I feel cheated...

I pay over $125 per month in health insurance. I go to the doctor maybe once a year. I only keep my health coverage because I've been told it's good, and if I were to have a serious bike accident I would apparently be covered without having to pay thousands of dollars. But today I feel cheated by Blue Cross Blue Shield.

I have a tear in my groinal area known as an "athletic pubalgia". The only doctor that repairs this procedure is right here in Philadelphia, PA. Unfortunately, he's out of network. Well, this wouldn't be a problem for my great coverage, which will reimburse for out of network procedures if there is no one in network that can do it. *However, they will only pay the rate they find appropriate for the procedure, not the rate the out of network doctor charges (*this last tidbit is conveniently unpublished).

Where does that leave me? Well I have the tear. I need the procedure if I want the pain to go away. The surgery costs $9,000. And Blue Cross Blue Shield will reimburse me for ~$2,000. That made scheduling pretty easy... I can't have it done.

This frustrates the hell out of me because there is a  battle going on here between the insurance companies and the doctors, yet I am the one who gets punished. Blue Cross Blue Shield sets the cost for procedures as if they should control everything, and then the doctors rebel by not accepting the insurance because they don't agree on the rates. Surely both businesses are only looking out for themselves, while the consumer is left out in the cold. Should my procedure cost 9 grand? Probably not. Is it worth more than the 2 grand that BCBS is willing to pay for it? Probably. Regardless, I am a paying customer and can't get the coverage I need. I'm pissed.

Is it a necessary surgery? No. I probably tore the ligament in at the Philly marathon in 2010, which means I trained for and raced IMLP already having the injury. However, does it bother me? Yes. It is an annoying, dull pain that I can work through, but I shouldn't have to. I'm 26 years old. I have a long 'career' ahead of me racing and training. Sure I could just stop running (which aggravates it the most), and it would probably not bother me, but I can safely say that I will be a swimmer/biker/runner for quite a while to come. I shouldn't have to stop something I love to do at this age - especially when there is a way to get it fixed, and when I am paying for insurance to protect me from a situation like this...

Sorry I had to vent. I'm also procrastinating by choosing to write a blog post rather than a final paper... I will try to keep things more positive from here on out.

Good news on the horizon - no surgery this winter means I won't have to take any (more) time off, and I have no excuses for not getting after it as soon as finals are over. Even though I don't have IM dreams for 2012, I have a few ideas dancing around my head...