Saturday, April 18, 2015

Cancer Complicates Communication at Work

Healthcare is changing. That’s not news. And if you have been dealing with cancer for several years you can track many of the big changes as they have affected your treatment, your co-pays and your costs and your paperwork. 

Oh God, the paperwork!

Olden days: You had health insurance through an HMO and you had co-pays for various services. So much $ for a doctor’s visit, so much $ for a specialist, so much $ when you went “out of network” etc. Then another copay for your medications—there was a range of course, and you learned to ask about brand name and generics.

Then it began to change: Maybe you had a heath savings account—you put money into it  pre-tax and you could spend that down within 12 months for legitimate healthcare expenses. No plastic surgery, teeth whitening etc. But that was the least of your worries-unless you needed plastic surgery to realign some things that got moved around with cancer surgery or your chemo left your teeth gray. (Then you appealed and debated and probably lost your appeal.)

If you wanted massage, acupuncture or chiropractic you were on your own…but the medications and prescriptions were still relatively reasonable.

But then the description of chemo started to change: Was oral chemo a treatment? Or a medication? Did you pay $25 each time or $250 each time or $2,500 each time? And then was chemo by infusion reclassified as a medication too? The battles began. 

Your record keeping system had to get pretty sophisticated. One fat file would no longer be useful.

But the thing you could still count on was being able to talk about your cancer at work and never feel you were at risk or that there would be negative consequences. Or that people were looking at you in a “certain way”.

Now, as health care changes again, and we are taught to be conscious consumers, we are learning how the healthcare industry views a cancer patient and how –by default not by unkindness—employers also view cancer.

Organizations—businesses and corporations and nonprofits have to manage their healthcare dollars much more carefully. Healthcare is one of the biggest expenses of any business and its more than, “How many employees to you have to cover?”

Now an organization has to look at its Medical Loss Ratio: that is, How much does Company ABC have to spend based on the wellness and healthcare demands of its employee population. The rate the company will be charged by the health insurance company is based on how much usage a particular company has over time. Yep—“How healthy is this company—overall?”

Lots of math and statistics go into those calculations. They try to keep it fair and reasonable. So, for example, if there are ten pregnancies (babies are expensive in health insurance) a company’s usage might be high in 2013, but the next year there are no babies but one employee heart attack so several years get averaged together and projected to determine a rate reflecting how much demand (expense) this company’s employees are likely to incur (cost).

So here is how it starts to get creepy. And why you have to be a little bit careful.

No one is allowed, of course, to ask about your health in a job interview, and you have learned not to lead with “I had cancer last year,” but maybe you are still growing out your hair, or you have a resume gap to explain, cancer is going to come up. And this is where it is delicate for you and for the folks in HR. Because, remember the HR folks are also the ones who are negotiating with the insurance companies and they (of course) want to have as healthy an employee population as possible to keep costs as low as possible.

Yes, you are getting the “heart-healthy lunch” on Friday and the pedometer on Wellness Day because they care about you—and because they care about how much the company’s medical loss ratio will increase if a high proportion of employees has cancer—or a heart attack or a baby—this year.

The dynamics are changing. How health insurance costs are measured and attributed are changing. You need to know this as you make choices about how you communicate about your cancer at work.

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