Insurance

I keep mentally composing yet another post about how I don’t have a chore partnership in my marriage, but I am so extremely sick of thinking about that and writing about that. Usually the way it seems to work is that once something like that occupies my mind, I HAVE to write about it before I can write about anything else; but I deeply don’t want to, and it doesn’t feel as if it would be therapeutic to do so. Maybe it would work to pretend I already wrote about it, or pretend that this paragraph counts as writing about it. Or what if I just say that one of the other things I’ve been mentally composing is a little speech that begins “I’m leaving,” and then goes on to explain why actually I should have left 25 years ago / why nearly anyone should be able to understand, without 25 years of explanations, that they need to do their own fair share of household chores / the many, many ways in which men systemically and societally and personally exploit women. Okay, let’s call that “written about.”

We have been home from the hospital for a week and a half. I don’t remember if I mentioned that, when we’d been home several days, and it had been a week and a half since Edward’s surgery which led to a hospital stay, we got a letter from our insurance company explaining that our doctor’s request for the emergency surgery and hospital stay was denied, because it was not medically necessary. As if it were not FAR TOO LATE at that point, and as if they were not WELL AWARE OF THAT, and as if they did not KNOW that such a letter would stop the heart of anyone receiving it.

The main reason I did not need to be scraped out of the batty attic is that this has happened before, and what has happened each time is that, without my needing to get involved at all, our doctor has called the insurance company and, I like to imagine, used some colorful language to explain to the insurance company that ONE OF THE PEOPLE ON THE PHONE is the Chief of Pediatric ENT at a large children’s hospital and knows what is medically necessary, and THE OTHER PERSON ON THE PHONE is not and does not.

And that is what apparently happened in this situation, because we got another letter yesterday, two and a half weeks after the surgery, saying that the doctor had provided them with “new information,” and the procedure and five days in the hospital were now approved. We spent either seven or eight days in the hospital, depending on how they count it, so let’s see if we get another letter soon. In any case, imagining having to pay out-of-pocket for two or three days in the hospital (which will not happen) is a much nicer nightmare than imagining having to pay out-of-pocket for surgery plus seven or eight days in the hospital. (My understanding is that doctors actually get all of these things fully approved before the things happen, because they know, as the insurance companies do, that almost literally no one can afford to pay for them out of pocket, and doctors/hospitals would like to be paid; and that this paperwork is just the late-arriving chaff of those long-since-made decisions.)

51 thoughts on “Insurance

  1. Diane

    It infuriates me that there is a whole entire man who, of everyone on the planet, gets to be married to YOU, and clearly does not worship you or even BEGIN to appreciate you and that is bullshit of the highest magnitude because you are an absolute treasure.

    Reply
  2. Ehm

    I don’t have a chore partnership in my marriage. I rage-typed a paragraph about it and then deleted it, you’re right it definitely didn’t make me feel any better. The only thing that seems to get through is explaining how utterly humiliating it feels picking up after him. At this point in our lives I don’t even want a chore partnership, I just don’t want to have to deal with his messes.

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  3. Chrissy

    I am here to commiserate about the chore inequity – mine only became solved through divorce, which I do not always recommend. It was not the reason for the divorce, BUT one of the biggest benefits of being divorced is that I no longer have to be angry about chore inequity. I’ve also discovered that I am messy and so the house is messy, but it is not accompanied by the old anger that I used to feel at someone else’s mess.

    But 25 years is a long time and even though you are (hopefully) staying married for much longer, it is a long time to feel slighted. I wish I could offer a solution. It sucks. I did find some success farming out chores to kids, but of course that comes an additional chores for mom called Nagging.

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  4. Liz

    I am so angry for you about the chore partner thing, and also angry on my own behalf about it.

    I am furious about the state of healthcare financing in this country and am so relieved that your doctor came through for you. But enraged that it came to that.

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  5. M.Amanda

    The thing that infuriates me is not having someone capable of doing chores who chooses to leave them to me, but that it doesn’t even occur to that person that he could, and maybe should, at least make an attempt to do those chores.

    The business of healthcare in this country is truly messed up. We got an EOB from our new health insurance provider saying we owed $130 for my daughter’s regular therapy session. Except that isn’t what we owe. It’s just the difference between the counselor’s billed amount and what this insurance company will pay, which the counselor won’t expect us to cover. If I didn’t understand how they billed these things through a job with a mental health agency, I would be freaking out at suddenly having to pay 5x more. Messed up.

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  6. Nicole

    Re: the first paragraph. HUGS.

    I am SO glad your doctor came through for you, because what even. Not medically necessary WHAT EVEN. I am so sorry that insurance is such a fuckaround.

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  7. laura

    Sometimes I think that the insurance company sends these letters and then makes all go through the trauma of trying to figure out how to deal with it entirely to make us feel grateful when everything works out and we are not bankrupted by our healthcare (this time…). This way we expect to bankrupted by healthcare and it doesn’t feel like a particularly complicated misery, but when we aren’t we feel elated like we dodged a bullet (they win both ways). Then I feel like a crazy conspiracy minded person, but the more I hear about it the more I am SURE that the way we do healthcare is WRONG.

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    1. Alyson

      All of this, ditto.

      This entire country is a scam. And so disheartening. I want to climb back under my rock of ignorance. But then that’s just super privileged. And accomplishes nothing anyway. Sigh. Thank heavens I knit or the anxiety/frustration/disgust/helplessness would overwhelm constantly instead of just often.

      Also, the chore thing, what everyone else said.

      Reply
    2. Swistle Post author

      I WONDERED THIS TOO. Because…then I DO feel so grateful not to have to pay!! Even though THAT IS WHAT I AM PAYING FOR!!!!! IS NOT HAVING TO PAY!!!!!!!!

      Reply
  8. B

    Oh the chore inequality! A few,maybe ten,years ago I had a fed up plan to help bring realization to my partner. I booked a two week trip to see relatives on my own and began the pre-planning to spousal awareness. First, I stopped grocery shopping, making sure that certain essentials, milk, butter,bread, eggs and cheese were to run out in one or two days. Toilet paper was down to a few sheets in every bathroom. I did leave a roll in the basement pantry, I am not heartless. I stopped doing laundry for a week, the amount of time that under garments would run out. I stopped doing housework, no sweeping, bathroom cleaning or tidying. I used soo many dishes and pots for the dinner and breakfast before my trip.i did not clean a one of them nor did I even put them in the sink. I left about a gallon of gas in the car. I took down the household calendar, kissed my partner goodbye and hopped into the taxi to the airport.
    Well, after two days the calls and texts began. I answered in the evening after 8pm with a sweet shrug of what can I do from here?
    Things were discussed when I came back. Things changed. Things got better. Not perfect but. Now whenever I feel a need for appreciation and acknowledgment I mention needing to visit the family for a good bit.

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    1. Swistle Post author

      I can tell already that this is a story I will be telling myself on nights when I am agitated and need Good Thoughts to fall asleep. What a triumph. What a delight.

      Reply
    1. BSharp

      It certainly helped our marriage. My husband is very active in doing and managing chores, however he has been known to wonder what I do all day if the work is invisible. Yes I did two loads of dishes; no you still cannot see the counters, but did you notice the toddlers are alive?

      We used that book 2 years ago, and while we still get baffled and frustrated on occasion, neither of us ends up resentful any more.

      Also, taking off for 3 short, blissful days while the husband handles kidlife works real well too. I have only managed it twice, but it thoroughly resets expectations.

      Reply
  9. Kim

    We have chore inequality at our house too. And I was thoroughly sick of it until I started leaving the big chores for my husband and not offering to help. So while I do the majority of the cooking and regular cleaning, he has to vacuum the stairs and furniture, shampoo the carpets, scrub the shower, pick up after the dogs, and most of the outdoor work. That helps me although it is hard for me to sit and relax while he’s doing chores but I’m working on it!

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    1. Alyson

      That is the HARDEST bit. The sitting and relaxing or not assisting even with the chores. No one has an issue with the reverse, though.

      Reply
  10. Cece

    In our house I solve the chore inequality to some extent through the medium of having my husband cook all the evening meals and deal with the kitchen clean-up afterwards. Sure, he does a mediocre at best job and I have to sweep, vacuum and clean the floors (we have a toddler…), clean down all the chairs and cupboards, declutter, clean the fridge etc. I also do the meal planning. BUT when I’m doing almost all the laundry, hoovering, dusting, bathroom cleaning, school admin, etc etc I know that at least I’m not cooking dinner or washing up the pots afterwards. It’s a fixed thing so it’s super hard for him to avoid.

    But let’s not pretend that’s a magic solution. It’s my birthday this weekend and I spent all my spare time (around my very nearly full-time job and 2 kids) this week deep cleaning the house before guests came. Nothing says ‘happy birthday!’ like stress cleaning your own house because your husband hasn’t even noticed it needs it…

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  11. Suzanne

    This kind of thing is so infuriating. Rage inducing. We just got a letter from our new health insurance company (which is supposedly better!!!!) (cough cough according to the employer offering the insurance) that a medication I have been taking for well over half a decade may no longer be covered. I am livid.

    My husband says he spends a LOT of time writing appeals to insurance companies, assuring them that the prescribed medication/procedure/etc is, in fact, medically necessary. Argh.

    Also the Paul stuff. Ugh. UGH.

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    1. Swistle Post author

      We recently got a letter from our insurance telling us that the medication Edward gets through an IV for his Crohn’s disease, one of the VERY MAIN AND VERY BEST of the VERY FEW treatments for Crohn’s, would no longer be covered. The news was delivered in a “Have you tried aspirin?? KISSES!!!” tone. Thank goodness the medical community is accustomed to dealing with this: doctor AND hospital pharmacist both were fully prepared to explain to the insurance company that This Would Not Fly—without me having to do anything at all. I was so grateful.

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      1. Suzanne

        It is just… cartoon supervillain nonsensical to me. WHY. There is not even the PRETENSE that they have the patient’s best interests in mind. Just money. It is so purely, clearly about money it makes me want to scream.

        I am so glad Edward’s medical team is on top of it. But so exhausted for them and for you.

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      2. Hks

        This happens to my parent with Crohns every few years. The insurance says they won’t cover the remicade or she’ll have to pay double or triple and she’ll start considering delaying treatment. Her doctors keep having to fight with the insurance to get it covered and it’s exhausting for everyone.

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      3. GENEVIEVE

        I’m glad the doctor and the hospital are on top of this for you, but it also infuriates me that THEY have to spend the time to do this when they could be devoting that time to the actual patient care that they probably went into this job expecting and wanting to do.

        We recently had a huge battle with my husband’s insurance where he had the same tests done at an annual physical two years in a row and the second time they refused to consider something “preventive” (and therefore 100% covered) and instead insisted it was “diagnostic” (and therefore only partially covered). When the doctor’s office pointed out these were the same codes they’d used the previous year, the insurance kept insisting it had ALWAYS been a diagnostic code. I kept waiting for them to say “so we shouldn’t have paid it last year, either” but they never did. Hours and hours of time wasted by us and by the staff at the doctor’s office.

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      4. LeighTX

        My daughter takes Humira injections for UC and without insurance, they would cost $17,000 each. (She takes one per month.) With our insurance, our co-pay is $4,000. (That is a four, with three zeros after it.) But the drug manufacturer offers a discount card! And with the card, our cost is only $5!

        And that’s amazing–$5 is much less than we pay for a lot of our other meds. But (1) what if I didn’t know about the discount card? No one told me about it; I Googled the drug name when it was prescribed and found it. Otherwise she wouldn’t be taking the med. And (2) why can’t it just be $5, then? Like why do we have to go through this whole process?

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          1. LeighTX

            You would think that the insurance companies and various medical offices were conspiring to give us all heart attacks and/or strokes so they could make MORE money . . . #newconspiracytheory

            Reply
  12. Jd

    Insurance: insurance companies add to the cost of delivering healthcare. They charge 15% more in administrative costs vs Medicare. because of increased competition insurance companies have less leverage to keep prices down so on average pay 12% more for the same services as Medicare. Plus about 1% profit. So healthcare costs almost 30% more using private insurance. Generally when I pay for for something I expect improved quality or service. Yet while Medicare is not famous for customer service I just don’t think we are getting our moneys worth with the current system.

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  13. Stephanie

    I am not a maid so I told my husband (who does almost NO chores) that if he wanted his pile of clothes on the bathroom floor (!!!) washed, he best bring them downstairs to add to the obviously sorted laundry piles 🤯🤯🤯

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  14. Slim

    Me traveling backwards in time: “Hey, Swistle, can you write about two widespread injustices that have pretty simple solutions? And the solutions are relatively simple but not following them is easier for the people in power, because they’re not the ones who are being ground down and also irritated by said injustices?”

    OK, off to swap the hunt for a marital duplex with a search for a charming pied-a-terre

    Reply
  15. Kay

    Maybe a small suggestion to the first paragraph, although I am not 100% sure if helpful suggestions were really being called for. On the other hand, you can just ignore me and eat chocolate instead.

    That “I’m leaving” speech: I think it should be written, maybe in a new, pretty journal devoted to that purpose. Then, down the road, maybe another “I’m leaving” speech will come up. They might sound exactly the same, or maybe not! I went though a long line of “I’m leaving” speeches, only some of which I wrote down, but which ended in actually leaving (not totally recommended either, does not solve all problems, and chores were only a part of this). Nevertheless, I think the slow and gradual shifts in tone of the speeches helped me understand what was at the bottom of the frustration and the humiliation–it was so much not about the pile of dirty clothes on the floor and so much about not being seen. In ways that went so much beyond the dirty clothes. And sometimes the writing was therapeutic in the end, even when it didn’t feel that way at the start.

    Otherwise, hugs, we see you.

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  16. Hillary

    Recently, my husband and I were in the kitchen and he said “you should clean out her water bowl” referring to the dog. I snapped, “Yeah, I’ll get right on that,” because I was in the middle of loading the dishwasher, putting away the leftovers from dinner (which I cooked), had just switched the laundry from the washer to the dryer, and was about to go harass our son into taking a shower while also making sure his backpack was ready for school the next day. “But I’m the only one who ever does it.” he said, plaintively. I said, “Yes, and I do all of the other things.” And he shut up and washed the water bowl himself. It was a small victory, but one I will cherish.

    Insurance companies are the worst and I love that the doctors and their offices are being so helpful.

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    1. Sarah

      This sounds like something my husband would say. He loves to point out things that need to be done: Upon opening the silverware drawer and seeing the soiled plastic sorter: “This needs to go in the dishwasher.” Opening the fridge, “these leftovers need to be thrown out.” “These towels need laundering.” HOW ABOUT YOU JUST SHUT UP AND DO IT?

      Reply
      1. LeighTX

        I saw a TikTok the other day where a woman said that when she hears of men not doing things, she asks in a sad voice if they don’t have hands. Like someone was telling her that she hoped her son would marry a woman who could cook, and she replied, “Oh, no! Does he not have any hands?!” So maybe that’s a reply you could use: “These towels need laundering.” “Oh, no! Do you not have any hands?!”

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        1. M.Amanda

          This made me laugh. The next time my husband says, “You should go upstairs and make sure he actually got in bed,” I will put on my sad face and ask him if he lost his feet.

          You’d think I was the only parent capable of determining if a child was asleep or playing with Legos….

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          1. LeighTX

            My husband does it with the dogs: “The dogs need to go out.”
            OH DO THEY? So sad that he cannot open doors, it’s a real problem.

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    2. Maggie

      The use of the passive voice and similar is what drives me nuts. For example: “someone should clean out the dog’s water dish” or “we really need to ____” I finally started saying things like “Yes, someone SHOULD clean out the water dish” and “by ‘we’ do you really mean me?” Petty? Maybe, but it was that or run screaming into the night. I’m not sure these things really worked to get H to do the things he noticed needed doing, but it made me feel a little better to point out the BS.

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      1. Alyson

        I do a lot of “someone who is not me needs to…”

        Because enough.

        And I also typed a reply to the FOUR THOUSAND DOLLAR Humera and the internet ate it but the short version is: um that’s a MILLION DOLLAR mortgage payment and SO KUCH RAGE.

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        1. LeighTX

          Yes, and my husband was just prescribed a new med that with insurance is well over $400/month out of our pocket, which is more than our car payment. There’s no discount card for that one, so I ordered it from Canada and with shipping it’s $120/month. Thank you, Canada.

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      2. Natalie

        The passive voice… along those lines my husband is prone to asking “do we have ____?” it’s always some inane item that of course we have, like scotch tape or a large bowl (seriously). What he really means is “find/get it for me” and no, we will not be doing that anymore. I just tell him “yes we have ____” and maybe, if I happen to know where it is, I’ll tell him.

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        1. yasmara

          I have stopping finding things or even telling someone in my household where they can be found unless they have already looked in the 2-3 logical places those items might possibly be.

          I don’t know why this was my hill to die on, but it was. My standard answer now is, “Where have you looked already?”

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        2. Shawna

          One time my husband looked for the nail clippers and didn’t see them. He knew I’d used them so he asked me to look for them. I was busy, and I knew I’d returned them, so I sent my daughter to help him look. After a few minutes she came back apologetically and told me “Dad said you’re the one who lost them, so you should be the one to find them.”

          Lips pressed into a straight line I marched right to the bathroom, opened the drawer where they’re kept, reached in, grabbed them, and brandished them at him with a “They’re right HERE! RIGHT WHERE THEY’RE SUPPOSED TO BE!” He was very apologetic and said neither he nor my daughter had seen them and supposedly they’d both looked there.

          Even thinking about it I’m wishing I could insert an appropriate rage gif.

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          1. Swistle Post author

            I have thought of this story MULTIPLE TIMES since you posted it yesterday, and will likely think of it with accompanying rage for the rest of my life. I think the part that sends me from tooth-enamel-wear to MUSHROOM CLOUD is “you’re the one who lost them, so you should be the one to find them.”

            Reply
            1. Alyson

              Kinda makes me want to poke his eyes out with them, TBH.

              And then I think: “how many times has Shawna single handedly found things lost by the OTHER PEOPLE LIVING IN HER HOUSE?” and that line, man. Shakes head.

              Reply
  17. Kate

    Mentally sending hugs and commiserations and soothing hand pats and quiet outrage on your behalf. It doesn’t actually help anything but I am seething here in solidarity.

    Reply

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