow! That IS horrible! I love how you were able to relate your insurance experiences to "dystopian book fodder". That's how it's done guys! I do hope things improve for you though. I know what it is like to have horrible insurance, but my current one is even much better than that. I can't believe they would do that! What I dislike is that insurance companies won't cover hearing aids or at least assist with the costs because that is mostly the only constant expense I have other than vision. I agree health care these days and insurance companies need to take a good long hard look at themselves and ask, "what if this were me?" Anyhow, happy writing!

    I also have a YA story centered around the health industry--add in the government and a few desperate individuals and that would sum it up a bit more. YIKES!

  3. WAAAHHH that's ridiculous!! And 138 is nothing, geez. I don't have any good advice about the insurance, just sympathy. But I agree that we writers have 1 advantage when things (good, bad, ugly) happen in our lives: we can focus on how to turn them into something useful for our stories!

  4. How dreadful, are all providers like that?!

  5. Now, what I have to know is--have you ever shook up your pedometer at the end of the day when you didn't have enough steps? :)

  6. A dystopian story indeed!! Sounds so insane, but certainly something so many people can related to! I'm not a fan of America's health care... with health care, it still cost us $14,000 to deliver our second baby - and other than a standard c-section and a minor breathing problem that had to be monitored for about 2 hours, everything was normal. My daughter turns 4 this year and we're STILL paying it off. :(

  7. Yeah, just to pay for decent care you have to get one of those huge deductables, my mom is going through that now with a recent surgery.

    But...That far?? Are there any other possible companies you could join or something?? That's...just ridiculous! Well regardless I hope it gets better...somehow with that situation. I mean c'mon, an auto insurance version of this would be better by now.

  8. Woow, that's horrible. I had no idea things could get *that* bad and am suddenly very glad I live up in Canada. ;)

    I hope things will get better for you!

  9. Carole, not all providers are like this. That's the problem. Some people have FABULOUS coverage. Growing up, I didn't even realize what a blessing my parents' insurance was. They had 10 buck co-pays, and most everything was FULL coverage. Man, did I get an eye opener when I got married and went off that.

    Jamie, I plead the fifth:P Just in case Evil Dictator Insurance is WATCHING ME.

    Marisa, yikes. Yeah, if it weren't for medicaid, we'd be in the same boat. Luckily, the government was nice enough to deem us poor enough to cover babies (not anything else, though). We would still be paying too if they didn't.

    BET, I wish we could get something else, but independent insurance premiums are more than we can afford to pay in a month as well. Luckily my husband passes all his tests, and I can pass most of mine. So yeah, it sucks but we have to...

  10. That's crazy! I've never heard of anything like that. It makes me feel grateful for the insurance I have, even if we do pay through the nose.

  11. Ugh. That's awful. As a few hypoglycemic, I can totally relate to the fasting issue. That's hard. Insurance seems to suck, no matter what type of plan you have...and we can't do without...

  12. Suddenly feeling very patriotic knowing that I live in the UK and almost all health things are FREE. I'm disabled and therefore unable to exercise at all - I'm paying for it with my health, I don't want to pay for it with my money as well!

  13. You know, I was screaming "dystopian" in my head before I even got to the end of your post. That's insane! I wonder how many anorexics/bulimics have been born from that plan...

  14. #medicalsystemfail

    That's ridiculous.

    Bad me, but I'd strap that pedometer onto my two year-old and let him go wild. :)

  15. This is shocking and sickening. I had no idea this was happening.

    I spent my young life trying to keep my weight under 135, when my body wanted to be 140. Every single diet made me fatter--as they do 98% of the time--and now I really am fat--thanks to the draconian diets. This is evil AND hazardous to your health.

    I hope you'll broadcast this on more than your blog. The overprivileged few who have glorious health insurance (like the US Congress) don't have a clue what's going on with the rest of us.

  16. Every time I hear another story of health care in the US, I cannot believe that a democratic country would allow its citizens to be treated like that. A number of years ago I had a life-threatening condition that required six surgeries and innumerable doctor visits, after I was too old to fall under my parents' company insurance but before having any of my own, and I cringe to think how different life would be for me now if we didn't have a public health care system that covered the cost of making me better. Sure, it's argued that our taxes are higher, but you know what? It's totally worth it for the peace of mind.

  17. I'm going to write that book. It will be called The Fatty Games.

    Any citizen over the government's rigid weight limit will be forced to compete in a series of treacherous, exercise-themed obstacle courses.

    The last one standing wins. (Provided they lost at least five pounds in the process . . .)

    I think it's gonna be the next big thing.

  18. Sounds like one of their executives read Nineteen Eighty-Four and thought it would make a really good model for health insurance.

    Next thing you know they'll be installing a screen in your home so that Big Brother can watch you exercise every day.

    I'm sorry that this crappy company makes your family go through hell just to get sort-of-decent health coverage.

  19. That's insane. I can't believe you have to do all that. We don't have private insurance because the government program, Medicare, pays for most things. It's kind of shocking, actually.
    And you're right--great story fodder.

  20. This is truly evil. They're setting impossibly high standards as a way of getting more money out of you.

    The UK National Health Service is in a bit of a mess but no one here has to go through what you go through.

    In the US I'd have no insurance cover at all - with the CFS I can't exercise so I'm putting on weight and I'm generally unhealthy after a liftime of trying to live healthy.

    I do hope Obama does something radical. Too many Americans are suffering under the current system.

  21. Seriously?! That is the WORST thing I have ever heard! They should not be given the right to treat people that way!!

  22. Ugh, what *bleep* *bleep* these people are. Seriously? because life isn't *bleep* hard enough as it *bleep* is. Man, that's one of the nastiest, worst *bleep* insurances I've ever had the *bleep* displeasure to hear about. Sooooooooooooooo sorry. Totally *bleep* sucks and I'd love to tell that company to go *bleeeeeeeeep*.

  23. What the ....?? OMG. That is absolute craziness to put someone through that crap, not to mention degrading and humiliating.

    So sorry you have to deal with that shit. You'd think there would be a better way ....

  24. Yikes, I would fail that test...I think last time I checked I was over 30 percent body fat...yet I think I'm pretty healthy....

  25. Natalie,

    That is truly disgusting. I manage employee benefits for a living (you know, when I'm not hitting my head against a wall trying to get an agent to fall in love with my book) and I could have lengthy conversations about this with you (just email me).

    My mom has a $3000 deductible, which is horrible IMO. Our plan has a $200 deductible and I've had more than one employee complain about the "sucky coverage" (totally true). If only they knew what other people have to live with.

    I understand what the company is trying to do and why, but I think it's wrong. My two cents!


  26. What you do with the pedometer is you strap it to your kids. Maybe give them sugar for running laps.

  27. Yeah, you could cheat on the pedometer, but then you would still lose on the other categories. So it would just be a false sense of accomplishment.

    To continue the dystopian theme, we could continue to extreme polarization of government-dependent people and the people at the top gaining a hoard of interest off the general public and the world governments, and money inflating to worthlessness and the upper crust (nobility basically) owning all precious commodities, not to mention everything.

    Revolution! Crazy stuff ensues. Will the governments of the world go silently, or will military mobilize to pop the balloon? How about a peaceful "start over" with all of its own problems?

    I can't wait! Send me an ARC.

  28. Can I just say, I wish I was 138.

    And I'm not even as tall as you are.

  29. Yes, we DO need health care reform. But is it going to happen? I am so grateful my daughter was injured 24 years ago, before HMOs etc. It was a different world then. I feel so bad for families today like yours who have to go what you're going through!! Wish I could offer more than sympathy. Wish I could change the world!!!

  30. Scott Westerfield would have a field day!


  31. Probably won't make you feel better...exactly...but in Japan you could get FIRED from your job in your waist is larger than "standard." Apparently the standard waist size for a male is 33.5 inches. (WHAT?)

    I'm not saying insurance doesn't suck, but it IS worse in other places.

  32. I've always wondered about the US health care system.

    The UK NHS is coming in for a lot of stick at the moment and there are many who would have it cast aside in favour of a US model.

    But in spite of its inefficiencies and structural shibboleths, in spite of the ludicrous rise in medical costs and the length of time people are living these days, it's been the case that since 1945, if you're sick, you get treated. Hips, guts, car accident, cancer, heart attack — whatever it is (apart from 3rd & 4th cosmetic nosejobs), the doctors reach for the stethoscope/resussitator before the cheque book.

    Very useful when you're ill not to have to be concerned whether or not you're "covered".

    Yes, it's expensive, but peace of mind doesn't often come this cheap.

    Such a system HAS to be possible in the US.

    Hope you get it.

  33. Wow, that's amazingly awful. I'm suddenly really glad I'm in Australia - ours has problems but nothing on that scale!



  34. Every time we talk about this I swear my blood pressure goes sky-high. I will keep my mouth zipped about what I'd like to do to that insurance company.

  35. Completely insane. I could see giving you a discount if you do certain things but fining you because you don't is completely nuts.

  36. Ugh that sounds awful! I can't even believe what they're making you go through :(

  37. I agree that we need health care reform, but Obamacare is not the reform we need. Because of the new health care laws, our deductible just quadrupled (actually making it $3k now). Thanks ever so. But your post has made me realize the bright side: at least I don't have to jump through those kinds of hoops.

  38. Yeah we need health care reform. Not Obamacare by any means as depending on the gov't for my healthcare would surely be like standing in line at the BMV. No thanks. But insurance companies should NOT be like that. I know my the insurance my husband's work provides is coming closer and closer to what you're going through (yearly checkups and measurements to make sure you fall into the "right" category, using the outdated model of BMI, among other tests). They also only cover a handful of vaccinations for infants and children, which is going to be loads of fun next year once our baby comes.

    I could rant forever on it so I'll stop now :P

  39. Move to Canada. :)

    Your story makes me realize how much we take for granted up here. Yeah, so we don't get dental care and the waiting lists for certain procedures are sometimes long. But at least we can go to the emergency room without going bankrupt.

    I always find it amazing that the country that prides itself on being the best in the world can treat its most vulnerable citizens so badly.

  40. Natalie,

    I was thinking about you this morning as I read through some recently-released FAQs from the Department of Labor on wellness programs. They must not be "overly burdensome". Of course, that is open to interpretation, but I think you should write the EBSA and detail your plan, and see what they say. Here's the contact link:

    Good luck!