This post is not about health care reform.

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‘Crap.’

That’s all I said when Dr. John told me I have a two-surface cavity on numbers 14 & 15.

Since my catastrophic injury & sickness insurance doesn’t cover dental, nevermind preventative medical care of any kind, we charged the $170 and scheduled the appointment to return for the $140 filling next week.

Not having an income and benefits of my own adds a whole new dimension of stress to every physical anomaly that appears. Is that thing on my toenail a bruise or is it flesh-eating bacteria? Is my sore throat allergy inspired or the genesis of a strep virus that will infiltrate my organs one after the other? Did I sleep funny or do I have TMJ? Am I tired because of the weather or am I tired because I have cancer?

The last time I had good health insurance with a reasonable deductible was 2003. The health insurance I have now is similar to the student coverage I had through grad school — catastrophic injury & sickness — the one major difference being that I no longer have access to the free student health center when these anomalies arise. Currently, we pay $70 a month for my individual plan, which is an 80/20 PPO and has a $2,500 deductible. Basically, if I get sick or injured, I’d better get really sick or injured to get our money’s worth.

I love preventative care. I believe it’s my duty as an inhabitant of this body to get a complete blood count, pee in a cup, and allow the doctor to feel me up once a year. Ironically, not being able to maintain myself this way because of cost will likely generate enough worry for me to get sick and have to use my injury & sickness insurance.

I’d been staving off this worry pretty well, floating peacefully on my back in the shallow end, gazing dreamily into the blue sky of ignorance before this damn cavity came along. When I told my mom about the $170 cleaning and the impending $140 filling, she offered to help and reminded me that, had I not gone for the cleaning, this would’ve turned into a far more expensive ordeal. (That I’m 32 years old with a master’s degree and still need my mom’s help to pay my medical bills is one thing; that she’s painfully right about the necessity of preventative care despite our inability to afford it is another.) It was only at her urging and with the promise of her financial assistance that I set out to schedule an appointment with my OBGYN, the same OBGYN I’ve known intimately since 2000 (minus the last three years because I haven’t had insurance to pay for our intimate time together).

Like any good consumer paying outright for medical care, my first question for the Appointment Lady on the phone was:

‘ How much will it cost for an annual exam?’

Appointment Lady at the main hospital had no clue, so she referred me to the clinic where the doctor practices.

I called the clinic where the doctor practices and Clinic Receptionist Lady referred me back to the main hospital billing department.

I called the main hospital billing department and Main Hospital Billing Department Lady said she would pass my contact information and question along to the appropriate people and I would hear from them within 48 hours.

My phone rang shortly thereafter. “Hi,” said the voice. “I’m Pathology Lab Lady and the cost for the pathologist to read the pap smear is $81, but please know that the pathologist only reads less than 10% of pap smears depending on what the technician finds, so you may or may not be charged this $81.”

I clarified that this $81 was the reading fee and asked what would be the charge for the pap smear itself. Pathology Lab Lady had no clue, so she referred me to the Client Services Lady at a different lab and told me to ask her for the ‘technical charge’ of a pap smear.

Before I could call Client Services Lady, however, my phone rang. “Hi,” said the voice. “I’m the Billing Manager Lady where the doctor practices and the cost for an annual exam is $189.” 

‘What does that mean?’ I asked.

“That’s the physician’s charge for a head-to-toe assessment for an established patient, but it doesn’t include any labs or anything that might come up during the assessment or anything else the doctor might need to do.”

‘Okay. Would it be possible for you to put that in writing?’

“Absolutely not!,” she snapped.

I explained that it was to help me remember what she said, not to sue the doctor when a line-item for a miscellaneous swab appears on my bill. After skillfully disarming her, she acquiesced in an email  loaded with legal disclaimers.

I took a breath and called Client Services Lady at the lab. I asked, ‘What is the technical charge for a pap smear?’  She said, “The technical charge for a pap smear is approximately $80, but that’s only if there are no abnormalities. If there are abnormalities, it will be more.”

I thanked her as I had thanked the half-dozen women before her, clapped my phone shut, and stared numbly at the manic shorthand on the notepad in front of me.

I’m looking at it now (two days later), in fact, and thinking about how much I miss the awesome insurance I had back in 2003, insurance that negotiated itemized train wrecks like the ones described above on my behalf.

I’m thinking about how my wife has the best insurance ever, but  that her employer won’t let her include me on her plan because of my girl parts.

I’m thinking about how I could dump my catastrophic  coverage for one year to become eligible for the public  health insurance offered in Wisconsin …and I’m thinking about how I don’t even like to play the Pick 3 lotto for a buck a pop.

I’m thinking about the millions of people without any insurance, without generous mothers, or without the knowledge or stamina to advocate for themselves.

I’m thinking about the din of the health care reform debate and about how something needs to be done and that even the smartest guys in the room can’t figure it out, so where does that leave us.

I’m thinking about my brother in his fifth year of cirrhosis and shaking off fears that his eligibility for a transplant might be hindered by Medicaid.

I’m thinking about how I’ll probably forego the rapport I’ve built with the doctor who’s known me intimately since 2000, how I’ll probably get a free annual exam at Planned Parenthood with a random nurse practitioner, and  how I’d rather not.

I’m thinking I still don’t know how much it costs for an annual exam.

I’m thinking about my filling next Tuesday and the $140 from my mom and how a visit to the OBGYN doesn’t even include a complete blood count and about how this post has given me a headache and now my jaw hurts and I need to take a nap.

I’m thinking ‘Thank God I’m a therapist’ because my catastrophic injury & sickness insurance doesn’t cover mental health and, when all of the above makes me crazy, I’ll need to heal myself.

If only I were a dentist.

Or an OBGYN.

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