Tuesday, August 31, 2010

Why healthcare sucks

This is not a political blog entry. This is an entry of a personal story, which illustrates the craziness and absolute lunacy of our healthcare system in an event that happened to me this week.

As a state employee of Wyoming, I get up to $500 for “Wellness Visits,” which are supposed to be preventative care. No deductible, no fee. Free. Up to $500. Not only that, but a wellness exam is mandatory for you to get a discount of $480 of your health insurance premiums throughout the year – a good deal, to say the least.

On July 12, I went in for my annual physical exam – my wellness visit. It encountered all the regular annual physical stuff – blood pressure, pulse oxygen screening, weight, height, the female stuff – you get the gist. And, I should point out – this is usually my only visit to the doctor during the year.

Three weeks later, I got a bill from my doctor for $50 that my insurance didn’t cover. Well, it’s supposed to be covered, up to $500, like I said, and the original bill was $196. So I called the insurance company.

Me: “Why did I get billed for a wellness visit when it’s supposed to be covered up to $500?”

Helpful and perky insurance agent: “Because of the way the doctor coded your visit, it was billed as a visit with other services. You need to get your doctor to change the way they billed it. If they bill it as a wellness visit, we’ll cover it.”

Cool.

So then I call my doctor’s office.

Me: “Yes, hello – I got a bill for my wellness visit, and I was told that you need to re-bill the insurance company so they’ll cover the entire exam.”

Also nice lady: “Let me see here – let me look up your visit.”

Waiting …

Lady: “Oh, well it says here that you talked to the doctor about migraines, so that’s not a wellness visit.”

Me: “First of all, I’ve had a history of migraines for the past four years. She simply asked me how the medication I’m on is going, and refilled my prescription. Isn’t that part of a routine annual exam?”

Lady: “Well, if you discuss any symptoms, that’s not technically a wellness exam.”

So let me get this straight. In a program that is supposed to have a preventative focus, if you talk about anything that might require further care, it’s not covered. So if you happen to be having regular stomach pains lately, they’d rather you say nothing and then later have to treat your cancer rather than getting it early and taking out a tumor.

The doctor’s office lady told me that she knows it’s stupid, but now she has to get a provider to review my file and make the determination of whether it can be re-billed as a wellness visit or not.

Regardless of the outcome, I already have my game plan for my next mandatory wellness visit, about a year from now. When the doctor asks how I am and if I’m having any problems, I’ll just look at her and respond:

“I’m well.”

Friday, August 13, 2010

I came, I saw, I ... conquered?

Well, perhaps "conquered" is a bit strong. Regarding the two races I’ve been training for, worrying about and obsessing over for the entire year, I finished both, thus meeting my goals.

It may not sound like much of a goal: to finish something. But anyone who has ever taken on a marathon or another endurance event can sympathize. The Laramie Enduro was a 70.5-mile mountain bike ride (that’s with the small detour my race partner and I took after missing one of the turnoff signs) that took me 10 hours and six minutes to complete. It was challenging, fun, and one of the most gorgeous rides I’ve ever done. It was definitely the most well supported ride I’ve ever done. Volunteers, food, course – it was a fantastically well planned and supported from start to finish. Kudos to the Enduro folks.

A quick rundown: at the starting line at 6:45 a.m., riders riddled with goose bumps in the cold morning air, an announcement comes over the sound: “Make sure you walk the bridges, always follow the course … and, oh yeah, at around mile 7 you WILL be attacked. I repeat … you WILL be attacked.” A Goshawk (whatever the hell that is – a mean bird, apparently) had recently taken up residence near one of the trails and was protecting her nest with her life — and her huge talons. Luckily, the expert riders started before us. They must have tired the poor bird out before we got there, for all we heard were angry squawks as we rode by. Incidentally, this is also the time a man passed me who was pedaling a bike without a seat. I don’t know if it fell off or if he was planning on doing the whole race standing. Weird.

After we got past the hawk, we traveled through some scenic gravel roads and into the familiar singletrack trails of Happy Jack. With 30 miles beneath our tires, we followed the course across the Happy Jack highway for the next section – only to find that after a few miles down a gravel road, we were conspicuously alone. Coming to an unmarked fork, we determined we had gone the wrong way, and backtracked to find the trail, which promptly when down a hill, into a marshy area filled with cow shit. I guess you’re not racing until you’re covered head to toe in cow manure.

At the next checkpoint, around mile 40, my beloved Cheetos were waiting for me in our drop bag, along with a 5-hour energy I took with me just in case. But I was feeling surprisingly spry and ready to go. Unfortunately, Jim, my partner, was feeling fatigued. We rested a few minutes so he could pop his cramp-preventing pills and I could eat my Cheetos, my personal antidote to cramps, hunger and a foul mood.

Coming out of the third aid station, we went through some sagebrush-covered singletrack as we spun through fields littered with cattle, who couldn’t have cared less about us. Then we popped out onto some more forest service gravel roads that appeared to have one purpose: to take us to heaven. They were all uphill, and they all climbed so steeply that when you looked up, all you saw was the looming hill above you and blue, blue sky.

Not to toot my own horn, but on this section, I was a champ. I felt good, my Cheetos and energy bars were treating me right, and I was climbing like a friggin machine, hammering hill after hill in my granny gear. Unfortunately, the climbs were not as good to Jim. Feeling the first twinges of cramps, he continued to bravely soldier on up hill after hill. During one portion, I summited a long, sustained climb ahead of him, only to see at the top that another long, sustained climb awaited. “Jim, don’t look up,” I shouted back. “Just keep pedaling – you don’t want to see what’s ahead.”

Luckily, after being passed by a few support guys on motorcycles who wanted to make sure we wouldn’t end up as buzzard meat, we crossed the highway and reached aid station 4. Of all the aid stations, this was the most festive. They had music, people cheering loudly, and it was fun. Jim sat down to pop more pills, I went after some watermelon and Gatorade. When I got back to him though, he had a soft taco in his hand, which was apparently the last one. He offered it to me, I refused – but I’ll bet that was the best damn taco on Earth.

Once we left, we faced more climbs up to singletrack that circles a mountain. Up down, up down. At mile 55, I was pausing at the top of every climb for Jim to pedal up, in agony against his seizing legs, which were beginning to cramp badly. He urged me to leave him, I told him I didn’t want to. He said he didn’t think he could make the cutoff. In that moment, my entire seven months of training flashed before my eyes. If you don’t make a cutoff, they give you a Did Not Finish, put you in a truck, and drive you back to the start. I got mad just at the idea. This would not happen to me. So I left.

The next few miles were more brutal up down, up down. But near the end of the singletrack, there was a field filled with wildflowers as tall as my waist. It was like a freakin’ Allegra commercial – so beautiful words don’t do it justice. But it was the last beautiful moment of the race for me. I got back on the gravel roads that would take me back to the last section of singletrack before the finish, and then got onto Headquarters Trail, a brutal 1-mile section of climbing switch-backed singletrack with technical rock gardens scattered throughout. I rode what I could, I walked the rest. At the summit, a group of teenagers cheered me on, bored that they had probably been out there for hundreds of racers before me, seeing that I looked more pathetic than any of the others that had passed through. Didn’t matter, I just kept spinning.

By this time, my neck had flared up and I had numbness and tingling all the way down my left arm and a sharp stinging every time I tucked my neck to my chest. This is the real limiting factor for me in riding, and it was making me acutely aware of my mortality at that point. Yet I kept spinning, slowly and deliriously until a pudgy guy (and I say that affectionately, as one with pudge of her own), whom I had dusted earlier, passed me. “What am I doing?” I asked myself. “Get your ass in gear and finish the fucking race, Kat!” So I did.

The next weekend’s ride, the Copper Triangle, was not nearly as grueling. It was about 80 miles of road, which had three serious climbs in it, the last of which is Vail Pass – not something to take lightly. But other than starting out at 38 degrees and not being able to feel my fingers until an hour into riding, the ride delivered as promised: great, friendly people (it was, after all, a fundraising ride, not a race), wonderful support stations, and breathtaking vistas of Colorado’s mountains. It took us about seven hours, and I wouldn’t want a minute more on my road bike, which makes my neck feel like I want to pull my head off and just set it on my handlebars.

Oddly enough, Vail Pass was one of my strongest climbs throughout the day, but that’s not unusual for me – it seems my legs don’t seem to warm up until around mile 50. But the thing to know about Vail Pass in the Copper Triangle is there is motivation in the form of big, chewy, chocolaty brownies that are waiting for you at the top. I can’t think of a better reason to climb a 10,000-foot mountain.

I owe a lot of thanks to people for their support as I undertook my two challenges this summer. First and foremost, thanks to my husband. I had to sacrifice my weekends to be out on my bike, which means he had to sacrificed his weekends because we couldn’t go anywhere. He also gave me words of encouragement during my ups and downs of training, mostly by saying “You’ll be fine … you always are.”

Also, to my race partner, Jim, who came out from Missouri to do these crazy events in elevation with me and put up with my general crankiness and know-it-allness during our three-day trip to Yellowstone and the Grand Tetons in between races, thanks. Without your arm warmers on the Copper Triangle, I would have frozen, and without my gas stove in Yelllowstone, we would have starved. J

Also, to all the people who were forced to look at my bruised and battered body all summer, I thank you for asking how it’s going and taking a sincere interest in my undertaking. A special thank you to my friends, all the football ladies and my coworkers, you were incredibly supportive about all this. As some of the people I spend the most time around, it meant a lot.

So my predictions from my last blog entry were mostly correct, although I’m happy to report there was no blood, I got over my cold in time, and although I did swear never to do another one, I’m already looking at what’s on the horizon for next summer. With any challenge I’ve done, I always seem to find that no matter what, you can always endure more suffering, more pain, and more miles than you think you can. But you never know until you try.