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My Health Insurance Horror Story

I guess I should weigh in on this subject since the left is documenting the Obamacare Clusterfuck atrocities.  Be sure to visit Lambert at Corrente for the latest updates in the series.

So, my horror story started in February, right after I made an offer on this house.  I was looking forward to moving to PA because the cost of living here in Pittsburgh is orders of magnitude less than it is in NJ.  While that might be a slight exaggeration, the most significant savings I was anticipating was going to be in the cost of health insurance.  My COBRA, already at a whopping $987/month, was running out at the end of April and I couldn’t find an affordable substitute in NJ.  Every plan I looked at was about 50% higher than I was paying in COBRA *with* cost sharing for two healthy people.  I mean, it was absurd.  So, unless I moved to PA where the cost of insurance was about 1/4th the cost, I was looking forward to going without.  You just can’t do that when you have kids.

Enter the kid.

The kid developed a health condition in February that required several trips to the hospital.  We’re still not totally sure what is wrong with her but it was very serious and scary.  She’s missed a lot of school because of it.  Thank goodness I had health insurance at the time because I honestly don’t know how I could have afforded it.  It would have bankrupted me for sure.  We have learned since her hospitalization that CHIP would be unavailable for her in NJ because to be eligible, she would have had to be uninsured for 6 months.  I don’t know what hard assed Republican in NJ dreamt that rule up but it screwed us when the insurance ran out at the end of April.

I scrambled to find a replacement policy in PA.  Now that I’m a resident, I could qualify for the lower rates.  But since she now has the dreaded “pre-existing condition”, my rates were going to be higher.  I started shopping around before the insurance ran out, because as we all know, you can only get insurance, jobs, loans when you don’t need them.  Almost all of the insurance companies I called did not cover her condition.  I finally found one in Pittsburgh that is probably designated a “silver” policy next year.  There’s a steep deductible, 20% cost sharing and her drugs are covered only partially.  But there was one other catch.  She could not be denied coverage as long as she was on my policy but they reserved the right to charge me double for the policy on my portion because of her pre-existing condition.  So, I am paying $870/month for this individual policy.  I’m looking into a CHIP option for her in PA because my income is pretty low right now.  Maybe that will take the sting out of this plan.

The thing that ticks me off about Obamacare and health insurance policies is that there is an underlying assumption that the higher prices of the policies and mandatory cost sharing is going to teach us a valuable lesson about the cost of healthcare.  And you know, I get that.  I’ve worked with people who are in the upper middle class bracket who think that just because they have insurance, they must see the doctor every couple of days and then detail all of their ailments to their colleagues.  Or senior women who get attention they crave by visiting one specialist after another for vague maladies.  There’s something about relating these ailments to an audience that gives them satisfaction and a reason to live but, frankly, these people bore me to tears and I resent having to shell out money on their fibromyalgia and third course of antibiotics for a cold when what they really need is 30 minutes a week with a psychologist or a vocation.  We also shouldn’t be spending money on chiroprators and acupuncturists.  I don’t want my insurance dollars going to your back cracking quack when you should be seeing a physical therapist with a scientifically proven track record.

Hey, if you’re offended, go read someone else’s blog.  I have no obligation to support your fondness for quackery or tendency towards exhibitionist hypochondria.  Insurance is not for fun and games.  My employer provided health care was there for my and my family’s health.  It is not supposed to be an all-you-can-eat buffet like the kind you get on a Royal Caribbean cruise.  You know, where people gorge themselves on heaping piles of food that their already bulging waistlines suggest they do not need?  But it’s there and they paid for it so they feel entitled to overindulge.  That’s wasteful and people who abuse their health care should be ashamed of themselves. Health care is a necessity, not a fricking free-for-all.  Take it seriously.  Chalk my unsentimental attitude up to my no-nonsense, efficient military health care childhood where there were no bells and whistles and no one was there to give you unnecessary attention.

But my experience is not about appreciating the cost of care.  My experience was about getting care, period.  I wasn’t looking for the most expensive hospitals or drugs or doctors and we certainly didn’t seek them because we were feeling neglected or indulgent.  We sought them because the need was great and urgent and there was no opportunity or possibility to shop around. And for that, we are getting slammed with this insurance policy that will seemingly never decrease in price.  Furthermore, I’m healthy as an ox but the cost of my share of the premium has doubled so as to cover the kid’s share which couldn’t be rejected.  Maybe you think that’s fair but it’s certainly not “spreading the risk”.

She’s fine now, or at least she’s getting better.  We still need to see some specialists and that will be paid out of my pocket until the deductible is reached.  I’d pay it no matter what, reaching into my IRA for her if that’s what it takes.  But we shouldn’t have to do this.  From what I know, the cost of services are not controlled at all by Obamacare.  All the burden of spending less is on the patient and their families, even when such costs cannot be avoided.  And yes, some people will still go bankrupt until we as a nation get our collective brains and wills together and tell the health care industry that we’ve had enough of exploitative profit mining.

14 Responses

  1. The biggest disappointment of the 2008 election were the lies about Health Care Reform. I was personally lied to by Congressional Candidates on both sides of our state line. I REALLY believed that Democratic Senators and Congressmembers were committed to making real reforms that would help regular people. I believed that. I was so wrong.

    It turned out there wasn’t anyone up on Capitol Hill to stand up for us. No one to Insist that their pledges to us had real bite.

    And the self serving lies since …. that it’s the fault of the evil Republicans … that makes me see red.

    A decent bill could have been put together and passed within hours of the 2009 session. Just pass it as reconciliation in the Senate and shove it through the hugely (then) Democratic House. But, NOoooooo.

    We had to spin wheels and play act until the piece of shit ACA stumbled across the finish line. Sickening.

    And still, there is no one fighting for us. No one.

    • There are a couple of things about the ACA that concern me greatly beyond what influence the insurance industry had on it. One is that it was rushed through. The propaganda was that it was going to be Obama’s signature “accomplishment” and that it had to be passed now, now, NOW, no matter what the price in order to overcome Republican objections. The speed of the passage really bugs the shit out of me. I can’t help but wonder where the fire was. Why did it really have to be shoved down our throats so quickly? Is it so we wouldn’t see all of the potential problems with it? And now that it has been passed and three years old, why is it taking so long for the administration to get around to, you know, *administrating* it? There are shitloads of unemployed computer interface designers and database administrators and stuff. Why aren’t they busily coding away at making the transition easier? So, he really dropped the ball after the ACA was passed making him not only deceitful and devious but the most incompetent president ever.
      The second problem I have is what role Michelle Obama played in formulating the policy. Yes, yes, supposedly, she was tending to her spinach in the Potemkin White House garden. But she was also an attorney representing some powerful hospitals before she was First Lady and I’d like to know what she helped those hospitals get.

      • When I said, something good could have happened that first day, I mean they could have expanded and opened Medicare for Everyone right away.

        The insane hodgepodge of legislation that was passed obviously wasn’t proofread (the bit about employers being required to offer insurance to dependents but not spouses — oops — is either a mistake or evil)

        And what Lambert says about the buckets — I just can’t get over that. I worked a part time job for 5 years where my hours fluctuated wildly. Keeping track of which bucket I belonged in would have driven me insane.

  2. At least it’s good to hear that Brooke is feeling better. 🙂

    My COBRA (only for me; I have no dependents) was roughly $550 per month.👿

    My new health insurance (BCBS) will be roughly $240 per month–and that’s with a 40% surcharge for my reflux and high blood pressure.

    I’m paying a little more for my dental insurance now, but this is dental AND vision coverage, where my COBRA dental was dental only.

    Even if we can all get together on health care costs, why would the bought political class listen to the majority wish for rational health care cost controls any more than they would listen to the majority wish for a non-imperial, non-provocative foreign policy? If they lose their offices, that just means they go to “work” at cushy jobs provided by their owners, and/or go straight to cushy retirements provided by their owners. The threat of losing office matters to them only if their pride exceeds their greed. 👿

    Meanwhile, speaking of medical procedures, I’m glad I didn’t go to this school: 😈

    • Go figure. I have no health issues. My blood pressure is the same as it was 30 years ago and the only health care expense I’ve had in years was that stupid gall bladder operation in January. Gall bladder gone, no more attacks or possibility of pancreatitis.
      And yet, even without the kid’s preexisting condition, my premium, just for me, was going to be >$325/month. It would be nice if there was some consistency and logic to these premiums but alas, there is not.

  3. universal single payer….that’s the ticket and I guess the U.S. will never get that

    but countries like Canada, France, UK, Germany, Finland, Norway, Sweden, Denmark, and many others, manage to have great health care for their citizenry without putting those citizens in financial jeopardy…and still have robust economies

    I guess even Russia, China, Hungary, etc. … yeah, most countries…

    it is sad that Americans have to pay such high premiums and get so little

    • Many of my fellow USAmericans would rather pay exorbitant fees for health care or do without it than have some of their tax money go to buy health care for people they don’t like.

      It is sad that so many of my fellow USAmericans are stupid enough to cut off their noses to spite their faces. 😛

    • Pilgrim, you are preaching to the choir. I grew up on military medicine, which is pretty much the same thing as socialized medicine, and lived to tell about it. But for some reason, that’s just not good enough for a lot of Americans who seem to believe they have to have an abundance of choices and all the unproven alternative medicine they can eat.
      Yeah, the premium sucks big time.

      • I was born in a US Naval hospital in which my mother said she was treated better than her friends who all had babies around the same time in non-military hospitals. The bill for 4 days, 3 hots and a great delivery and doctor was $12.25. I had navy doctors until the age of 18 and they were dedicated and first rate. They could have made a lot more in civilian life

    • Yup, Single Payer or the Public Option HR676 is the way to go. I am paying through the roof and today a friend told me she was required to pay $300. per day for her hospital stay and her deductible of a couple thousand…she voted for Obama the first time, but not the second time and was just informed her premiums are going up by 42% in July. OUCH!

  4. I agree a single payer system was the only sane option.

    I could well be wrong on this, but my understanding is that even before the current prohibition on not offering any coverage (at steep prices) to people with pre-existing conditions, insurance companies were prohibited from tagging someone’s condition as pre-existing, if the person was covered by health insurance elsewhere. In other words, when one is switching providers, it is not pre-existing. When one is trying to get insurance after having no insurance, it is considered “pre-existing.”
    I did some searches and found this about the 1996 HIPPA LAw:

    “An important feature of HIPAA is known as “creditable coverage.”
    Creditable coverage is health insurance coverage you had before you enrolled in your new health plan, as long as it was not interrupted by a period of 63 or more days. The amount of time you had “creditable” health insurance coverage can be used to offset a pre-existing condition exclusion period in your new health plan.

    “The bottom line: If you had at least a full year of health coverage at your previous job and you enrolled in your new health plan without a break of 63 days or more, your new health plan cannot subject you to the pre-existing condition exclusion.

    http://healthinsurance.about.com/od/healthinsurancebasics/a/preexisting_conditions_overview.htm

    (Good wishes for her continued improvement.)

    djmm

    • There was no break in coverage. We were not without coverage for even one day. As I understand it, we could not be turned down for coverage for a pre-existing condition but there is nothing forbidding the new insurance carrier from charging more because of a pre-existing condition. That is what happened in our case. The new insurance carrier told me that they were able to charge up to double the premium. That suggests to me that there is a limit to the amount they can charge. It’s still a ridiculous amount of money.
      So, to recap, we did everything we were supposed to do and had no break in coverage but got slammed on the cost because of the pre-existing condition. What I found shocking was that they doubled MY share of the premium even though I had no pre-existing condition. That apparently is legal.

  5. I visited a chiropractor for years due to work related injuries. The cost was covered totally by Workers’ Comp. I’ve retired and my spine has deteriorated so I’ve been going to an orthopedist who recommended physical therapy. I paid the same for physical therapy than I would for chiropractic and the PT’s did exactly what the chiropractor did except for the adjustments which relieved my pain and allowed me to work for more than ten years without the pain medication that would have made it impossible for me to work.

    Some chiropractors are too far out for me but I’ve had MD’s who were worthless, too. The naturalist MD that I saw was practically a witch but she did understand that I should take Vitamin D through my skin because I wasn’t processing oral Vitamin D. Her no grain diet was very hard to stick to but I had no gut problems for the three months that I followed the diet. No MD ever spoke to me about my diet until I had that experience.

    So, the quackery isn’t all in the alternative group. The pill pushers have their incompetents as well.

    • There’s always one.
      There is no study that has shown greater benefits with a chiropractor than a physical therapist and the only area where chiropractors are as good as PTs is lower back pain. If you are benefitting from a chiropractor, it could be a placebo effect. You *want* to believe so you feel better. But the data doesn’t bear you out.
      So, why should I help YOU pay for a chiropractor when I am really paying for your right to believe something that isn’t true. For all I know, your “alignments” are just going to lead to more serious problems down the road.
      Same goes for acupuncturists. You can actually hurt yourself by going to an acupuncturist. Meanwhile, I have to pay through the nose for legitimate, proven healthcare for my kid. The money that goes to your back cracking could be paying for my kid’s specialist and you could be seeing a PT.
      In other words, can you legitimately say that your chiropractic back cracking rises to the level of my kid’s specialist? and if it doesn’t, why are my premium payments supporting that? Shouldn’t we be pooling our resources to pay for things that have the most effective rate of return?
      Let’s put it up for a vote. Which should we pay for? A chiropractor or a cardiologist? An acupuncturist or a urologist? Maybe we shouldn’t be rationing health dollars like this but that’s what we’re forced to do and I would argue, and I think MOST people would argue, that your chiropractor does not rise to the same level of importance as a neurologist.

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