Monday, November 01, 2010

Not So Select Care

I have a feeling that when Calvo's Insurance on Guam named their health care program "Select Care" they were envisioning that it would convey images of this being a "choice" health care program, and something only a select few could have the privilege of having.
But after some drastic changes were made to their health plan for GovGuam employees this year, I see the "Select" in "Select Care" more in the way it is sometimes used to name generic sodas or products. The way the name mocks you for not getting a "real" brand name soda, but instead trying to save a couple cents, and because we have all been so conditioned to see branded goods as value or trustworthy goods, you cannot help but wonder if this Select Doctor Rocket soda is actually soda.

With the new changes to Calvo's made in response to the passage of Health Reform earlier this year, I regularly get that feeling of having health care but not really having health care. My rates went up, although they are still affordable. My deductible (for the entire family) is still $6,000, same as last year. The big difference is now almost all the regular co-pays for things such as doctor checkups or prescription medicine are gone. Last year I got nowhere close to meeting my deductible, but given how much the cost of even simple medicine for a child's cold can be, I actually might meet it.

The changes in the plan prompted i nanan patgon-hu Jessica to write a letter to the editor of the Marianas Variety about her frustrations when she took Akli'e' to the doctor two weeks ago and found that Calvo's Insurance was an inert insurance force, immovable and invisible until that magic number of $6,000 was reached. The Variety has had her letter to the editor for a week but hasn't published it, so I thought I would post it here. I'm assuming they didn't publish it because things are too busy with the election season, or perhaps they thought it might be a fake letter from the Gutierrez Aguon campaign which has campaigned aggressively against the current GovGuam Health Care package.


If you are a GovGuam employee, I would like to ask: Have you or your family members been to the doctor lately, since the adjustment to the Calvo’s Insurance plan has been implemented?

I am a mother of two young children, a 3 year old and my young one turned 1 just a few months ago. My son recently had a cold -- some coughing and a fever of 103. I took him to the doctor, and we went through the usual -- the nurse placed him on the scale, took his temperature, and after a short wait, the doctor looked at my son, asked some questions, and prescribed some medicine. The only thing unusual was then when I took out my $20 (my usual co-pay for a regular doctor visit) to pay the cashier, he told me that the visit cost $78. I said there must be a mistake, my son is covered by insurance. The cashier explained that yes, but my son is covered by Calvo’s GovGuam SelectCare 2000 insurance which now would not pay for regular visit unless I reached my deductible (which, unfortunately, is $6000).

Well, I said to myself, at least they co-pay for the medicine and left the clinic. I went to the pharmacy nearby, and purchased the medicine prescribed. Imagine the shock I was in when I was told that one bottle of cough medicine and one bottle of antibiotic totaled to $99. When asked why it was so expensive, I was once again told that Calvo’s GovGuam SelectCare insurance does not pay a dime for it.

All in all, my son’s doctor visit cost me $177. What would normally cost me $50 to $60 now cost me $177, close to $180. I asked myself, why am I “Covered” but “Not Covered”? I went online and did a little research. Apparently, I am not the only one who asked those questions, Lt. Governor Mike Cruz also raised his concern in regards to the new SelectCare insurance rate in a letter sent to the Plan Administrator of Calvo’s SelectCare, Mr. Frank Campillo.

In response, Campillo explained that “Federal law requires compliance with new mandates effective to health plan years beginning on or after September 23, 2010, which means that compliance must be in effect for the GovGuam FY2011 plan year. New benefits: include increasing annual maximum from $300,000 to $750,000, providing preventive services without anymore co-payments or deductibles, extension of medical benefits to dependants age 26, among others, must be in effect for the years…”

Preventive services? Did he mean the fitness and wellness program that according to the Office of the Public Auditor “only 6 percent of the 10,250 members of the Government of Guam Health Insurance Plan have participated in,” and the government paid about “$700,000 for both private facilities. Paradise received $496,388 and SDA Clinic was paid $203,400.” Wait, are we talking about the same program where GovGuam employees can join a gym or the SDA Wellness Clinic for physical fitness services and health management issues such as diabetes, obesity, cardiovascular diseases and smoking, which is great for adults, but DOES NOTHNG FOR MY 1 YEAR AND 3 YEAR OLDS?!

Before the insurance rate hiked up, I was pretty content with my insurance policy. I know it is rate vs. deductible, I know that in picking the SC2000 plan it would not offer much if my family members have major health issues, at least not until we cough up the $6000, which would normally be difficult to reach considering that there is no one in my family with a chronicle illness or in need of constant medication. But in terms of small health issues, my family was covered. As long as I keep a watchful eye on my children and promote a healthy life style for my children, major health issues can be avoided, and I could sleep soundly at night knowing that my family is covered.

Now, all that changes with the newly implemented insurance plan. Now, my family is “Covered” but “Not Covered.” Premiums are deducted from paychecks, but until my deductible is met nothing is covered, except I can choose that after 8 hours of work, picking up my kids from daycare (meanwhile, get stuck in traffic for an hour for the roundtrip) and somehow, drag my tired body to the gym and run on a treadmill.

I have decided to start my own small protest. If I am stuck for this next year with this health insurance, then I will boycott all the other forms Calvo’s Enterprises takes on Guam, from grocery stores to political candidates.

No comments:


Related Posts with Thumbnails