As you know, April was all kinds of busy here at LBYM headquarters. Thanks to the haranguing of some dear, and very pushy girlfriends, I also caught up on some routine health screenings. It says a bit about how your month is going if a Pap smear is among the more relaxing parts of it. Yeah, my doctor had the same look on her face when I told her that.
What?
I’m lying down, no one’s bothering me, I’m wearing a huge, loose caftan, and everything’s paid for. WHAT’S NOT TO LOVE?
I also got a mammogram in April. Really—it was a riot of a month. That screening, though … that one wasn’t quite as stress-free. And not only because I was awkwardly standing, not breathing as directed, and having my lady parts jammed between cold, metal plates. Ladies, on the long list of gender-based indignities, I give you #216.
And if all that wasn’t enough, I was ruminating about … health insurance. Hello, anxiety.
First, some background. Like approximately 57% of Americans under the age of 65, I participate in an employer-based health insurance plan. For the entirety of my working life, I have been covered by some form of employer-based health insurance. I’ve been lucky. For the most part, the coverage has been both sufficient and affordable. It is an unfortunate commentary on the current state of affairs in America that having sufficient and affordable health insurance coverage indeed puts you in the fortunate camp rather than, say, the everyone camp.
Ever since a high-deductible health plan option became available through my company, that’s been our family’s choice. The cost of high-deductible plans is generally lower than that of other options because the insurance doesn’t kick in until after you’ve paid a certain amount out of your own pocket. That amount is higher than it would be for other types of plans—hence, the high in high-deductible.
Participating in a high-deductible plan also allows you to optionally set aside pre-tax money in a Health Savings Account (HSA), money that you can use for those aforementioned higher out-of-pocket costs. The dollars in HSA accounts can even be invested to grow (or not grow) as the funds in other types of retirement and brokerage accounts do.
On top of that, preventative care—such as routine mammograms—is included at no out-of-pocket cost. For optimists, these are, for sure, the best plans. They’re cheaper, you can’t imagine you’ll need to see the doctor for anything other than routine check-ups, and at the end of the year, you might have a pot of money you can grow through your savvy stock picking.
Even to pessimists with children who attempt to injure themselves on a daily basis—*raises hand*—these plans are appealing. They’re cheaper, and at the end of the year, you might have a pot of money you can prudently invest in low-cost index funds.
But then you show up at your included-in-health-plan routine mammogram and the technician asks if you’re sure you want the 3D one versus the 2D one since your insurance company happens to not be on the list of ones that guarantee 100% payment for the 3D version but most likely, if they don’t pay for the more advanced, better 3D version, they’ll just charge me the difference between the two and don’t worry, she’s only ever had one patient—out of thousands!—whose insurance company denied the claim completely because it was the 3D version and did I want to give the insurance company a call before I had the mammogram just to make sure?
Did I mention my phone was in a tiny locker down the hall along with ALL MY CLOTHES?
In that moment, I understood exactly how little empowerment my health insurance “choice” had gotten me and how absurd the whole system was. Even though I had ample funds in my HSA account, I considered switching to the not-quite-as-good? 2D mammogram. Because who wants to be another insurance cautionary tale? In the end, I leaned into my expertise as squeaky wheel extraordinaire and stuck with the 3D version. GIVE ME ALL THE Ds.
People, who’s coming out ahead here? The insurance company? My employer? The guy who came up with that third D? I’m pretty sure the technician would rather be getting on with moving my arm jiggle out of the way and squashing my breast tissue into place than warning me about financial obligations.
Cancer screening notwithstanding, it certainly didn’t seem like me, either, pinned there absorbing radiation and mentally waving goodbye to my HSA dollars. Turns out, once I have money in an investment account, regardless of what the dollars are supposed to be for, I don’t actually like using that money. Oops.
Imagine your “choices” if you didn’t even have that money to begin with.