Sunday, September 29, 2013

Virtual Camping Out in Line for the Health Insurance Exchange (Post No. 3 of Adventures in Health Insurance)

Being both a writer and a lawyer, I have hard time turning off my brain (or maybe that's why I became a writer and a lawyer). As I wrote in my two previous posts, I'm self-employed, so I have no group insurance option, and I was turned down for individual health insurance. So I did some preliminary research on the exchanges. Below is what I learned.

Differences in types of plans:  The main difference I found between the Bronze, Silver, Gold, and Platinum plans that will be offered is the estimated percentage of healthcare costs you will pay versus the insurer -- 60%, 70%, 80% or 90% respectively. I'm a little confused about whether the percentage of payment refers to a co-pay, deductible level, or out of pocket. Or all three.

Deductibles: I found one article that estimated the Silver deductible as averaging $2,550 based on data for 6 different states. There may be more info out there on this, but as Tuesday is only two days away, I'll wait to see what the actual exchange says. (It's too nice a day outside to spend it all in front of the laptop. After all, this is Chicago, tomorrow it could be snowing.)

Premiums and costs: Kaiser has a calculator which gives some estimates, with a lot of caveats about how no one really knows. Here's what the calculator calculated for one adult living alone (errors in typing in data, if any, are mine):

47 year old non-smoker living in Chicago, IL (no subsidies):

Silver: $259/month (out of pocket limit of $6,350)

Bronze: $186/month (out of pocket limit not listed)

31 year old non-smoker living in Chicago, IL, earning $35,000/year (no subsidies):

Silver: $191/month (out of pocket limit of $6,350)

Bronze: $138/month (out of pocket limit not listed)

31 year old non-smoker living in Chicago, IL, earning $20,000 (qualifies for subsidies):

Silver: $85/month (subsidized) (out of pocket limit of $2,250)

Bronze: $31/month (subsidized) (out of pocket limit not listed)

Questions I still have:  The premium estimate for me is about $50 less per month than I pay now, but there's no way to compare apples to apples. Now, both my deductible and out of pocket limit are $5,000. So if I am under the deductible, as I am this year and was the first year I had the plan, the Silver plan would be far more affordable for me. If I'm over the deductible, my current plan might be a better. I'm also unclear on differences in the quality and breadth of the networks offered, the deductibles, and the co-pays.

Whether I have good coverage now depends on your perspective. I'm in the Blue Cross PPO. Nothing, even prescriptions, is paid for until I hit the $5,000, which I obviously aspire each year not to reach. The plan thrills me, having faced no coverage at all. A friend who has never been self-employed, though (and who is against any type of universal health insurance) said to me, "That's terrible. Can't your firm get you better coverage?" Me: "I am the firm. And according to the health insurance companies, I'm not insurable." Friend: "But you're healthy. Can't your doctor write them a letter?" But that's not how it works - see my last post: Once I Became Self-Employed

Happily, it looks like I misunderstood a previous communication from ICHIP. While my particular plan may go away, I can be migrated to a similar one that might cost me slightly more. Still, I will likely purchase through the exchange, as it seems to me that my plan won't continue in the long run if the exchanges work well.

Links that may be helpful:

Lisa M. Lilly is the author of Amazon occult bestseller The Awakening.  A short film of the title story of her collection The Tower Formerly Known as Sears and Two Other Tales of Urban Horror was recently produced under the title Willis Tower.  Her poems and short fiction have appeared in numerous print and on-line magazines, including Parade of PhantomsStrong Coffee, and Hair Trigger.  She is currently working on The Awakening, Book II: The Unbelievers.
The Awakening for Kindle:

Friday, September 27, 2013

Once I Became Self-Employed (Post 2 of Adventures in Health Insurance)

On a sunny day about about a month and a half before I planned to leave the large law firm where I worked, I played tennis for the first time in years.  I felt great.  I'd arranged for office space for my own practice, FindLaw had finished my firm website, and I'd set up my landline and bought a Blackberry.  As noted in the last post, I'd been very healthy, didn't smoke, and was the appropriate height and weight (see photo -- that's me).  But I'd had an exclusion a decade before for carpal tunnel on my health insurance at a small firm, and I liked my Blue Cross PPO coverage from my current employer, so I decided to COBRA for the full 18 months.  A day after I played tennis, the side of my left calf started hurting.  I assumed I'd pulled a muscle.  Over the next week it became worse instead of better, enough so that I had trouble sleeping by Night 5.  I saw the doctor, who sent me for an ultrasound. 

I had a blood clot.  The good news was it was superficial - meaning in a surface vein, not one that led to the heart or lungs.  Medline Plus says this condition is "usually a short-term condition that does not cause complications. Symptoms generally go away in 1 to 2 weeks...."  So, basically, it's not a blood clot that will kill you but, as I learned a year later, it will keep you from getting health insurance.  My treatment was similar to a muscle strain.  Rest, elevate, ice.  My doctor had me take a baby aspirin a day and told me not take birth control pills just to be on the safe side, but said I didn't need to worry about it.  That lots of people get these and never even know it.  Also that everyone should get up and walk around to help prevent clots rather than staying in one position for long periods.

I started my law practice as planned.  Just over a year later, I applied to Blue Cross for an individual policy, hoping that, given that they had my records and knew my health, they would just extend my current coverage.  That's not how it works.  I filled out a long form.  It covered the last 5 years in depth, but asked about my medical history for my entire life.  It did not ask about my general health habits, other than not smoking.  There was nowhere to list that I walked 10 miles a week, did yoga 3 times a week, and practiced meditation.  I'm sure I went into more detail than many people would about my medical history, including my eye surgery at the age of 4.  If I'd omitted anything, even by mistake, I knew I could find myself without coverage down the road right when I needed it.  For instance, let's say I forgot about the eye surgery, then three years later I was hit by a car and needed surgery on my leg.  If the insurer found out I'd omitted the eye surgery and could show that was material -- meaning the insurer would have denied coverage if it had known -- it might then refund all the premiums I'd paid and leave me without health insurance.  I could then be facing over $100,000 in hospital bills with no health insurance.  (Hospital bills can easily run above $100,000 when a pedestrian is hit by a car.)

How much I included on the form, or in the follow up telephone interview, turned out not to matter.  The insurer wrote a letter saying it was rejecting me because of the blood clot without looking at anything else.  I'd just met a health insurance broker at a networking event who'd warned me that 40% of people get turned down when they apply for individual coverage.  I called him, and he helped me through the process for another major carrier.  That application was just as involved, plus I had to disclose that I'd been turned down for health insurance.  I was turned down again.

Both carriers sent me information on the Illinois Comprehensive Health Insurance Program.  ICHIP had two programs I qualified for, both for people who had no group coverage available to them.  One was for people who'd kept their COBRA coverage the entire 18 months and wanted to continue insurance.  That had no waiting period and picked up as soon as my COBRA ended so long as I filled out all the correct forms.  The second option covered those who'd been turned down for individual coverage.  That program often had a waiting list, then excluded pre-existing conditions for a set time, something like six months.  I opted for the first plan.  The people administering it were very helpful and always available by phone when I called.  And I got the Blue Cross PPO. 

My plan has a $5,000 deductible and costs around $300/month (based on being a 47 year old female non-smoker).  Nothing is covered under the $5,000, so I was a bit shocked when I discovered my allergy nasal spray was over $100 per month.  I'm very fond of breathing, though, and the less expensive medications I tried didn't work, so I paid it.  I could and probably should have gotten a lower deductible, but I'd been very healthy, so I figured it was worth the risk.  I hit my deductible one year, when I had to have surgery (see Goodbye Ovaries below). 

One thing worried me -- I was required to pay my premium by certified, not personal, check.  And all over the premium notice it said if I missed the premium, my insurance would be gone and I could never reinstate it.  Before my surgery, I thought, what if I have a tough recovery and can't get to the bank to get a certified check?  So I prepared a financial power of attorney to be sure someone could do it for me.  I also didn't know what I'd do if needed to move out of state, as ICHIP is only for Illinois residents.  Fortunately, I love Chicago.

Other than that, I've been happy.  I got to keep my doctors.  I've learned a lot about healthcare pricing.  That's led me to think that a co-pay based on a percentage of the actual charge might be a good thing, as otherwise the co-pays are completely disconnected from the amount of the bill.  On the other hand, I also learned the actual bill has little to do with reality, so long as you are insured.  My surgical bill and emergency room bills were something like 3 times the PPO rates.  So even before I hit the deductible, the insurance was valuable, as I still paid only the PPO rates.  If I'd been uninsured, I would have been liable for the whole amount.

Now my ICHIP program is going away because the Health Insurance Exchange is supposed to make it unnecessary.  According to the state, this should mean my premium will be cheaper because the ICHIP premium is always set at 150% of what the rate would otherwise be.  I'm relieved that, unless Congress makes changes, health insurers can't deny me coverage.  I'm also happy I'll have the option to cover employees, if I hire any again, through the exchange.  (I've had a few different part-time employees over my five years in practice.)  And, presumably, if someday I want to leave Illinois, I'll still be able to get coverage.

I'm concerned, though, that Congress will succeed in getting rid of the insurance exchanges, and I will then be stuck with no ICHIP and no coverage.  I'm also concerned about whether I'll be able to keep the Blue Cross PPO.  I heard that premiums will vary with network size.  So the cheapest plans will have smaller networks; the Cadillac plans will have wide networks. 

On 10/1, I will go on the exchange and see what I can see.  Even before I read articles raising potential technology issues, it seemed unlikely to me it would all be working on Day 1.  I figured that for the same reason I try not to buy a new Microsoft version of anything.  The ones I've bought have always had bugs.  (It was a nightmare when I bought a computer with Windows Vista when it first came out.  I used to walk around the office saying "I hate Bill Gates" over and over.  But I digress.)  I don't expect the government will do better than Bill Gates.  On the other hand, I was pleasantly surprised every time I dealt with the ICHIP people.  So I'm crossing my fingers they are in charge.

I will let you know how it goes.

Lisa M. Lilly is the author of Amazon occult bestseller The Awakening.  A short film of the title story of her collection The Tower Formerly Known as Sears and Two Other Tales of Urban Horror was recently produced under the title Willis Tower.  Her poems and short fiction have appeared in numerous print and on-line magazines, including Parade of Phantoms, Strong Coffee, and Hair Trigger.  She is currently working on The Awakening, Book II: The Unbelievers.
The Awakening for Kindle:

Thursday, September 26, 2013

From Then Until Now (Post No. 1 of Adventures in Health Insurance)

Many people in both my professions (writing and law) are self-employed and, as do I, face the on-going issue of how to pay for healthcare or obtain health insurance.  With the changes occurring due to Obamacare or the Affordable Healthcare Act, whichever you like to call it, I thought it might be helpful to share my journey.  I plan to check out Illinois' healthcare exchange on Tuesday, October 1, 2013 and will report on my progress.

I first purchased an individual health insurance policy a couple years out of college.  I had a group plan at my office job (my degree was in Writing/English, thus the office job), but I'd discovered I could earn more temping through a downtown agency and give myself the freedom to take time off to write.  I shared an apartment, lived on a very limited budget, and usually worked about 3 weeks, then took 1-2 weeks off to write, which I loved.  My limited hours meant no health insurance through the temp agency.  For less than $100/month I got a policy with a high deductible that I kept for about 4 years.  Never met the deductible.  I had no trouble qualifying, I don't even recall if the form was long or short or what questions there were, though I'm pretty sure someone came out and gave me a blood test.  A few people told me I was young so I ought to just go without coverage, and I could always get treated at the county hospital.  That sounded like a very bad idea.  One of my friends, a year younger than me, out of the blue needed emergency surgery during a brief coverage gap.  Her bill was tens of thousands of dollars, and she earned not much more than minimum wage.  (She eventually finished paying about 15 years later.)  Also, I felt that if I could afford health insurance, I should buy it, especially because I'd chosen to work less and earn less.  Unlike many people who find themselves without insurance, I could have opted to stay at my job and keep my benefits.

Fast-forward a few years, and I developed carpal tunnel/tendinitis from all the typing for work and for my own writing (and my guitar playing).  The treatment options weren't good back then, and the work comp doctor recommended working until it got really bad, then having surgery.  I researched a little, learned that many people needed surgery again when they returned to work, and decided I ought to find something else to do for a living.  It was a very rough time for me, but eventually I returned to school, earned a graduate paralegal certificate and got a paralegal job where I relied on my research and writing skills and had a secretary who did the majority of my typing.  (Not everything was computerized at that time.)  I also had health insurance with an exclusion for carpal tunnel/tendinitis, as I worked at a very small firm and the policies were more like individual than group policies.  As I'd rejected the idea of surgery, the exclusion didn't affect me too much, but it didn't make me happy.  I didn't know what I'd do if something aggravated my hands and I needed treatment.

Later I went to law school and became a lawyer at a large firm that had a group plan with Blue Cross.  Hooray!  No worries on exclusions, though I never needed treatment for the carpal tunnel while I was a lawyer, having discovered the Microsoft Natural keyboard (which I'm using right now).  Even before I went to law school, I'd had in mind that eventually I'd open my own practice.  Partly, again, so I could take time to write when I was able to afford it, and because I wanted to work for myself.  It turned out I liked the large firm quite a bit, so I stayed 8 years.  After year 6, though, I started talking to people who'd started their own firms to gather information.  One thing I always asked, given my previous experience, was what they'd done about health insurance.

Those who were married generally got coverage through a spouse.  Others practiced part-time and had a full time job where they got health insurance.  Some tried to get insurance through an organization, like a bar association or writers' association.  It turns out those types of plans are not group plans, but individual policies where the members get discounted rates.  Which means, unlike a group plan, the insurer can turn you down.  Which happened to a colleague when she opened her practice.  I was shocked, as she'd never had any health issues and had only been hospitalized when she had her children.  But she'd sought counseling during her divorce and was turned down even though she'd applied through the Chicago Bar Association (she was a member).  The carrier -- one of the major, name brand ones -- said they don't cover people who have had any type of psychological counseling.  She got insurance through another major carrier. 

I decided to use COBRA for my first eighteen months on my own, which cost over $400 a month but kept my Blue Cross PPO.  Everyone told me health insurers only look back 5 years, and I didn't see anything in the last five years that should be troubling, though I had gone to counseling for relationship issues myself before that time.  I hadn't had any major health issues other than the carpal tunnel.  My friends and colleagues thought I was crazy to be concerned.  My only medications were for allergies, I don't smoke, I exercise and am within the recommended weight range for my height, and I'd only missed perhaps 3 or 4 days of work for illness in my eight years of practice.  So I figured when my 18 months was up, I'd apply for an individual policy and I'd be set.

That didn't turn out to be the case.  But more on that next post:

Lisa M. Lilly is the author of Amazon occult bestseller The Awakening.  A short film of the title story of her collection The Tower Formerly Known as Sears and Two Other Tales of Urban Horror was recently produced under the title Willis Tower.  Her poems and short fiction have appeared in numerous print and on-line magazines, including Parade of Phantoms, Strong Coffee, and Hair Trigger.  She is currently working on The Awakening, Book II: The Unbelievers.
The Awakening for Kindle:

Friday, September 20, 2013

Anatomy of (Rewriting) a Thriller

A few people have asked me where The Awakening II is. Which makes me very happy, as I hope it means they read The Awakening. The answer makes me less happy: It's on my dining room table. That is, the first draft of it is. A second/third draft (I rewrite in pieces) is in the laptop. I should add that, actually, first I outline, which sometimes takes longer than the first draft. So I basically write from point to point in my outline, in sort of a mad dash to the end. 


During the first draft, rather than get distracted by the Internet - not that I ever am, of course - if I need to research something I put a bolded note in brackets to check it later. For instance, when I wasn't sure what the national language for Turkey was, I used "Turkish," then in brackets said [check this]. (Turns out it's Turkish.) 

This approach to first drafting means I spend a lot of time rewriting.  I start with the various plot lines. I did a Find in Word for Ray - Tara's biological father, who has a small role to play. I read each scene involving Ray in order, skipping over everything else, to make sure his story fit together, then did that for the other characters.

I'm now pretty much done with that, so my next step is to look at the overall plot to be sure it makes sense, is consistent throughout, and has high enough stakes. Next, I'll rewrite from beginning to end on the laptop, asking myself what each scene's viewpoint character sees, tastes, smells, hears, and feels (both tactile feeling and emotion). Finally, I'll look at the lines and words themselves. This includes lengths of sentences, paragraphs, chapters. Also actual words - is the same word used too many times on a page or in a chapter? Can I say anything more succinctly? As in, can I use fewer adverbs like "succinctly"?

Then I'll print the whole manuscript out, wait a couple weeks, and read it. I'll particularly look for any scene where the characters are sitting and talking or sitting and thinking. Or standing and talking. I don't cut all those scenes, but if there are a number in a row, or one is very long, I'll try to intersperse the dialogue with action.

I also look for too much action. Sometimes a reader needs a break to just breathe and be with the characters. After I've made those changes, and I feel like I'll throw up if I look at it one more time, I'll send it on to first readers. (That's Mr. Bird reviewing some of my writing. I don't always takes his suggestions, but don't tell him, he's very sensitive.)

So, not-so-short answer (I do like to write novels, after all), The Unbelievers (Book II of The Awakening series) is on its way. I'm hoping it'll be ready by Christmas, more likely it'll be somewhere between Christmas and Easter.

In the meantime, if you join my email list by 11/30/2013, you'll be entered into a drawing to have a character in The Unbelievers named after you. Just email me at with your first name and say you want to be in the contest.

Feel free to join the email list after 11/30/2013 as well. No spam, I would never do that to you. Just a short monthly newsletter discussing books in the mystery, occult, suspense and thriller genres and an occasional update on new novels or short stories I publish in between. (And as you can tell, it could be Easter before you get one of those.)

Monday, September 9, 2013

Stranger Danger, Comic Con and Girls Gone Gore

Last month I  presented a panel, Girls Gone Gore, at Comic Con Chicago with author Carrie Green. The first time we met, Carrie and I talked about how both of us have had people suggest that because we write horror/suspense/thrillers, we ought to consider using our initials or male pen names. The idea that readers believe male authors more likely to write good horror is nothing new. As I learned when I researched for the panel, Mary Shelley's Frankenstein originally was published with the author listed as Anonymous. Everyone assumed it was written by a man.

Why the bias toward men still survives is puzzling considering the success of Frankenstein, as well as of works by other women horror writers like Shirley Jackson (The Lottery, The Haunting of Hill House). But something Carrie pointed out on our panel is that when women write horror, suspense or thrillers, it's often called something else. I read The Lottery in English class, and a lot of people read Frankenstein in school as well.  So these horror tales are called literature, not horror.  (I don't know why there needs to be distinction between the two, but that's a whole other post.)  Happily, when I asked the audience of about 40-50 for our panel what they thought, most did not seem to care if authors were male or female, they were just looking for good books.  One young woman said she hoped women would not use pen names or initials because she actively looks for women writers.  She believes they are more likely to develop the characters' interior lives than are men, and that's something she likes in fiction.

Another thing we talked about is the portrayal of women as victims. Based on a lot of popular movies, TV and fiction, one would think strangers are a great danger to women. Curious about how reality and fiction match, I checked the FBI website. It turns out over 75% of homicide victims are men, not women.  (There is one exception. Serial killers, who are rare in real life, are more apt to target women.)  Even more interesting to me was that men, not women, are more likely to be killed by strangers.  Women are more likely to be killed by people they know. Specifically, husbands, boyfriends, and relatives. Which led me to comment that despite what we see on TV, the most dangerous thing for a woman to do probably is not to walk down a dark alley, but to get married.

The Comic Con panel attendees, many of whom are Buffy fans (as am I), were great to talk with on this point. These readers want to see strong women characters. They love reading about and watching on film girls and women who are portrayed as three-dimensional characters in all type of roles, including as heroes.

And the more such books and films and TV shows sell, the more of them there will be.


Lisa M. Lilly is the author of Amazon occult bestseller The Awakening.  A short film of the title story of her collection The Tower Formerly Known as Sears and Two Other Tales of Urban Horror was recently produced under the title Willis Tower.  Her poems and short fiction have appeared in numerous print and on-line magazines, including Parade of Phantoms, Strong Coffee, and Hair Trigger.  She is currently working on The Awakening, Book II: The Unbelievers.
The Awakening for Kindle: