July 5, 2009, 8:23 pm

Think You Know the Answers, but the Questions Never End

Crutch WalkingWhat is this?

An illustration from “Physical Therapy for Zombies”?


The crutches are way too long and there is no banister on the stairs.

Actually, I don’t even see a second crutch.

Is the nurse is standing by or running up to rescue this guy?

If he is trying to elope, he isn’t going to get far!


Remember to send your Change of Shift submissions to me by Wednesday evening! The anniversary edition will go up this Thursday.


I figure if you are trying to understand something, begin with how it affects you. Make it personal, and it’s easier to grasp.

So I took on my health insurance coverage. I am covered through my employer, but surely I could get comparable coverage as an independent buyer.




I am covered by Anthem Blue Cross.  You know, Blue Cross. The company that used to be the Gold Standard of health insurance? The one my physician no longer accepts because of their reimbursement rates? I figured my best bet was to check out and compare coverage from the same company, so I hit the Anthem Blue Cross website to try and get a quote.

You can get an overview of policies, but they make you put in your phone number so a representative can call you. I didn’t mind, as I had some questions.  I spoke with Danny, who was very helpful.

But before I go any farther, you should know one thing.  Just in case you are looking to purchase a private plan.

If you have insulin-dependent diabetes, Anthem Blue Cross will not issue you a private policy.

Whoa. Found that out when I asked about pre-existing conditions. I had always heard that folks were denied coverage for pre-existing conditions, but to actually hear it coming from a representative floored me.


If I wanted to quit my nursing job tomorrow and make my living blogging (offers accepted), I would need to purchase insurance. I could go with COBRA and buy through my hospital for 18 months, or I could buy my own policy.

The payment for COBRA coverage for a family of three adults (ages 55, 52 and 19) is $2157.00 per month. That is $25884 per year, and includes everything from pediatric well-baby checks to maternity coverage.

Twenty Five Thousand, Eight Hundred and Eighty-Four dollars a year.

Pardon me while I go take a meclizine, just typing that number gave me vertigo.

Private PPO insurance for the same family of three, through the same company, with coverage for brand-name medications is $897, or $10,764 per year.

Huge difference.

On the surface.


To get the private-pay plan you must be vetted. Screened. They will take you if you have high blood pressure, but only if you are controlled and have been on meds for a certain amount of time. Same with high cholesterol.  Same with GERD.  I’ve already mentioned the diabetes. If you don’t meet their criteria, it’s “buh bye”.

My friend in Human Resources told me that our insurance coverage was “more robust” than what was offered in the private plan. Our deductibles are less, our out-of-pocket per-year expenses are less, our co-pays are much less.

She was right.

But I am still confused.

And I have a lot of questions.

  • Why is my employer paying for coverage I no longer need? I’m long past needing the services of a pediatrician and maternity coverage is not an issue (been there, done that, may my ovaries Rest in Peace). Why can I not opt out of these things, saving my employer money? What if I did not want coverage for mental health, for example? The private pay plan is available without maternity care.
  • Why can’t I have the money that is spent on my health insurance premiums (more than some people make in an entire year!) put in a savings account that allows me, as an individual, to choose what type of coverage I want to have?  And have whatever is left available to pay co-pays and deductibles? They are paying the money anyway – why not put it in the control of the patient/employee.
  • Where the hell does the private insurance industry get the authority to decide who they will and will not cover? Is that not discrimination?
  • What happens when/if I develop an illness that would have denied me private coverage to start with?  Am I dumped? Is the illness covered?  For how long?

And I still don’t understand…

  • Why my doctor charges $140 for a visit, I pay $15 and the insurance company pays another $40, and my doctor winds up with only 39% of his fee? No wonder he doesn’t take new patients with Blue Cross.  What other profession has no control over their reimbursement?
  • Why, with my background as a nurse, I still am unable to make sense of an “Explanation of Benefits” report. There is an actual fee, a negotiated fee, a deductible, a co-insurance portion and then what is left is for me to pay. And trust me, the amount paid by either the insurance and/or myself never, ever amounts to the actual fee.  Ever.
  • Why I have a bill for lab tests and screening exams that far exceeds what my deductible is for the year, and yet the deductible is not yet satisfied.  Seems to me I’ve paid out the deductible-times-five and yet it is still not satisfied.

I don’t even know where to start to try and get an handle on this.

Either I’m an idiot or the system is way out of control.

Maybe both.

But I do know this.  I am a 52-year-old woman who is welded to her employment solely for the medical benefits. I’m getting older, I am going to need coverage for conditions and diseases that I did not have to worry about in my 30s.  Every decision I make, whether it be a new job or attending school full-time at a university will be decided by the availability of health insurance and what it covers.

Thank god I have that coverage.

I just wish I had more control over how it was applied.

Lord knows I could do it more efficiently.

July 2, 2009, 5:53 pm

Welcome to the World of the Entitled

109842-main_FullThis. Is. Pitiful.

This came from a site describing how to make a nursing costume.

Have I ever tried to make one?

Oh, hell yeah!

I’ve made a ton of them!
capAnd they look better than that one!

I have proof!

Is that cool, or what?

(This is what happens when I don’t have any classes to study for!)


Next Thursday will mark the 3rd anniversary of Change of Shift, which will be hosted right here at Emergiblog.  I’m out and about looking for submissions from the nursing blogs I have come to know over these many years, and would love to have as many nurses submit as possible! After all, Change of Shift doesn’t exist without YOU, be you doctor, nurse, administrator or patient!

I’ve been wasting time working hard on a permanent new logo to start off the new year, so join in the celebration! Click the “contact” button on the top bar and send in your nurse-related stories.  This has the makings of a great edition!


Why shouldn’t we have to pay for our health care?

Why….we don’t have that sort of money!!!  How dare you even suggest that we should pay!!!!

We manage to buy cigarettes. We manage to buy fast food.  Often. We manage to get all the channels we want via cable or satellite television. Some of us even have satellite radio in our cars. And GPS.  Our cell phones are really nice, but all that texting costs a pretty penny.   We drop a few bucks at Starbucks every week without thinking twice.

And then we roll our eyes when we have to pay for….god forbid…..health care!


Think I’m heartless?  Think I’m an elitist?

Think I’m talking about the Medicare patients in my ER who bring in a super-sized number 8 from McDonalds for the entire family and hold out their right arm for a BP while they text rapidly with their left hand?

I could be.

But I’m not.

The patient rolling their eyes at having to pay was me.




Showed up for a colonoscopy yesterday and the receptionist went over what would and would not be covered by my insurance.

My out-of-pocket payment would be $216.

And my first thought was “why the hell am I paying anything out of pocket for this? I have insurance!”

I was ticked.


But why was I ticked?

Why shouldn’t I have to incur out-of-pocket expenses?

I have insurance.  Good insurance. Insurance I don’t pay a single penny for. It’s a benefit I get from my employer for working 24 hours a week.

Did I think I was entitled to full coverage because I was insured?




Isn’t that term used to describe some patients who get their health care for “free” through a public plan?

Well, I get my coverage for “free”, too, and god help me, the emotion I felt in that office yesterday was “entitlement”.

Now I understand.

And I won’t use that term again.


June 24, 2009, 11:25 am

Healthcare and the Headache

AnacinWell, apparently they call a nurse!

Either that or Nurse Nellie caused the headache.

But we know that nurses never cause doctors to have headaches, so that can’t be what’s happening.


Trust me, there have been a few doctors over the years that have given me major headaches and I have no doubt that I have been the impetus behind a few MD migraines myself!


Man, re-entry sucks.

Four days of Nascar. If it didn’t have four wheels, it did not exist for me last weekend.

You don’t just attend a Nascar race; you absorb it.

Eventually, you re-enter the real world. The adjustment takes a day or two.

I’ve re-entered, but I’m not sure I’m adjusted just yet!


Change of Shift is up tomorrow at RehabRN. Get those last minute submissions in! You can submit through Blog Carnival (button on the right sidebar) or send them directly to “hotelrehab at nyms dot net”.

I’ll be hosting in two weeks – it will mark the start of the fourth year of Change of Shift!!! Time for a new logo!


The guy in the Anacin ad must be doing what I’ve been doing for the last two days.

Trying to get a grip on healthcare reform.

That alone is enough to give you a migraine.

There is so much information and conjecture and opinion and debate, it is difficult to know where to start.

Who gets covered? What gets covered? Who pays? Who decides the charges? Who decides the fees? Who has an agenda: political, financial or otherwise? Private or public plan?

And the most important question of all: Who is fighting for what is best for the patient?

Because, when all is said and done, WE are “the patient”.


Okay, so I’ve come up with some foundations; these are things that I feel must be at the heart of any health care reform debate:

1.   Every citizen must have health care coverage.

2.  Every citizen needs to own their health care coverage.

3.  There should be a choice between private and public plans.

4.  Every citizen must be able to choose between a private or a public plan and switch between as necessary.

5.  Each plan must cover basic health care: physicals, screening, immunizations, well care.

6.  Each plan must cover chronic or catastrophic illnesses. (Diabetes, asthma, MS, cancer – just a few examples)

7. After basic health care and chronic/catastrophic illness, each citizen should be able to choose how they want to be covered. I have heard this called the “cafeteria plan”.


Gee, I don’t ask for much, do I?

We don’t have to invent the wheel here. Other countries have gone before us; there are models of universal coverage we can study.

The operative word here is “study”. Take what is good, understand what does not work and use that knowledge to form a unique form of universal health care that meets the needs of the citizens of the United States.


Probably the easiest way to tackle health care is from a personal angle.

I just found out what my COBRA payment would be if I left my job tomorrow.

I’m hoping my jaw heals before I go to work on Thursday.

But that’s a topic for the next post.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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