Lehe: Insurance for health insurance

Your vertebrae don’t just stack on top of one another like Jenga blocks. Cushy little cartilage beer coasters called discs sit between the vertebrae. But sometimes, a disc slips out a little bit and puts pressure on the sciatic nerve, and that hurts like a b*tch, it turns out.

I know about slipped discs because the bottom disc in my lumbar spine slipped out a little bit back in April. The pain was pulsing and horrible.

“Et tu, vertabrae?” I asked, gasping. I felt stabbed in the back — both proverbially and otherwise — by my own spine. Like most people, I’m aware that my body depends on all kinds of behind-the-scenes finesses, but I expect little invisible miracles like posture to run smoothly as long as I don’t smoke, get fat or sit too close to the TV.

As if this disappointment wasn’t hard enough, I also had to face the failures of another invisible system I’d always just assumed would be there for me — my insurance company. My testimonial goes like this:

When I first felt pain, I went to Student Health. They sent me to the emergency room, where a doctor told me that I had all the signs of a slipped disc in the lowermost vertebrae. She ordered an X-ray.

When the X-rays came back, the doctor said that I would need an MRI. In order to get an MRI, I needed to be evaluated by a doctor at Student Health, she said.

A few days later, at Student Health, the doctor told me that she also believed I had a slipped disc in my lowermost vertebrae. She wrote a prescription for an MRI. I called my insurer and asked about getting the MRI, but the insurer said I needed a special authorization, which was different than a prescription.

To get this authorization, the insurer needed my primary care physician’s tax ID number, since my insurance is from Tennessee, because my mom’s law firm that buys our insurance is based in Tennessee, although my mom lives in Birmingham, Ala., and I live in Pittsburgh, Pa., and Birmingham is called “the Pittsburgh of the South.”

At this point, I had not been to a doctor since high school, so I didn’t have a primary care physician. I called my pediatrician’s practice anyway and found out he was retired. Then I called Student Health, but the doctor would not give me her tax ID number.

By then, several weeks had passed since my slipped disc. I was still in pretty bad pain, so I scheduled an MRI and decided to just wing it. When I got to the radiology office, I pretended I had no idea what all this authorization business was about. I held up my prescription with a devil-may-care nonchalance that proved irresistible to the radiology industry. I don’t know what happened, but from the waiting room, I could see a knock-down, drag-out phone battle going on in the little office area between Student Health, the insurer and the radiologists. Eventually, they gave me an MRI.

After carefully examining my MRI results, two orthopedists concluded that I had a slipped disc in my lowermost vertebrae. They gave me a prescription for pain meds and a list of physical therapy centers I could contact. Four weeks after my disc first turned on me, I started physical therapy.

Later, I started to receive bills. Often the insurer would deny that I was covered until we called a second time. This happened every time I went for physical therapy. For several weeks, I dreaded going to the mailbox or answering my phone for fear of bills. The insurance company gained this weird power to reach into my life and steal one hour of my time at random.

Living under siege, I started to fantasize about “health insurance insurance.” It would be an insurance plan where you paid a premium, and if you ever had to actually use your health insurance company, the “health insurance insurance” company would call the health insurance company and yell until it did its job.

I’m writing about all this because my experience is pretty illustrative of two problems with the U.S. health system that afflict even those lucky enough to have insurance: cost and inconvenience. Why did I have to get thousands of dollars in tests when the common sense diagnosis was that I had a slipped disc in my lowermost vertebrae? Why was it my responsibility to get a tax ID number?

Some say that President Barack Obama and the Democratic congress are moving us in a socialist direction on health care. Looking at the legislation, I would agree. But looking at my experience, I have to disagree. To say we are moving in a socialist direction on health care implies that today we are in a somewhat market-oriented position. A prerequisite for a market is that individuals are aware of the incentives and outcomes they face from various choices. Life in a market should be better than random.

E-mail Lewis at ljl10@pitt.edu.