Krazy A to Z Challenge 2017 – “D”

Decisions, Decisions

When I think of a decision, it’s usually in the form of a choice between one or more equally good (or bad) alternatives. Those usually take me a lot of time and analysis to tackle. But there is another kind which I’ve recently become acquainted with: the decision to take an action. The key difference here is the fact that I wasn’t previously presented with an issue and I don’t have to select a solution. Simply put, there is something I want, and I have decided to pursue it. Now, this may not seem as difficult as the first kind of decision, mostly because there is not as much urgency. There’s no time limit to follow, except the one that I impose upon myself. And even more importantly, there can be no second-guessing after the fact as to whether I should’ve gone with option “A” vs “B”. It’s not an exercise in “picking”, it’s one of taking action. Hold on, now, that is starting to seem scary. Turns out there is a big risk. What if I’m being foolish or frivolous, even? How did I come up with this idea? Is it brilliant or krazy? The truth is, I can’t know for sure. But as terrifying as it may seem to go after what I want, it would be far worse to never even try.

#AtoZChallenge

Krazy Like a Fox

Sometimes things happen which seem out of our control. They sneak up and invade our lives, causing us to question our own sanity. That happens to me all the time, because it seems I am a magnet for weird and unexplainable occurrences.

For example, I got a call the other day to confirm an appointment I have next week for a medical test (routine, preventative care). The person on the other end of the line was very nice and explained to me the way my health benefits work and how that would affect the amount I was required to pay. Since I have a plan with a deductible and coinsurance, those amounts have to be met before the insurance company has to kick in their share. I totally understood, and I knew that my plan covered mammograms 100% with no out-of-pocket, so I wasn’t worried.

Let me give a little background, though, before I continue. Thirteen years ago my mom passed away. Five years prior she had been diagnosed with breast cancer. That automatically placed my sister and me in a high-risk group.

What I learned since that time is there are different types of mammograms. There is the garden-variety, routine type that all women should start getting at a certain age. This is called a screening mammogram. It’s apparently not good enough for someone in “high-risk”, so there is another procedure called a diagnostic mammogram. That’s the one I need, in combination with an ultrasound. It is what I have always done, and thanks to health insurance, I’ve never had to pay before. After all a mammogram is a mammogram and the basic purpose is the same for me as it would be for any other woman: prevention.

Welcome to the new age of group health coverage. Diagnostic mammograms are billed using different medical procedure codes and this gave insurers a great opportunity to exclude them from being categorized as preventative care.

Thank you Cigna for sending me all of the pamphlets stating that routine preventative care is covered at 100%, as long as I go for my yearly check-up with an in-network provider. What they forgot to print on the brochure was “Except you, and you know who you are”.

That would be me, in case you were wondering.

Anyway, back to the phone call. After all of the calculations of procedure cost, deductibles and any other mumbo-jumbo, I was informed that my out-of-pocket cost for the visit would be $645. My response of course was that of shock, and the young lady on the phone realized she wasn’t getting anywhere by offering me various payment plans. So, she explained one more choice. If I pay for the visit myself without using insurance coverage the cost is $395. What else could I do at that moment but call the customer service line at Cigna and inquire why my insurance, for which money is deducted out of every one of my paychecks, would charge me more for a medical service than it actually even costs?

Ten minutes later, I heard myself saying to the Cigna Customer Service Rep: “So, you are confirming that it is better for me to pay for this service myself, rather than use the coverage that I have already paid for in 24 bi-weekly payments so far this year?” His answer was yes, of course, because $645 > $395.

I could not believe this was happening. And forget the fact that mammograms are usually covered by insurance companies, I assume because it is more cost effective for them to try and prevent breast cancer than it is to pay for the treatment therein.

Except for someone who is at a higher risk, right? Um, no, that doesn’t make sense.

Am I being penalized because they think even if they pay for my yearly screenings, I’ll still end up getting sick and costing them a lot of money? No, that seems too shady, even for health insurance executives.

So then why? And furthermore, how is it allowed?

I pondered those questions for a few days, and I still have no idea.

But you can bet I’m going to keep trying to find out.

I’d have to be krazy not to.

Krazy Brain

I looked up conundrum in the dictionary and it is defined as “an intricate and difficult problem having only a conjectural answer”. So basically it is like being presented with a problem that can be solved in a few different ways, none of which are clearly the best, and all of which can only be verified by making a guess. I have always associated the word with the idea of having to decide between two choices each of which has properties that overrule or negate the properties of the other. Therefore, the choice cannot be made without sacrificing. It is like making a long list of pros vs cons, and when you are finished you realize that every single pro has a corresponding con, and vice versa.

So, then what do we do?

From personal experience, I can tell you my first step is to complain about the fact that I can never get what I truly want without sacrificing. It is the “woe is me” procedure, which is really a ploy to procrastinate in disguise. Forget the fact that this is a scary, potentially life-altering choice I am considering, because the real tragedy is how much the universe has wronged me.

Next I’ll usually move into feeling bad for expecting things to be handed to me without being willing to sacrifice or compromise. It’s the “first world problem” stage. I’m a horrible person. I don’t deserve a good outcome. I shouldn’t even be allowed to have choices. More stalling.

And then the fun begins. This sets off a whole period of analysis, which I like to call “brain noise”. I will take the conundrum and spin it around in my head in every conceivable direction I can think of. The two column list of pros and cons turns into a multidimensional matrix of “what ifs” and permutations of an exponentially growing amount of cause and effect pairings. Of course, I’ll be going over the exact same amount of supporting data that I had previously when I arrived at the conclusion that there was no satisfactory answer.

So the “paring down” kicks off. What can I take out of the equation to make the decision simpler? Essentially, what am I willing to forego? Again, I have to consider every single fact and possibility in order to decide what gets cut. And as the slicing proceeds, I find myself subtracting things I previously thought were imperative, and adding back things I just gave up a few minutes ago. More “brain noise”.

Once that proves futile, I move on to the “nothing” phase. Yep, that’s right, I do nothing. I have reached what I believe is the only conclusion that makes sense: that is to NOT choose. I envision myself taking one of the paths and quickly write it off as unacceptable. Then I sample the other and similarly dismiss it. So logically, there is no solution. I’m saved; I don’t have to make that tough decision after all.

The only problem with that is the fact that the time will invariably arrive when the decision must without a doubt be made. It was a difficult and problematic choice with no obviously good direction, which one hundred percent of the time means it is absolutely necessary to select. This is the “duress” stage.

Now I’m scrambling. What were the choices again? What were my issues? Why couldn’t I pick? What happens if I opt for “A” instead of “B”? I can’t remember, but there were so many words and thoughts before; and so much information that I now no longer have time to review. It’s “put up or shut up” time. So I do it. I make my stand, and I immediately slip into “Buyer’s Remorse” mode. Did I make the right choice? Did I do the right thing? Will it be ok? Will it make me happy?

It’s getting noisy in here again.

Finally, here comes the really Krazy part:

The answer to all of the remorse questions is yes. It is yes, because it has to be, and because I will make it that way. It WAS the right choice, and it WILL be ok. I knew all along what I was going to do before I did it. I made my decision before even the first phase began. It turns out the torture that followed is my process! It is what I NEED to do, what I always do, and what, in the end works for me. Without “woe is me”, “first world problem”, “brain noise”, “paring down”, “nothing”, “duress”, “buyers remorse”, and the final “Krazy” part, nothing makes sense. Conundrum or not, the real victory is in making the decision, believing that either way, I can handle the outcome.