Damocles & Max

Previously, I wrote about the possibility that I might meet Max this year.

After looking a little more closely at all the numbers, it appeared there was a chance to avoid it.  If we pay for my orthotics out of pocket, and if nothing unexpected happens in the next two months, we could barely squeak in under the limit.  Those are pretty big ifs.

There’s something comforting in knowing that the insurance company says, “Amount charged against lifetime benefit limit:  zero.”  When nothing has reduced the limit, I feel like there’s no limit.  It’s as if insurance will always be the safety net to cover anything that might occur.

I don’t feel that way any more.  There is a limit to what insurance will cover.  It’s like a huge sword hanging over my head; the smallest thing could bring it crashing down.


Would I be better off paying cash the rest of the year to avoid hitting the annual out-of-pocket maximum?  Sure, it would cost a bit right now, but in the long-run, if things get really bad, it could save me thousands of dollars.

I’ve talked to our insurance plan administrator.  Co-pays don’t count toward my annual out-of-pocket-max.  Prescription meds don’t count.  My annual deductible doesn’t count.  A lot of things don’t count.  Of the $2200 that I’ve paid out of pocket so far this year, insurance only counts $912 of that amount toward my max.

The rules change once I’ve met my out-of-pocket maximum.  When they’re looking at the benefit limit, they count every penny they’ve paid on my behalf this year.  All those numbers that didn’t count toward reaching the annual limit?  Now they matter.

I could make myself crazy trying to figure out a way to control these costs.  I could pay cash for the rest of the year to avoid having my lifetime benefit reduced by $11K.  In the end, though, I have to take this the way I decided to face RA: one day at a time.

It would take 99 more years like this one to blow through my million dollar lifetime limit.  The chances of my living another 99 years are mighty slim.  Therefore, I’ve decided that insurance will pay for the rest of this year.  I’ll enjoy the slight reprieve while insurance picks up 100% of the tab instead of just 80%.

If, someday in the future, I end up on expensive biologics (isn’t that redundant?), and have that lifetime benefit reduced even further, I’ll deal with it.  In the meantime…

Meet Max



What is Fair?

Happy Hospitalist says, “Life isn’t fair,” then argues that he want things to be fair for himself.  Because he chooses to live a healthy lifestyle and has had good luck with his health, he wants to be rewarded monetarily.  Why?  Because it’s fair to reward people for healthy lifestyle choices.

And it’s not fair for Happy to pay a higher insurance premium when he’s not likely to reap the benefits.

If life were fair, when Joe down the street smokes like a chimney and is going to cost the insurance company extra money, then Joe would have to pay more for his insurance and Happy wouldn’t be saddled with the expense of paying for people who’ve made unhealthy choices.  That’s what Happy wants, because that’s what would be fair.

If, however, you make healthy choices, but get hit with bad luck anyway, you no longer qualify for Happy’s lifestyle reward because life’s not fair.

Am I the only one who sees the irony here?

You can’t have it both ways.  You can’t ask for fairness when it benefits you, then say there is no such thing when it doesn’t.


See the post (and my lengthy comments) at Is Lifestyle Insurance a Solution to Healthcare Finance?

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Ostrich alert!

Found a very interesting article, Confessions of a Health Care Rationer:

My son summarized my new situation with typical teenage irreverence: “Gee, Dad, after thirty years of providing health care, your new job is denying it.”

It’s a funny line, of course, if somewhat harsh. I’ll probably let him out of his room in a few weeks. But his quip is largely untrue. Its bite comes from the fact that it’s not entirely untrue.

It’s a strange turn of events, really. After all, I have always been opposed to healthcare rationing. But, then, I have always been opposed to aging, too. I have come to recognize the fundamental similarity between the two. They are simply unavoidable evils (pace Chesterton, Cicero, et al.). The best we can do is to manage them with wisdom and compassion.

There’s more.  It’s definitely worth reading the entire article.