🤬 TMI: When The Responsible Route™ Fails
Or it fails you — on America's soul-crushing health insurance racket
“A [person] whose enemies are faceless bureaucrats almost never wins. It is our equivalent to the anger of the gods in ancient times. But those gods you must understand were far more imaginative than our tiny bureaucrats. They spoke from mountaintops not from tiny airless offices. They rode clouds. They were possessed of passion. They had voices and names. Six thousand years of civilization have brought us to this.”
—Chaim Potok, Davita’s Harp
Nothing enrages me more than senseless, time-sucking, soul-eating, KafkOrwellesque bureaucracy. Especially when I’m paying an over two-thousand-dollar-a-month “““premium”””1 for it.
What was my great crime this year? Trying to be a good adult and making my first appointment for an annual physical in years.
My second crime (and I’m sorry if this is TMI, but it’s relevant for our story today): needing a urine test for a possible bacterial infection after a week of daily sweaty summer morning Peloton rides. See also: trying to be a good adult. Again.
God forbid I had actually gotten sick-sick; I don’t know what this post would be. I wouldn’t be able to see through my rage to write it.
At forty-two years old, I am (miraculously, knock on wood) in pretty good health!
I lost thirty puppy-pandemic-marriage pounds last year, putting me back within “normal” range, whatever that means.
I haven’t had dessert since February 2024, when I quit refined sugar.2
I intermittent fast almost every day because I enjoy it, and it gives me energy.
I exercise four to five times per week. I sauna and steam when I can.
I walk Ryder for up to three hours each day, playing outside in dirt and grass. I call friends.
I don’t keep alcohol at home, and I can count the number of cocktails in a month on one hand (or less), imbibing only when out with friends.
I don’t smoke (never did), and I don’t do drugs (never got into that either). Unless you count my inhaler.
But still, it’s not enough. It’s not enough to stave off senseless medical rage, nor the fear of aging in a predatory system. God forbid I need care at a level greater than next-to-nothing. Do I even need to explain myself, to justify all the ways I try to avoid care?
One thing I have (re)learned this last year: if I miss too many days in a row at the gym, my nerves are strung tighter than a violin.
This is how I found myself, yesterday, sobbing in a coffee shop where I was *trying* to write any new post other than this one to the kind woman who called to inform me that my main hospital in New York City would no longer be covered by the health insurance company that I rage-quit the day prior when completing my other adulting task: picking amongst bottom-of-the-barrel health coverage options that cost nearly $2,000 every month for “bronze” coverage for our family of two.
Yes, I’m aware, I got your letter, I said. But while I have you, there are two outstanding bills on my account that have been there since April and September; I am going in circles with your hospital and my health insurance company, and I cannot resolve either one no matter how hard I try, no matter how many hours I spend. I can’t get any answers. It makes me scared to go to the doctor for anything at all!
For thirty minutes, this angel of a woman stayed with me on the phone—even though she was late for her lunch break—trying to help me get to the bottom of things.
Crime number one: a visit to a new primary care doctor for the most basic “hello” visit you can imagine. A nurse took my vitals, and then the doctor and I spoke for twenty minutes. He refilled my inhaler prescription. This resulted in the following:
Can you believe they billed insurance $3,470 for that?! This whole system is a racket worthy of a mafia movie. But why is my portion of the bill $193? It’s December, and I still cannot tell you.
The second crime: I called to schedule an appointment due to a possible infection. I asked to take a urine test at Quest, the nearby lab, where I know the cost is ~$20. No. The doctor’s office insisted I come in person; however, my Primary Care Physician was on vacation, so would I like to see a nurse? I’d rather not have to come in at all, but okay. Didn’t want things to get worse. I peed in the damn cup. She asked droll, perfunctory questions for ten minutes, then a few days later when the results were in, wrote me a prescription. THAT’S IT. And it resulted in this:
Hey, look, my part is only $343! Plus the over $2,000 I paid that month for the “silver” level health insurance premium for our family of two. If by silver, they mean wanting to gouge your eyes out with silver forks whenever you need anything remotely medical, then yes, their plans are labelled correctly.
So, in my quest not to drown in bills—or spend money I shouldn’t just to “make the problem go away” as I might have in flusher pre-pandemic times, I tried to take The Responsible Route™, calling to fix what must have been two simple errors.
HAH! This is how I’ve spent my year (Mount Sinai hospital call history x 2 on the left, Anthem x 2 on the right):
Every call shorter than fifteen minutes was a failed attempt to reach a human being in their horribly knotted phone trees, or a hold broken by an incoming call. In addition to those, I spent over five combined hours when I did reach someone, to no avail.
Should I keep calling? What could I possibly do or say next? Should I just pay the damn bill, and value my time more highly than this, as many fellow entrepreneurs advise? Would I be less emotionally brittle if those extra dollars didn’t matter to me so much right now? If I wasn’t trying to do the responsible thing by not overpaying?
I might feel better if I just swallowed hard and paid what’s (erroneously) outstanding, except that I can’t stomach the idea of them getting a single dollar more than they deserve. I refuse to reward extortion. I know these bills are wrong. I just don’t know exactly why, or how the f**k to fix them.
My primary care visit is supposed to be free. A simple nurse follow-up should be too, or at maximum, a $30 co-pay. Michael’s in-network therapist hasn’t been paid Anthem’s portion for their weekly sessions since April; same never-ending “pending” story. My TalkSpace therapy was supposed to be free. It wasn’t—surprise-billed in arrears after three sessions at $121 a pop—so I stopped.
Why am I telling you all of this? Surely these criminal enterprises companies can’t be shamed into any meaningful reform. My friend Paul Millerd, who lives abroad, told me about cost-sharing collectives like Crowd Health and Christian Healthcare Ministries. (His friend, author Nat Eliason, recently took the leap and wrote about it).3 I am still researching alternatives, such as with the Author’s Guild, even though open enrollment closes in two days.
You know what terrifies me? That some freak accident will happen, and I’ll be one of the small percentage of families for whom these alternative solutions don’t work. And then any resulting financial mess will really be my fault—you should’ve known better than to go outside of The System. It’s a risk I don’t feel I can afford to take right now, and yet, staying in The System is obviously no cake walk either.
I look forward to downsizing by finding a renter for our place as soon as we are able—or even selling it, who knows—then moving abroad if/when that’s in the highest good after that. But between now and then, this is the stuff that makes life in America feel so impossible sometimes, at least if you’re not in a corporate job with robust benefits, retired (on Medicare), or in the top 9.9 percent.4
In nearly fifteen years of self-employment, I’ve met many people afraid to leave a golden-handcuffs-type corporate job that is slowly killing them with inexplicable chronic illnesses, but who are afraid to quit and deal with health insurance on their own. I get it.
And I am among the lucky ones. I speak fluent English to make these senseless, circular calls. What if I didn’t? I’d probably assume the bills—and my lack of understanding of the erroneous charges or rote telephone operators—was my fault. I have family support if needed in an emergency, and the ability to earn. My heart breaks for families who have kids with special needs or who are dealing with more serious medical conditions, who have to navigate all the above and much, much worse, all while their family member’s health suffers terribly.
It is a terrifying way to live, knowing this level of criminal bureaucracy is ready designed to prey on us at our weakest, and that only by the grace of God we stay well enough not to truly need them. For now.5
❤️
Continue reading the next post in this series . . .
🤬 ALL the scare quotes. I’m that angry. I recommend her often, but that’s because I love her work and what she stands for! Dive into any one of Sara Eckel’s essays from It's Not Us :
“It’s Not Us explores the relationship between personal and systemic challenges. How do we address the difficulties in our lives, and do our best to improve our circumstances, while also understanding the larger forces that often stand in our way? How do we gather communal power in a highly individualistic society? How do we separate what we can control from what we probably can’t?”
🥐 About a year in, I did cave and create a “carve-out” for almond croissants. I wish I hadn’t. But they really do bring me tremendous joy when out-and-about in NYC coffee shops, especially since I wasn’t allowed to have croissants growing up (too much butter/fat for the diet-crazed eighties).
🤷🏻♀️
Here’s Nat Eliason’s post—don’t miss his writing and publishing podcast, Between Drafts.
😡 I would be remiss not to mention that this is also why there was such an uproar over UnitedHealthcare, despite the egregious crime that precipitated it.
🚙 See also: kyla scanlon’s recent write-up of her 30-day cross-country road trip.
“What became clear almost immediately is that the prosperity is real, it’s just not showing up in the places people actually live. It exists in balance sheets, in stock portfolios, in data centers behind chain-link fences. But in daily life like in commutes, in childcare costs, in housing, in safety, in community, people are feeling decay. I kept running into the same contradiction: a wealthy country where everything visible seems to be slowly breaking while everything invisible keeps getting richer.”
👉 If you enjoyed this post, you might also appreciate:
This system is so bad. You should research direct primary care in NYC and then add that to crowd health. You should be able to predict your costs at least
I’m beginning to think medicare for all may be better than this sh!t show. My wife and I are 78 and lucky to be on it, both of us having had cancer. The background music playing in my mind while reading Jenny’s piece today was from Dylan: Desolation Row ( that’s Charlie McCoy on the guitar fills) and It’s All Over Now, Baby Blue (that’s Spike Lee’s father, William Lee on the bass accompaniment.) The government- both sides - is not serious about fixing the medical insurance mess. It’s not just lobbyists; I think it’s simply that our elected officials get superb coverage and they don’t care beyond that. As usual the answer is to stop letting them be immune from the laws they pass on us. If only that could happen.