Mark and Vinny's Blog

When I try to explain the draconian machinations of the US health insurance system to my friends and family in Europe, they just can’t understand why we allow it.

In Denmark, where my mother was born, and were my cousins still live, there is universal practically free health care. Hospitals, tests, doctor’s appointments, prescriptions – everything is almost completely covered for EVERYONE. In fact, health insurance is illegal in Denmark.

Of course, the Danish people are willing to make trade-offs that we Americans will not. They think it’s reasonable to share the total health care budget with the whole population, so they won’t approve expensive tests and treatments that we in the US consider routine. For example, because of Vinny’s age and multiple, terminal diagnoses, the Danish system wouldn’t consider the ridiculously expensive course of treatment that’s kept him alive for the last ten years.

The Danish people also share this view. I remember when my mother was in the last years of her life and her routine level of health care was equally ridiculously expensive, she wondered if it was moral for her to accept this level of care to extend her life for another few years, if that meant the health care funds were unavailable, say, for fifty poor mothers to be able to get adequate prenatal care.

I guess I’m hypocritical. I’ve been very politically active for years fighting for universal health coverage in the US, but as someone with great health insurance, I love the huge piles of money that are spent keeping us alive and healthy. Well, I love the positive effects anyway.

In New York State, we are fortunate that folks with chronic medical conditions like HIV/AIDS and hepatitis can get health insurance. Most US states allow insurance companies to exclude preexisting conditions or deny coverage if you flunk a physical. That was our problem when we lived in Connecticut and why we had to move.

But individual policies can be really expensive. For example, Vinny’s health insurance is $975.70 per month. Group plans can be easily half that. I had a pretty good health insurance through POZ, so I was going to take advantage of a 1986 a federal law called “COBRA” that permitted folks who left a job that provided health insurance (like I did going out on disability), to continue that coverage by reimbursing the former employer for the complete cost ($416.03 per month) for 18 months (28 months if continued disability).

In theory, submitting a COBRA form, like mine on the right, should be only minor bookkeeping item. The health insurance is not supposed to be effected. You don’t even get a new card. It’s the same old policy.

On Tuesday, I saw my Ear, Nose & Throat Surgeon Stacey Silvers to figure out why I’ve been gagging and throwing up so much. I was worried that it was a complication from my tonsillectomy in 2005. It turned out that it was “just” that I’ve developed acid reflux disease, but that’s treatable with a prescription and regulating how and what I eat.

Next stop was Village Apothecary to get the prescription filled and pickup some other refills. They said the computer said I didn’t have health insurance. I said “you mean this prescription isn’t covered by my plan” and Chris said “no, it’s covered, but your policy has terminated.”

I was shocked.

Right there from the pharmacy counter I called the Dennis Daniel, the POZ human resources person who called Wendy Frank, the insurance agent. These are two terrific people and they too were dumbfounded with the insurance company’s response: “most of the time COBRA transitions are seamless, but sometimes one record has to be deleted and another added, and that can take ten days to straighten out.

There was nothing more I could do that night, and besides, I needed to go home a take my Pegasys shot.

This week my Pegasys side effects were a bit rougher than the previous week, so I didn’t do too much out of bed on Wednesday, Thursday or Friday.

On Friday, I was starting to really freak out. Every number I called at Oxford just told me I wasn’t insured. I hadn’t been able to pick up any prescriptions all week. Some insurance person suggested that I pay out of pocket and then submit for reimbursement. This week would be over $1,000. Next week will be over $2,000. That’s just not an option. Next, two of my doctor’s offices called that I was coming up uninsured and that I had to have this resolved before my next appointment.

Everything is just so automated, it’s impossible to make any headway. I don’t usually “borrow trouble” but I got to worrying what would happen if my crappy side effects got worse and I had to head to the hospital over the weekend. There was no way I could convince them I really had health insurance and that it was just a clerical glitch.

Fucking “A”, I’ve beat HIV/AIDS for almost 25 years and now I might be derailed by an insurance company clerical glitch.

On Saturday, I woke up and was feeling MUCH better, so it doesn’t feel so life and death, but I HAVE TO have this resolved before the next Pegasys shipment has to go out next week. It would be REALLY BAD to have to stop and restart this treatment. I won’t worry about that now. I’m sure collectively we’ll figure out how to escalate this next week.

Also, I got a little more perspective on all this. We're damn fortunate to have such great health insurance, even though mine had a little glitch. For both Vinny and me, our injectables cost more than our pills, but somehow the huge pile of pills are more tangible to show our efforts in working to be well. Between the two of us, we take more than 25,000 pills each year: