Chapter 2


Labour was always something I was scared of, but the epidural scared me more. I had my first baby, without much fuss and an epidural. I was grateful.       

When I was in my 5th day of labour with my second, I was pretty darned ready for the drugs. I felt that needle rip right through my spinal column. I felt it twist and turn every time I moved.       

I told the Dr. “You did it wrong”. He said “No, I did not.” And so my adventures as a Painie began.       

My back felt weak, tender and unstable after I went home. Three months postpartum, I was walking my toddler, dog and infant. My toddler ran into the street, I grabbed her and dropped like a stone. It took 45 minutes to get home. It felt like I was shot. I called my husband and said, “I can’t walk”. Where do you go from there? I am in a bedroom with a dog, an infant and toddler. I can’t even get to the bathroom by myself.       

Fortunately my General Practitioner saw me right away and was a little flabbergasted at my situation. It should hurt to sit, if I have a herniated disc, but it hurt to stand. She referred me to a Chiropractor in the same clinic.  Cost number #1. I can’t remember exactly (it was 7 years ago), but I think it was $150 for initial consult and $60/visit thereafter. Luckily, the cost was partially covered by my husbands’ group plan. I was out-of-pocket approximately $100. If I did not have that coverage, it would be $210.       

Welcome to the world of Insurance. You know the story of the shoemaker whose children where shoeless? Well, for about 7 or 8 years, I worked for an Insurance Company. Yep, that is right. I travelled across the county teaching the benefits of Disability Insurance. I worked in the marketing department developing marketing materials, presentations, software etc. etc. for Life & Disability Insurance. Here I was self-employed with no coverage. Smart huh?       

Insurance, for most people, is an expensive extra you don’t think you need……until you need it. I should have taken my own advice, but didn’t.        

Disability Insurance

Here are 4 types of Disability Insurance that can fill the gaps left by Universal Healthcare. Some of the options may be paid by an employer, individual or both. These are brief descriptions only scratch the surface. Some of the products, like Group and Long Term disability, are very complex and intricate.  Having a basic knowledge of what is out there, is helpful. These descriptions are based on Canadian Insurance Companies and in concert with the Canadian Healthcare.       

Group Insurance – Coverage either provided by an employer, or purchased by a business owner/self-employed person. The plans vary in coverage styles, options, deductibles and restrictions. It is very complex, which most people don’t research or read until they need it. The most basic Group Plan coverage will allow;  a percentage of prescriptions, some Short-Term Disability Insurance, Life Insurance and possibly other features like Dental. Additional coverage options, may be purchased by the employee. For example; the base plan offered may provide 75% coverage for prescriptions. The employee may be able to change that to 90% and a specific dollar amount will be deducted from their pay.       

Long Term Disability – This coverage is for people who are not able to do their job for an extended period of time; as determined by the policy. It will provide a certain percentage of income replacement, depending on the policy. That period of time for payment or criteria for Disability depends on the wording of the contract. It may be purchased by the employee or offered through a Group Plan. It may be purchased as a standalone product, in addition to Group Insurance already in place. It may be purchased by a Self Employed person as an individual plan. Long Term Disability Insurance may also be purchased by business partners on each other. Partnerships, small and medium-sized businesses may also buy coverage in case the owner becomes disabled, to cover operating expenses. There are thousands of different variations on this product.       

Underwriting is very complicated, requiring a lot of information, patience and time. There may be exclusions based on pre-existing conditions. The most common exclusion is Back Pain; a very common problem and a difficult condition to prove. However, it is worth the perceived hassle when you need it. Long Term Disability claims are another factor to investigate and consider. This process can be very complicated, as the payout to the Insurance Company could be enormous.       

Critical Illness – A flat payout of money when the Policy Holder is diagnosed with a Critical Illness; as stipulated in the policy/contract.  Payout is similar to Life Insurance, but you are still alive. The underwriting process is relatively simple and product easy to understand. This product has gained popularity, as  it is relatively straightforward and inexpensive.       

Long Term Care  This product provides a certain dollar amount to assist in Long Term Care; when the policy holder reaches a certain age. This money may be administered in several different ways. For example, payment may be used for an Adult Retirement Facility that allows for independent apartment, communal dining room and facilities; but also has a palliative care floor and nursing staff on hand 24/7. It may also be used to pay for private nursing services or equipment. This is not a Disability Product, but with Public Healthcare limitations, it will assist in allowing some quality of life.       

Out of Pocket  If a patient does not have any of the above Insurance Coverage Options; it will be paid right out of the bank account. Chronic Pain has such a broad range of symptoms, that may require many treatments, medications, therapies and equipment; costing $1,000s’ a year. Hardly anything is covered by Public Healthcare.       

Conclusion

Understanding Insurance was something I did for a living. I knew the products inside and out, I have an in-depth knowledge of the underwriting system and I have trouble navigating it now. How is someone with little or no knowledge figure it out? The Government changes policy often; one year a treatment is covered, the next it is not. My Group Plan coverage has changed several times since I became disabled, changing (increasing) my out-of-pocket expense. Recently the cost of medication went up, and my percentage of coverage went down.       

Herein lies the rub, now that I am disabled, I am uninsurable for Long Term Disability. I have worked through the pain for the past 7 years, which has not helped my situation. I don’t want to rely solely on medication, willing to try any treatment possible. As stated in the previous chapter, I am fortunately able to pay for alternative treatments; but what of those who can’t? The best  Insurance Coverage are for those who can either afford it, or have excellent Group Insurance Coverage. This analysis is based on Canadian information, so I cannot even imagine what it is like in the U.S.? So many out there, left to suffer because they can’t afford to get help. Medication being the only solution for relief; but with that is the stigma. Addiction, criminals, weak, pathetic, unwilling are the adjectives used to describe Pain Patients. How do we change the system? First by understanding it; the following chapters will describe Insurance for Canadians. I welcome any U.S. contributions.

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