Hunting for Health Insurance
Published on - April 30th, 2012 (Modified on - May 1st, 2012) (by J.D. Roth) I am sick. For the past ten days, I’ve been wrestling with a high fever, a cough, a persistent sore throat, and a general malaise that’s kicking my ass. Basically, I’m the sickest I’ve been in over a decade. (The last time I was this sick? The evening that The Fellowship of the Ring premiered. I went to see it with friends, but don’t remember a thing about that night because I was sick with a high fever. High fevers suck!)
Normally, I don’t go to the doctor. My family has a funny thing about doctors, and usually prefer to let an illness run its course rather than to pay a doctor to tell us to “let the illness run its course”. Last Tuesday, though, I decided that sometimes discretion is the better part of valor. After four days with a high fever, and after sensing that something wasn’t quite right with my lungs, I drove myself to urgent care.
“You have the flu,” the nurse practitioner told me. “And it’d be even worse if you hadn’t had your flu shot. As it is, you may have pneumonia. It’s been going around.”
She prescribed an inhaler, steroids, and an antibiotic, but she seemed skeptical that they’d help. “Make sure you call us if things don’t improve,” she said. “In the meantime, you need to spend 72 hours in quarantine. You don’t want to give this to anyone else, and you don’t want to catch anything else that might be going around.”
So, for three days last week, I confined myself to my apartment.
Hunting for Health Insurance
But this article isn’t about how sick I’ve been. This article is about my quest for health insurance. Earlier this year, I promised to share my experience as I looked for an individual policy.
As background, I’ve always had insurance through Kris. Because we were married, my insurance was covered by the policy she had through her employer. And before that — long before that — I was on my parents’ health insurance. For 43 years, health insurance has been a non-issue for me.
That changed, though, when I asked for a divorce last autumn. I knew that I’d have to find my own coverage. In fact, Kris wouldn’t allow the papers to be filed until I could demonstrate I had replacement coverage.
“No problem,” I thought. “How hard can it be to find health insurance? I’m the healthiest I’ve been in my life!” Haha. Turns out, it’s not as easy as it sounds.
A Wild Goose Chase
My first stop was eHealthInsurance.com. Many people (including several GRS readers) had recommended this site as a great way to compare health insurance and to apply online without much hassle. It sounded perfect. Before Kris and I left for our trip to South America in February, I filled out an application. It seemed simple, and I had no doubt I’d be approved.
I wasn’t.
Some of my options at eHealthInsurance
While we were in Argentina, I got an e-mail that said my application for health insurance had been rejected, but didn’t offer any explanation. When I got home, there was a letter waiting for me in the mail that gave more detail. Turns out, I had a pre-existing condition that caused my application to be rejected. Five years ago, when I was fifty pounds heavier, I suffered from sleep apnea. Sleep apnea is a risk factor for other diseases, and insurers don’t like it. Never mind that I no longer have sleep apnea, that I’m fifty pounds lighter than when I had it, and that my health has never been better. There’s no way to convey that info on an application. Instead, I was turned down for health insurance.
Fine.
I went back to eHealthInsurance.com to apply for a different policy, but there’s a question on every application: “Has any other carrier turned you down for health insurance during the past 90 days?” It turns out that once one carrier turns you down, all carriers will turn you down. (This isn’t strictly true, but it’s mostly true.)
Fine.
I decided that my best bet was to just just continue receiving coverage through my same carrier. My logic was impeccable: I’d been with them for years already and they knew my medical history, so surely it would be a piece of cake to carry things forward. Again, this didn’t turn out to be true.
I called my carrier to ask about porting my policy from Kris’ work account to individual insurance. “We can’t do that,” they told me. “You have to call the employer that has the policy.” So I did. But Kris’ employer told me they couldn’t port it forward either. “Your only option is COBRA,” they told me. (COBRA is ongoing medical insurance available when your existing policy ends. It’s expensive.)
I’m telling this story in a calm, even-handed fashion, but I wasn’t feeling calm and even-handed during the process. I was feeling frustrated. I couldn’t figure out where to turn.
Finally, I started talking about my health insurance dilemma with everyone I met. I asked my self-employed friends what they do for health insurance. (Shocking but true answer: Most of them don’t have health insurance. No joke.) When I met other folks who’ve been through a divorce, I asked how they handled the health insurance question.
In the end, it was my colleague Mark Silver from Heart of Business who provided the answer. “I used an insurance broker to find health insurance,” he told me. “Here. I’ll give you his contact info.”
Taking Matters Into My Own Hands
Because I hate e-mail conversations and because I hate getting the run-around by phone, I tend to prefer face-to-face business transactions. Yes, they take more time, but I find them easier. It’s possible to discuss shades of grey and to explore multiple possibilities in person. For this reason, I drove across Portland to visit Ron Tate at Tate Insurance Services. I explained my situation.
“I need health insurance,” I said. “But I only want catastrophic insurance. I’m willing to self-insure almost everything.” Because I have substantial savings, I’m willing to pay more for routine coverage if that means my monthly insurance premiums are low. In the long-term, this should save me tons of money.
“No problem,” Mr. Tate told me. “We have several options.” He walked me through them. I chose the option that seemed to offer the best balance of cost and coverage, filled out the application. And waited. And waited. And waited.
After a week of waiting, I got word that my application had been rejected. Again. And again because of sleep apnea. “We have a couple of options,” Mr. Tate told me. “Because you’ve been rejected, you qualify for the Oregon Medical Insurance Pool, which is for high-risk customers like you. It’s nto cheap though. Or you can apply elsewhere. Or we can ask for an exclusion for the sleep apnea. That means you won’t have coverage for that condition, but everything else will be normal.”
“To be honest,” I said, “I just want to get this finished. I feel like I’ve been working on this for weeks, and I’m tired of it. It shouldn’t be this hard to get health insurance.”
My plan options at my insurance provider
In fact, I was so frustrated that I went home from Mr. Tate’s office and took matters into my own hands. I did what I should have done from the start. I went to the website for my current carrier and filled out an application for personal health insurance. I chose the cheapest policy (which still costs $128 a month!) and indicated I was a current customer. And then I waited. Within a couple of days, I’d heard back that my application was approved.
An Unhealthy System
That’s a long, boring story, I know, but I’m certain it’s typical of what everyone goes through when attempting to find health insurance on their own. It’s not easy. In fact, it seems a little crazy that it takes that much work to get coverage.
During the process, I spoke with dozens of people about their own experience getting insurance, or about their experience with family members who’ve had to use health insurance lately. I’ll be honest: I came away jaded. I’m far from being a socialist, but there’s no question in my mind that the current health insurance system in the U.S. is broken. It’s tough to find coverage, that coverage is expensive, and once you have it, it’s like a game for the insurance companies to get out of paying. This is dumb. I’d be happy to try some sort of socialized medicine as an alternative, and so would every single person I spoke to during this process. (But, of course, I live in Portland where even moderates like me would be considered liberal in other parts of the country.)
And, of course, the conclusion of this story is that I had to put my insurance to use last week. I have no idea how much my doctor’s appointment, x-ray, and prescriptions would have cost without insurance (and neither do the doctors, actually), but I do know that my total out-of-pocket cost was $29.26. (This may go up after the insurance company decides whether I owe more, but that’s the current total.)
I’m still not healthy. There’s still gunk in my lungs. I’m still running a mild fever. I still feel like sleeping all day. But it’s good to know that if I do need medical help, I have the insurance situation sorted out.
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This and many millions of similar stories are exactly why we need socialized medicine.
My husband turned down an exciting job opportunity because they didn’t offer health insurance and I have a thyroid disorder and none of the self-insure policies cover maternity care.
My Dad lost his job of 31 years when he was 50 years old. No pension, and not old enough for social security. My Mom still works at the same place but experiences frequent layoffs. Each time she gets laid off, they lose health coverage. They both have conditions requiring medical care and medications to manage the conditions.
They can and do work… my Dad takes on call jobs now and my Mom works overtime when she’s not laid off. These aren’t lazy, no good, handout grabbing bums. They’re hard working Americans who need to stay healthy to remain productive.
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It’s embarrassing that the U.S. has such a substandard healthcare system despite being the richest nation in the history of world. Health-related costs are the biggest cause of personal bankruptcy, and for those of us who are self-employed or with other non-traditional employment situations, getting health insurance is frustrating and expensive.
After I started my business–before my wife’s COBRA coverage ended–we looked at health plans and were turned down due to my wife’s pre-existing condition (2 hip replacements). We ended up going through an insurance broker to set up our current health plan, which is actually part of a state-sponsored program created by the state legislature specifically for small businesses. Without it, we’d likely be paying much more than we already do, and would likely have very reduced coverage.
If you’re self-employed and have an s-corp or LLC, to reduce costs, you can pay healthcare premiums as an employee benefit (depending on the structure of your business). I own a small consulting company, and my s-corp pays 100% of my health insurance premiums (I’m the sole employee)–which is essentially like saying that I pay my health insurance with pre-tax dollars,
For myself, my wife, and our 2 kids, I pay $1,200.00 per month; that’s over $14,000.00 per year, and that all gets paid as an employee benefit, which essentially means that those healthcare premiums are paid using pre-tax dollars. Not cheap, but it’s necessary.
Greg Miliates
StartMyConsultingBusiness dot com
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Even with employer-sponsored health plans, most people don’t realize how frequently they are getting ripped off by paying for stuff out-of-pocket when it should be covered by their insurance (and is covered if you read the fine print!). Every year I get hundreds of dollars (sometimes thousands) in refunds from either the doctors or my health insurance company because I find errors in the way they process their claims, and follow-up with them until they write me a check. It takes a lot of haggling and a lot of follow-up (and sometimes appeals), but it’s literally thousands of dollars over time.
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Sounds like a reader story nominee!!
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Agreed! Share some details!
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I would love to learn more about how you did this. How did you even think to do this?
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Matt — I am the odd type of person that likes to calculate things. I like to guess what hospital bills and insurance claims are going to be before they arrive, and how they are going to be calculated. When most people see a medical bill or an explanation of benefits, all they see is gibberish, but I see it as a puzzle, and I try to figure out if they actually followed the right math to get to the final amount. Let’s say you get an annual physical and the total charge is $300, the allowed amount is $200, and insurer is supposed to pay 90%, and your portion is 10%. Sometimes what I see is they say I owe $30, because that’s 10%. But in reality, what I should owe is $20, because I am only supposed to pay 10% of the allowed amount ($200), not the original amount ($300). Of course, if the bill is much larger, or the calculation error is repeated over a number of claims, the numbers can really add up. That’s just one example. I could literally write a book of all these little math errors I find on a day-to-day basis that I get refunded for (they are everywhere). Once I got the bill at a restaurant, and figured out that they had charged me 20% sales tax ($8 on a $40 meal). If you don’t do the calculation in your head, you don’t realize you are paying several dollars more than you should be. When I asked the server about the error, he assured me that there was no error and that was the appropriate sales tax. When I asked him to do the math for me, he got flustered, and came back a few minutes later with a corrected bill. Most of the time, I don’t know if it’s human error, computer error, or a combination of the two, but these errors are more common than you think. But I always wonder how many people at that restaurant paid 20% sales tax simply because they pay bills without thinking about all aspects of the bill. I think a lot of people check bills to make sure it corresponds to what they ordered, but never look at to see if the sales tax is properly calculated (or even if the prices on the menu are the same as those on the receipt).
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You sound anal, meticulous, and cheap…which is awesome! You should write about your experiences doing these types of things. I think some would argue that it’s not worth the time/effort, but, for me, being anal and cheap as well, I would actually enjoy the process.
Off topic: my cell phone company (AT&T) charged me $15 today because I used too much data (not sure how, my phone is so slow that I can’t do much with it at all). I called, and they gave me $25 back. I made $10!
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It is probably not “worth it” on a lot of small ticket items, but once you develop the skill set, you can use it on larger ticket items and it saves a lot. Last year, I determined that my healthcare deductible was being calculated incorrectly (they were forgetting to include certain items), and once the error was fixed it ended up saving me more than $1,000. When I first spotted the error, I thought there was no way it could add up, but when I put it in my Excel document it was an astonishing amount. Just like the power of compound interest, the power of addition is not to be underestimated.
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Welcome to the world of the self insured. My entire family of four was denied coverage due to pre-existing conditions: husband has sleep apnea also, I had cancer 7 yrs ago, daughter had knee injuries (that’s right, no coverage for her), and my son had occupational therapy for handwriting issues.
We had to join a high risk pool here in Illinois which costs us $2,000 a month!
We cannot get ahead due to this. We cannot, from the big picture perspective, purchase things (new car, do large home repairs, etc.), that would help get the U.S. economy back on track. Very frustrating!
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I think if I were in your situation, and already lived that close to Canada, I might just try to migrate there and get citizenship.
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Health insurance was THE reason that we emigrated when we did–I lost my job while I was pregnant and couldn’t afford 1500/month for COBRA. The move paid for itself within less than six months.
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I don’t want to sound cranky, but it drives me a bit crazy when people say they might try to emigrate to Canada. I’m a Canadian living in the US for the last 6 years; I was recruited for a senior academic position. When George Bush was re-elected in 2004, many unhappy liberals swore they were going to move to Canada – as though it was legal/easy/possible to do so. I am not saying you think this, but I just want to tell people that moving to Canada is almost certain to be IMPOSSIBLE for 99% of people who look into it. In fact, right now, Canada’s federal government is about to pass legislation purging the waiting lists of about 300,000 people who have been waiting over 4 years to get in! There are only a few ways to get in to Canada. I answer this question all the time. First, be in a field that is in high demand in Canada, or be recruited specifically for a position. This is not easy. You may get hired for medical or super-specialized technical or academic positions, but there aren’t many, and Canadian law requires them to consider Canadians and landed immigrants (like a green card) first. Second, marry a Canadian. Third, be a refugee from war or persecution of some kind. Or fourth, be rich enough to promise to invest and create a company and jobs that will employ a certain number of Camadians. That’s it, period. If you are an ordinary person, without one of these options, your chances of getting in are approximately zero. It is much harder to immigrate to Canada than the US. Canada is a small country, population-wise, and they have plenty of unemployment problems of their own – people are stuck in jobs, once they find them, for ages, because there is no place to move up to. The journalists writing for the major national papers there, for example, are the same ones who have been there since I was a kid, with the sole exception of a couple who are the kids of some of those journalists! There is no mobility, no chance to get in. One reason I was willing to leave is that the opportunities here are much greater. Now, given the health insurance situation here, I would not have come here if I had not been in academe, where health insurance for full timers is the norm. I like it here very much, but I think the health insurance situation is a disgrace. That’s the one huge flaw. It is utter nonsense to say the US cannot afford to care for it’s citizens. The US is the ONLY country in the Western world that does not provide health care for it’s citizens, yet it is the wealthiest country in the world.
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Its hard to believe this sort of thing is possible in a civilised, rich country. I can’t get over all your problems were to do with sleep apnoea (that you don’t even have any more!).
It makes me so mad when I see some american media spreading outrageous lies about european healthcare, whilst stories like this (and much worse!) are taken for granted really. How do people with chronic conditions (if they’ve had it since childhood, for example) live? How do doctors operating in this atmosphere square it with their Hippocratic oath? Seems like sheer madness to me.
Also, it seems like a rather anti-enterprise approach, if starting your business/being self-employed means that you could be uninsurable (as you say that many of your friends are) – which seems to go against the american ideal.
Anyway, I’m glad you have insurance now.
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Sian, to bring some perspective, I think most Europeans would agree that something like this cannot happen in a civilized country. While the approaches do differ, most European countries have at least some kind of mandatory coverage. For some reason, this also seems to keep costs lower, although many countries are struggling with increased costs as the population grows older.
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A lot of people see it as greed on the doctor’s part but I see it differently. I work in a chiropractic office as an office manager and handle the insurance aspect of billing. Some plans like Providence, Kaiser, and Health Net pay ridiculously small amounts of compensation for a visit. A person’s copay could be $20 and the insurance plan would only pay $20, even if the doctor spends 45 minutes or an hour on the patient. Not all insurance plans pay this poorly but it’s common. This $40 for the hour goes towards paying his paycheck, my paycheck, medical malpractice insurance, utilities and rent, school loans, and self-employed business taxes (which are quite high in our county). I absolutely agree that this system is broken, but disagree with the idea that all doctors are greedy. I can’t speak to all doctors’ ethics but none of the few I’ve known have been out to rob patients. I think it’s more of a problem with insurance companies in the US being for-profit entities and people forgetting that part of how European countries pay for universal healthcare is with higher taxes.
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Kris, I remember once reading an article about how the U.S. could never improve its healthcare system without changing EVERYTHING from the ground up, and one of the reasons that stuck out to me was that in Sweden, for example, doctors earn less, but it’s because the government pays for college and medical school. So our doctors come out of school with $500,000+ in student loans, and theirs have none. Therefore, they can earn less because they have no debt.
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The European systems aren’t subsidized by higher taxes. On the contrary, health care costs overall in Europe are much cheaper; there’s no need for such a subsidy. France, for example, pays only 6 percent of GDP on health care, compared to 19 percent for the United States. The high taxes go to other things, such as unemployment insurance retirement and bullet trains etc.
The doctors in France are much more frugal, and answer their own phones and do their own paperwork, but the problem isn’t with the American doctors; it’s the entire system.
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Interesting! I think Canada’s spend is 10-11%. I’ve sometimes wondered if our costs would be lowered if we weren’t so spread out (geographically, I mean). Would it be easier and cheaper to provide services if population density wasn’t so diverse?
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Highly, highly recommend Ezra Klein’s assessment of the Kaiser Family Foundation’s graphical depiction of this issue – http://www.washingtonpost.com/blogs/ezra-klein/post/the-three-most-important-health-care-graphs-in-the-world/2011/04/13/AFtU1E6E_blog.html
It demonstrates beautifully that, in comparison with the rest of the world, any benefit we get from lower taxes in the US is completely wiped out when you factor in private spending on healthcare.
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Maybe this is the reason US healthcare is expensive, government is spending too much on it. This drives prices up.
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The US isn’t rich. We owe ~$16 trillion.
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The line about debt made me laugh. This is a PF blog, after all — would we consider anyone to be “rich” if they were up to their eyeballs in debt and their spending is out of control?
Incidentally, Qatar is the richest country per capita (and when you’re talking about costs, you’re talking per capita). The U.S. is still fairly impressive at #7.
http://www.forbes.com/pictures/egim45egde/1-qatar/#gallerycontent
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Hi J.D.,
Thanks for the post; I’ll be going through a similar situation soon, and it’s helpful to hear about what your experience has been like.
I don’t mean to start a political discussion, but did anyone you talked to mention whether it would still be legal, in the future, for insurers to refuse to insure you for what they decide is a “pre-existing condition”?
Tom
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In 2014, when the next phase of the Health Care Reform Act (“ObamaCare”) goes live, it will become illegal to discriminate(aka Deny) based on pre-existing conditions. Insurers will still be able to to price your policy higher though, but “in theory” this will have to be done in the increased competitive/transparency situation of the reform act’s “marketplace”. (Assuming these parts of the language survive the Supreme Court decision expected in October…)
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But if they can price it as high as they want… then they can effectively continue to deny coverage for pre-existing conditions.
Just as every company can deny coverage today because all the other companies are doing it, they’ll all be able to get away with high prices because their competitors will be charging them, too.
Right?
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From an Australian perspective, the whole story just sounds absolutely crazy. I pay a little less than what you do, but it’s top end insurance. Besides that, there’s the national health care system (Medicare), which covers up to 100% of GP costs (depending on where you go) and 100% of treatment (including emergencies) at public hospitals. I cannot imagine what you’ve been going through finding insurance and I’m so happy for you that it seems to have worked out in the end.
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I live in Australia, one of those ‘socialist’ countries with ‘socialized medicine’. When I go to the doctor, I pay an out-of-pocket expense (around A$30), and the government pays the rest. BUT, it caps what it will pay to doctors, and there are plenty of doctors out there who don’t charge much (if any) more than the government contribution.
When I need medicine, I go to the pharmacist with a prescription. I know I am not going to get gouged, because my government has already negotiated with all of the multinational companies who want to supply drugs into Australia, to do so at a fixed price. I pay about A$24, the government pays the bit is has negotiated, and I don’t have to worry about my child dying from pneumonia, or me losing my house.
If I get injured, I go to hospital, and I don’t see a bill.
If I play sport, and I wreck my knee, it isn’t life threatening. If I want to pay nothing, I can wait on a waiting list to be seen in a public hospital, where it will get fixed at no cost to me. But it can take a while. So lots of Australians have ‘private health insurance’, to insure against possible future surgical needs that are non-life threatening.
BUT. This is not tied to my employment, it is something that I buy privately. However, the government encourages me to buy it by subsidising the price, and penalising those who don’t want to pay it with an extra income tax of 1.5%. And all policies are ‘community rated’, meaning the cost doesn’t rise based on my individual risk factors. I just choose the level of cover I want and pay the fee. More people in the system means cheaper prices for all.
I honestly look at the US system and am amazed. You are a smart country. But you bankrupt people for getting sick or hurt. Whose idea was it ever to tie your health system to your employment? Surely no-one looks back now and says ‘Gee, wasn’t that a great idea. Both increasing costs for employers, and reducing employee mobility. Good job us!’. You spend more on health care than just about any country on the planet, but don’t have substantially better health outcomes for it.
But you have the ‘freedom’ from socialized medicine. Better cherish it; it’s costing you a fortune.
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My understanding is that employer-sponsored healthcare is an accident of history. During WWII I believe it was, employers struggled to find and keep employees. The government limited employers’ ability to raise wages, but they could offer health insurance to their employees. That, coupled with tax advantages for employers providing coverage, gave us our wacked-out, messed up system we have today.
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One of the main reasons that I am working while my husband is the one to stay home with our baby is because I have health insurance through my job (the other reason is that I love my career). He has type 1 diabetes, and therefore, he will never be able to get health insurance under anything except a group policy through and employer.
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You are lucky that policies that cheap are even available. In Massachusetts, individual policies start in the $400s.
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No, the individual policy I purchased through the Connector cost $215 a month, and it was a pretty decent plan as well, comparable to the one I now have through my job.
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Try New York City– for a self-employed person a comprehensive individual policy starts at well over $1000 per month.
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Yeah, I’m astonished that he found a plan for $128.
When I lost my job in NYC, all of the private plans were $600+ per month, iirc. I was lucky that, after days of research, I found out about Healthy NY, a city (state?) insurance plan for low-income folks who don’t qualify for medicaid.
My high-deductible emergency plan cost me around $200 a month.
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Thanks for the post. Overall, I think you have done pretty well in terms of total costs. I’m self-employed with a wife and young daughter, and our total monthly payment is $600, for a policy with a family deductible of $15,000. The only stuff that is covered in full is basic preventative care, well-child visits, immunizations, etc. We combine it with an HSA, but the fact of the matter still remains that we can be liable for up to $22,000 before any insurance assistance kicks in. It’s astounding — and this is the cheapest plan I can find in my state, which I found after an ordeal probably more frustrating than yours
.
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Sadly typical story. But you’re lucky that you ended up with insurance! Some states it is even harder once you’ve been rejected, especially when the high-risk pools are incredibly expensive.
A good portion of the uninsured are actually relatively high earners.
The phenomenon folks are talking about in the comments where they cannot leave or change jobs because they need to keep their health insurance is called “job-lock.”
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We are unable to retire, which we could otherwise afford due to the need for health care. I work with people with disabilities and it is truly shocking to see hard working folks loose everything when they get sick. I’ve also seen people whose medical conditions have been made much worse when they felt they could not afford to seek treatment.
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“I have no idea how much my doctor’s appointment, x-ray, and prescriptions would have cost without insurance (and neither do the doctors, actually), but I do know that my total out-of-pocket cost was $29.26. (This may go up after the insurance company decides whether I owe more, but that’s the current total.)”
To me, beyond actually ACQUIRING insurance, is the number one problem with Health insurance in America.
When my wife was pregnant, we called up our insurance to find out what a birth would cost. We were even able to tell them what doctor and hospital we were using. They couldn’t tell us without codes
At the Hospital, they have you sign a waiver to agree to pay all the charges associated with your visit, but there isn’t a single nurse, doctor, or staff employee able to tell what anything associated with your visit will cost.
It infuriates me to no end, because I worked in a pharmacy, where you do get (relatively) instantaneous pricing. Even my vet and dentist can quote prices for procedures off the top of their heads!
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This is my pet peeve as well. Insurance company’s are often unable to tell you IF something is covered until after the procedure has taken place.
Even if a doctor can quote you an “out-of-pocket” price, there’s still the hospital fee, anesthesia fee, 40 other random add on charges. I wish you could order health care procedures like I do a take out order.
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My husband got a prescribed some medication and he had the audacity to ask the doc what it costs…
She honestly seemed offended by the suggestion that she should know this information – then proceeded to say – if you have health insurance it’s cheap
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Agreed, agreed! Last year I got a wisdom tooth removed and the dentist quoted me an exact price off the top of his head. I paid cash. This year I am getting a root canal retreat (yay! the fun!) and I know exactly how much it will cost me, so I can call around and price-compare, budget, and pay out of my own pocket– no need for 3rd-party meddling.
Our system is really dysfunctional in many ways. It really is not cost-effective. Doctors are under pressure to order a battery of unnecessary tests (billed to the insurance) in order to ward off predatory malpractice lawsuits– and you should look at the cost of malpractice insurance! Things are really out of hand. The whole system is on crack.
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My apologies if this comes off as a rant. I think that you, like too many people, were too complacent about this issue, which is surprising considering how much health care reform has been on the news since our current president was elected. There are 40 million uninsured people in this country but since that wasn’t your problem, you thought it would be easy and now you are finding out that it isn’t. Whatever legitimate criticism anybody can have about the Affordable Care Act, I’m appalled by how much vilification the president has had to put up with, as imperfect as it might be, AT LEAST HE TRIED TO DO SOMETHING ABOUT IT. I remember the last time anybody tried to do something about it was back with Hillary, she got shut down and things have gotten worse since then. I happen to be a physician and even back in the 1990s I knew we needed reform. I personally was denied health insurance due to pre-existing conditions back then and I’m a physician, and as a physician, I’ve seen how the insurance status of the person dictates the care the person receives. So person A could get the best care with the best medications or latest procedures, Person B would have to put up with suboptimal care because of no insurance or crappy insurance. But when somebody tries to do something about it, he gets accused of being Communist Fascist Hitler whatever. What alternatives the other side have proposed? Repeal the ACA and ??? I’ve only heard about expanding the market beyond state lines, but I don’t see how that’s going to prevent the pre-exisiting insurance exclusion. If there is a solution that would address these problems, I would embrace it, regardless of which side originates it.
OK, enough for my rant, a couple of possibilities:
Have you checked the PCIP program? (also part of the ACA, it is for people with preexisting conditions, check out http://www.healthcare.gov/). The catch is that you have to have been denied for preexisting conditions and be uninsured for 6 months to qualify. AND our Supreme Court could decide that it is unconstitutional and throw out the whole thing which would do you no good (but the Constitution would be safe, the 40 million uninsured be damned).
Would you be able to get group health insurance through your business? If you have a business and have employees, perhaps you could offer insurance to your employees and qualify for a group rate.
Could part of the divorce settlement stipulate that she can keep you on the insurance? Does your state law allow this?
Too bad you are not over 50 yet, as I was able to find coverage as an AARP member at a group rate. It has a high deductible but it’s better than nothing. Perhaps you could find an association, trade group or something you might be able to qualify for.
You might be interested in the single payer movement (I’m OK with not having single payer if the private insurance company stepped up to the plate and do the right thing), check out http://pnhp.org/ or similar groups. There is a book written a while back (I think in the early 2000s, before Obama was even in the picture) by the title “Uninsured in America” where it chronicles different scenarios from real people that are in dire circumstances. It tends to favor single payer but again, I would support a private solution if the private sector would actually put up a workable proposal.
I think we, as a country, COULD do better but that will only happen if we get past our current partisan/ideological divide, sadly, I’m pessimistic that this would happen any time soon. I don’t see that we have enough political will in this country to solve our problems because we are so focused on defeating the other side.
My apologies again for my rant, I don’t mean to offend anybody with different views, I would rather work together trying to solve the problem.
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Informative post, addoc. I very much appreciate the tips and the thumbs up for healthcare reform. We need reform and at least Obama tried to DO something about it.
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I don’t want to make this political either–but– it is– and that’s the sad fact. What I wish everyone realized is that “Obamacare” is a republican idea that never got passed in the 90s. A REPUBLICAN idea! Here’s a quote I just googled to prove it…from the Wall Street Journal:
“The ambition of the 1993 bill introduced by Rhode Island Republican John Chafee was to provide universal coverage, with all Americans required to buy insurance. The bill would have subsidized coverage for those with low incomes. It would have prohibited denial of coverage based on pre-existing conditions. And it would have fined employers who did not offer a qualified health-care plan. Sound familiar?
It was sponsored by 19 Republican senators, including Bob Dole, Pete Domenici, Chuck Grassley, Orrin Hatch, Bob Bennett, Dick Lugar, Alan Simpson and Ted Stephens.
You may not recognize all those names, but you should know this group was the Republican establishment in 1993. And that Republican establishment was far to the left of today’s Republican Party”.
This really should be a dead issue by now. Just get it done already!
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Actually – the idea of universal healthcare originated with NIXON back in 1974. Isn’t that amazing? He wrote a fantastic letter to Congress demanding that they pass universal health care coverage. I make a point of sharing this with people who are against Obamacare for political reasons – as Nixon is truly eloquent on this issue.
http://www.kaiserhealthnews.org/stories/2009/september/03/nixon-proposal.aspx
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Well put, Addoc. I would like to also point out that the people making these decisions, our legislators, have the best health insurance in the country. In addition, many of them could afford good medical treatment even without health insurance. I wonder if some of them would change their minds if they were in the same system as the rest of us?
I have many pre-existing conditions, so I know that I must work if I want to have good coverage at a price I can afford. Thankfully, I live in Massachusetts, where prices are high but I know that even with pre-existing conditions I would receive coverage if I lost my employer-provided insurance.
I do have a question for the country, though: why is socialist medicine such a bad thing? So many people are against it, but I can’t figure out why. People in countries like Australia and Sweden don’t go bankrupt when they get cancer or are in a car accident. Why is this a bad thing?
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US Health “coverage” always makes me laugh. Here in the UK we have the National Health Service. Have done for years.
Yes it might take a while (usually a few weeks) to get referred to specialists after an initial consultation, but at least we are guaranteed to be able to see a doctor as and when there is the need.
If you want to avoid the wait for the specialist stuff then that is where your personal health insurance comes into play.
Isn’t it about time that the US woke up to better health care?
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I’m pretty conservative about most things but health insurance.
I think if you break your arm or get strep throat; it shouldn’t matter if it happened on the job or at home or whether you’re even employed or not. You should be able to get the damn thing taken care of.
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Amen! And preferably without going broke to do it. My (new) husband is substitute teaching because he’s unable to find a job, so I’ve just added him to my insurance.
My cost went from $100/mo for a single plan to $625/mo for a ‘family’ plan – it more than doubled to add one extra person.
But like another commenter, he’s a type 1 diabetic. Not having insurance isn’t an option. Even /with/ insurance we pay quite a bit for prescriptions (no such thing as generic insulin!) and quarterly doctor visits to be sure he’s healthy.
It’s a nightmare. A quarter of my monthly income now goes to health insurance. And when I broke my wrist this past fall? I still paid $600 out of pocket. The only thing they covered were the doctor visits – but not a single procedure or X-Ray.
That’s what I’m paying for.
$625/mo for what amounts to catastrophic insurance, and no good options for changing it.
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I’m glad someone pointed out the “even with insurance” gaps. I wonder if there’s a health care system in the world that covers everything?
In Canada, there’s a lot that universal health care doesn’t cover — so people have group insurance through employers or a private policy to cover some of the gaps. Even with insurance, people here can still pay a fair bit out of pocket.
And if you seen an alternative or complementary medicine practitioner, you’re on your own.
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One more frustration- I’m not sure a ‘family’ plan should cost the same for a family with one or two children as for one with five, or eight, or as a cousin of my husband’s – THIRTEEN. Yes, thirteen children.
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You pay more as a married couple because they assume you’re going to have children and maternity coverage (crazy expensive!) is lumped in with generic health care. Although why they still think that way when something like 40% of all children today are born to unwed parents escapes me.
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Our employer based health insurance is ludicrous. What happens when you get really sick, you lose your job and with that goes your health coverage. My brother died at 43 from an evil cancer and it was appalling to see how the system didn’t work for him.
I could not get my panties in a twist about Obama care because it doesn’t seem to address the fundamental problem…people want healthcare not health insurance. Why are we so opposed to the notion of for-profit schools but have no problem with all of the profit in our health insurance system?
But then again I’m a fellow Portlander so know my opinions may be left of norm…
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I don’t think you have to be liberal at all to think that the current health insurance system is broken. But if you think it’s broken, nor do you automatically have to think Obama’s ruinous solution is a good thing and the only way forward.
By the way, since you’re slim, fit and healthy now, why didn’t you just go with the exclusion for sleep apnea? I would probably have done that.
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Because once one thing is excluded – it permeates everything. What ‘s the point of insurance if the insurer can willy nilly say – oh – that was caused by that thing that’s exluded.
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I don’t understand what you did in the end. You called your current insurer and asked for catastrophic insurance coverage? And got it for only $126 a month? And you’ve had less than $30 in bills so far for doc visit, xray and medication? I want your insurance. I pay out much more in co pays alone for a single medication (non generic).
We have a Flexible Spending Account (FSA), a pre tax health savings account (currently $1350) and most years we use it up for routine matters (Dr visits, prescriptions, eyeglasses, contacts, etc). JD, you should see if you can set it up for yourself.
Until this year when I had knee surgery I didn’t really have to think about medical expenses beyond th FSA and our insurance. Originally I had set up the FSA amount to meet our deductible but never changed the amount as our deductible went up over the years as we hadn’t needed the extra medical$.
An expensive learning experience. We’ve met the deductible, but still responsible for co pays and new bills are still coming in two months later.
I hope you update this post in a few months or a year. Health expenses for most of us are a given at some point. And that you set aside $ in your budget and savings account for both regular and catastrophic expenses. Don’t skip out on preventive care (eyes, teeth) because you don’t have coverage for it!
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I was wondering about the cost of this illness treatment as well with such a low premium for catastrophic coverage. I have a very high deductible plan ($4000 for family coverage – we pay the deductible via our FSA, which includes a $1000 yearly contribution from employer+our pretax contributions) and we pay all the expenses of sick visits (well visits/physicals are covered 100%).
I do get the “negotiated rate” for any visits/services but I’m still responsible for all of it.
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This is happening everywhere and not just in insurance, for example, you see it in the mortgage industry. The devolution of customer services, if you don’t fit the model that the computer can read, denied!
The job-lock of the employer provided model is also another failing of the industry. I think we all wish that we could take steps to adopt a open, free market approach or a socialist approach but we are stuck in this sticky middle ground that is neither. And the travesty is that there is no incentive to change, no drive to really fix the system. The PPACA did nothing to fix the core issues of health care (never mind health insurance) and will only make things worse for us as individuals.
I feel for you JD, I’ve been quite sick with those same conditions and it sucks. I will say after moving from Michigan to Georgia 11 years ago I have not had anything major like that, though the germs the kids bring home from classmates is not fun either!
Get well soon!
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J.D.;
Many years ago, I was in the same dilemma as you. Due to a pre-existing condition, I was turned down for health insurance twice. My state offers Blue Cross/Blue Shield insurance coverage for uninsurable people that cannot be cancelled.
In the previous state I had lived in, I was cancelled from a health insurance plan without explanation. I inquired but never found out why it happened.
So even though my policy is enormously expensive – $854/mo. (it increases about $100/yr.) w/a $2500 dedt.; I am covered well for hospitalization, doctor visits and I get good presciption discounts. I also cannot be cancelled when I need coverage the most.
My monthly medical expenses are high, but in a few short years I’ll be eligible for Medicare (if the system hasn’t changed) and then my expenses will be reduced.
J.D., please consider getting dental coverage as well because that can cost a lot, even for a healthy person.
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It’s cheaper for me to pay for dental treatment myself than to shell out to the insurance and then deal with their copays and denials of coverage.
In my experience, dental is not so expensive unless you get into an accident and need facial reconstruction or something.
Maybe there’s something I don’t know, but I’m getting treatment now and I can afford it out of pocket.
It’s possible to save for dentistry without going broke just like people save for car maintenance or the like. I think being on the hook for dental insurance is costlier in the long run.
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I agree with you if you have normal dental needs.
For those of us who don’t, dental costs can be a nightmare. About 25 years ago, I suffered heavy metal poisoning caused by mercury leaching out of my amalgam fillings, which are composed of over 50% mercury. The old fillings were removed and replaced with a safe material, which broke down in my molars because the early glass ionamers were not strong enough to withstand wear. Within five years, the glass ionamers were replaced with a newer, stonger material. In the past decade, due to normal breakdown, my fillings and crowns have been replaced again.
I easily spent over $100k in my mouth in the past 25 years. I’ve not had dental insurance and perhaps it would have reduced the cost of the services that I required.
Teeth cleaning averages over $100/visit, crowns run over $1000 and using safe materials for fillings cost a lot. If you grind your teeth, a mouth guard or NTI, can be expensive (over $1,000 for my NTI). Two years ago, I got a dental implant ($5,000) + a crown which made for a total of $6,000.
If you have more than one person, in the household, with extra dental needs, it can add up.
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Every dental insurance I’ve had has had a low cap, little more than the sum of the premiums. For instance, currently I face a $1500 cap and $75/month or so premiums. Though I admit, the cap is per person and the premiums cover my whole family. Nevertheless, even $4500 per year is not so much that I would be risking financial ruin if I chose to self insure.
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I have to say I’m grateful to have socialised medicine. Not that I think the NHS is perfect (it isn’t), but I know that my brother wouldn’t have survived without it, nor would my parents have had care for most of their medical problems.
When my brother (who was severely disabled, and miraculously lived to the age of 29) was young, my father was offered private medical insurance through his work. He applied for a family policy, only to discover that it would effectively only cover me. My brother was completely excluded because of his conditions, and the insurance would exclude any conditions in the rest of the family which they could put down to him. Which meant anything that can be caused by stress, any joint problems (blamed on lifting) etc. Doesn’t leave a lot.
I couldn’t get insurance for myself now. I struggle even to get travel insurance because of the drugs I take to control my asthma (even though, by taking them, I have it under such good control that I have hardly any attacks).
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The tone of this response is not angry or vindictive, but of someone who wants to help.
I am a broker for several companies in my state and understand your frustation. I help clients make their way through this every day. However, there are several things wrong with the current system and the new reform laws are not going to make it better, in my opinion it will be worse. As someone else stated above, as long as the two individuals (dr + patient) have no idea what it costs for procedures/tests, these problems will continue. When the doctor runs an MRI and the patient pays a $15 copay; then the medical practice charges the insurance carrier $1200, there is something wrong. That is why premiums are high. The two making the decision have no “skin” in the game.
This does not reflect the above conversation, but Americans also have to take more responsibility for their health. When a high percentage of our population is obese, there is a problem. I had a bad physical a couple years ago and completely changed my eating and exercise habits. Lost 20 lbs of fat and added about 15 of muscle back (crossfit). I am in much better shape. My doctor said I was one of the 5% in his practice that takes his advice to live healthier. So 95% of his patients ask for meds and then continue on with their current lifestyle.
I want people to understand that these companies want to provide a service and make a small profit (usually 3-4%), it’s just how they have to operate in the current environment. When the pool of people you insure continues to make more and more unhealthy decisions, costs will go up. I have conversations with people who tell me they take 3-4 meds and are healthy. No, that’s not really the case. You only feel good because of those 3-4 meds. Those meds should not also give you the “right” to eat at McD’s 6 times per week. The meds should be a warning to you to change your lifestyle. I know some conditions are not reversible, but the problems that come from long term obesity can be avoided if people don’t become obese. Again, I wanted to state what I see from the other side.
Advice to those looking for health insurance? Work with a broker who represents several companies in your state. I don’t recommned these online sites because you often get someone who’s only goal is to make that sale. Or worse yet, you simply choose the cheapest plan. My experience is people really don’t understand the ins and outs of health insurance thus make poor decisions. Brokers are paid by the insurance company, so there is no cost and the cost should be the same as these online services. Use the experience of a broker. They want to find a plan that fits your budget so they can keep you as a long term client. I get calls from people who have used these online services to get “cheap” insurance only to find out it’s “cheap” insurance when they really need it. I hope this helps everyone understand both sides. I wish everyone the best of luck.
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Rusty, thanks for the note but we need to clear the air on a few issues. The president’s plan is the same one the Republican party promoted for nearly two decades, it was originally sponsored by Republican Senator John Chafee and had broad support within the party and with right wing media. It was the basis for Massachusetts health care reform under Romney we can only guess at why the party suddenly changed its tune when President Obama supported this approach.
Also note that health insurance companies in the US may only make 3%-4% but this is a huge amount given that insurance is supposed to be a pass through. These are funds that are not going to heath care expenses. Further, US insurance companies charge overhead of 20% to 30% – many times what non profit insurance companies charge in Europe.
Finally, all available economic research indicates that the demand for healthcare in inelastic, a fancy economic term for, “When the life of a loved one is at stake, you will pay anything.” In a free market system, no health insurance company would ever freely insure someone with a preexisting condition. Life insurance and Long Term care insurance have similar risk profiles to health insurance but try to buy life insurance for a father with a heart condition, mother with breast cancer or child with Down’s syndrome. In short, private free market health insurance is a classic example of market failure. Working with a broker will do nothing to fix the underlying issue which is that no self respecting health insurer will willing cover someone with a preexisting condition. The current system appears to be nothing more than for profit eugenics.
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Rusty:
What if that 20 lbs of extra weight noted in your physical a few years ago, and an offhand comment from you that you snore a little more than you used to and you’re not feeling fully rested? That may have prompted your doctor to tag your record with the DRG for sleep apnea. Your doctor’s diagnosis is not something you can negotiate, and once part of your medical record, it’s impossible to remove. Even if you fix the problem.
And what about the essential tenet of insurance, the “rule of large numbers”, e.g., spread risk across a large pool of individuals? The insurance companies actively seek ways of dividing the pool into puddles, separating the low risk from the high risk by any means necessary, then refusing to participate (or effectively doing so with the premium rates offered) in the high risk puddle.
The only reason I like universal healthcare is to cut down the squabbling.
Insurance regulation controlled at the state level makes it easier to divide and conquer initiatives of any sort, and maximize the overhead (ultimately charged to the consumer) by requiring 50 state-specific specialists instead of 1 on all sides of the equation (corporate interest, lobbyists, law-makers, social health advocates, etc.).
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I am mostly against Obamacare, but I do like the provision that will go into effect in 2014, i.e. the fact that pre-existing conditions will no longer be used to deny coverage.
My wife is a Type I diabetic like some of the other folks referenced above. We met on the internet in 2000. I was in the Air Force, stationed in the UK, and she was a Canadian citizen. When I transfered to Tucson, AZ, in 2001, she moved in with me there. She has a complication with her diabetes wherein she cannot always tell when her blood sugar is getting low. Most diabetics can sense when this is happening and they know they have to eat something. When the blood glucose level gets very low, the body starts shutting down, including the brain. I was calling 911 about once a month to get the paramedics to bring her out of her lows.
Since we were not getting charged for the paramedics, it was something we could live with for a time. In the meanwhile, I had applied for a Fiance Visa so that she could legally immigrate and we could get married. This is another issue that is way out of control, as it takes forever. In June, 2002, she had a particularly troubling episode. She had to remain overnight at the hospital and needed several tests. Her brain had shut down to the point where she did not remember me, and barely remembered her own name. The overnight stay and tests came to about $1200. In the meanwhile, I had discovered there was an alternative to the Fiance Visa. We could just get married, and I could then “sponsor” her to immigrate.
Las Vegas is about a seven hour drive from Tucson, so we drove there on the 4th of July weekend and got married. The next day, I was in the Tricare (military medical insurance) office and signing her up.
I have since retired from the Air Force, but I am keeping Tricare. I pay $38.34 per month that comes straight out of my retirement check. I would have to pay over $1000 per month for medical insurance if I did not have Tricare. Before I get any hate mail about how low my medical insurance cost is, please remember that you, too could get your medical insurance for this amount if you are willing to give 20 years of your life to the military.
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I am asking this, because I genuinely want to understand: Why are you mostly against Obamacare? I have to admit that I think it was a great accomplishment by our current president, although I don’t believe it went far enough. Still it was a step forward. There are plenty of stories on this page of comments related to struggles folks have with insurance, many of which will be alleviated by Obamacare. So, really, because I want to understand your point of view: Why are you against it? And what would you put in its place that would solve the problems folks are struggling with?
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I am against the Federal Government mandating how I spend my money, i.e. purchasing medical insurance or anything else. The less the government interferes in my life, the better.
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So it would be better if society left you on the road side to die…? What’s so wrong with society taking care of the less fortunate and each other? I really would like to know…
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I, too, am interested in your position. Given that you want the govt to tell the insurance provider that they must cover someone with a pre-existing condition, it seems like an odd stance to take.
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Thanks for responding, Paul. So, my next question is, if you aren’t required to buy health insurance, are hospitals required to take you in if you have no insurance? And if they are, and that money comes out of my pocket in terms of higher medical costs, which require higher insurance prices to cover, do I get a say about this situation (say, arguing that you ought to be required to carry health insurance)? This is why I am all for such a requirement. People who do not buy health insurance (usually the young and healthy) are gambling that nothing unforeseen will happen, but they are gambling with my money (and the money of all who pay for insurance or healthcare in general). To me, this is similar to people being required to carry automobile insurance on their vehicle: if you were the only person to suffer, because you chose not to buy the insurance, I could see not requiring the insurance, but since your not carrying insurance affects others, you are reqired to carry. The difference is that owning a car is not truly a necessity (even when it feels like it). Unless you live an incredibly lucky and healthy life, you will need to consume healthcare at some point, if you want to stay alive and able to contribute to society.
I’m sorry, because I don’t mean to argue — I really do want to understand and dialogue. I would be interested in your response to my points above re: the insurance mandate.
If there is no mandate, which would lower insurance costs overall, what would you put in its place to create a system which would provide affordable coverage for all who desire it?
Thanks again for your response.
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Paul,
1st thing – thank you for your service! I have to respectufully point out that removing the preexisting condition clauses requires that we legislate all people have insurance. Otherwise – one would not get insurance until one is sick. But that doesn’t work. The way insurance works is that we all pool our money, and a small percentage of us get sick – and the money collected from everyone is used to care for the small number that are sick. But if everyone putting in (and taking out) is already sick – there isn’t enough money. You need all the healthy people kicking in to cover the unhealthy ones.
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Here’s an easy solution against the “mandate”
INCREASE TAXES. Allocate those taxes to public health care. It’s perfectly legal and constitutional.
Then, offer a tax credit for health insurance. Better than the stupid mortgage deduction.
But no, politicians would rather play football with our health and stir up partisanship with phony causes than solve problems. This is a manufactured issue but watch Alito and Scalia throw the baby with the bathwater in October.
Of course it’s easy for politicians to play with other people’s lives because they have top-notch FEDERALLY PROVIDED health insurance. Let them eat cake, right??
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“I am against the Federal Government mandating how I spend my money”
Hear, hear! Let the insurance companies determine whether we live or die, instead!
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re. #102 Bella, who said that “removing the preexisting condition clauses requires that we legislate all people have insurance. Otherwise – one would not get insurance until one is sick. But that doesn’t work”:
It most likely would not work like that. In Australia, for example, health insurance is not mandatory, but it is encouraged (through tax incentives). So there are people without health insurance. When they do decide to finally take up health insurance, there are waiting periods on the services that are covered. So, for example, after taking up health insurance, you will have to wait two months before general dental procedures will be covered. You’ll have to wait 12 months before endodontic services will be covered. Or six months before you can claim on optical services. Or two months before you can claim on clinical psychology. (These are actual waiting periods, taken from http://www.medibank.com.au). The standard waiting period is two months for the bulk of services. Once you’ve been with the insurance provider for the set period, you’ll be able to claim insurance. This prevents people from only getting insurance once they fall ill. I think it’s a good system. It leaves less room for abuse.
re. #27 and #70 Paul, who said “The less the government interferes in my life, the better”:
So you want to build your own roads, and you don’t care about how uneducated the rest of the country is? You know, having people be healthy and educated is not just in their interest; it’s in yours, too. No one except the corporations themselves benefit from having these industries (as well as so many other industries, such as telecommuications) privatised.
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Thank you for writing about this JD. I agree with you, the system is broken and is ripe for disruption. I fear it is too regulated for some sort of start-up to innovate. But honestly, the biggest reason I would vote for a single payer/government run health care system is I don’t feel there should be a link between profits and people’s lives…at least not this close. A close second is the fact that so many people are scared to quit their jobs and do something else for the same reasons you explained – the health care system is just too frustrating and expensive.
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what is also nuts is that I have coverage with my employer, and even with a high deductable (1500.00 that doesn’t include copays) I STILL pay what you pay
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Hi! Paying $1,500 is not high deductible insurance.High deductible is considered $5,000-$20,000 deductible & some are that high.Through my husbands work is $4,500 per person deductible & $200 emergency room & if they determine not an emergency , you pay it all.We pay $210 every 2 weeks, on a wage of $11 something an hour.Insurance is going to be higher with Obamacare, as the feds have to pay it for those who qualify for free. Who are the feds? You & me, the workers.
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Man… reading all of this makes me glad I live in Canada. Of course, not everything is covered – prescriptions, eye care, dental care, and services such as massage therapy or physio aren’t covered through Medicare (getting this covered happens through work insurance plans for most people, and for people on social assistance, most is covered by the government if it’s medically necessary). But when I’m feeling sick, or if it’s time for my yearly check-up or monthly prenatal appointments, or if something happens and I have to go to the emergency room – I don’t have to think about the cost at all. The health care system in the States is just ridiculous.
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This article sounds exactly like something I could have written last fall, when we were hunting for health insurance after we both went full-time freelance, except that in my case, the offending “pre-existing condition” is a bizarre, rare auto-immune disorder that was diagnosed from an allergy test, which I’ve never had any symptoms of, never required any treatment for, and think was actually a misdiagnosis anyway. Our (Maryland) state plan is awesome… but I don’t qualify because I technically still *could* get COBRA (which would bankrupt us, it’s so expensive). I ended up “accidentally” forgetting to mention that diagnosis and getting a relatively decent policy (apparently they didn’t check…), except that it doesn’t cover maternity. And then? Of course, we got pregnant. So we’ve got a baby’s worth of bills to pay out of pocket, and are STILL paying $400/mo for the two of us.
Yeah. Our health insurance system is completely and utterly broken.
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I just found out my sister was temporarily uninsured when she had her last child and is still paying off the hospital bills. Her “baby” is in 3rd grade now.
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FYI — they probably will check your records very thoroughly if you ever develop an expensive, progressive, and/or debilitating condition (cancer, MS, ALS). That’s one way insurers deny coverage, even if that condition has nothing to do with what you develop later.
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I have been on that self-insurance nightmare ride, and I sympathize. I will say that we were initially rejected because of a bogus pre-existing condition, and I contested it, successfully. On our rejection letter, it had contact info for contesting it, so I wrote in detail why the condition no longer applied. After a lot more waiting, somehow we got through.
. Now that you’ve got some coverage, it’s a lot less frustrating.
It might be worth trying for you, if for some reason your current coverage isn’t sufficient (though it’s sounding pretty good to me
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I am glad to hear this as well. Although, I’m for single – payer more than nationalised health care, it is because of health reasons I am in debt. I am a teacher (you know those people who supposedly have better plans than everyone else). We pay a $600 premium for our family plan and have a $7000 deductible. That’s also no co-pays until deductible is met. Considering all family members have been in this hospital this year, that’s quite a bit of money to play. However, because of my daughter’s near blindness we can’t get insurance out of our work plan (pre-existing) until the ACA kicks in. If we wanted the lower deductible, it would be only $750, and $1600 premium. I supposed I shouldn’t have been idealistic and gone into education, helping others, and into something more profitable, but hey this is the United States, where being healthy and educated is a privilege and not a right. Excuse me for being bitter about the issue, but equality and solidarity for our fellow man is something I feel strongly about. As an American and a Christian, I do believe I am my brother’s keeper and should help him, even when he wouldn’t help me.
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Don’t be bitter. Your situation is almost exactly like everyone elses, unless you are a Senator.
The truth is, teachers often do have better plans than other professions. My best friend is a teacher and was shocked to find out her health insurance was better than what was being offered by her husband’s company (transamerica).
None of my teacher friends with children are still paying off their births, unlike my non-teacher friends who are looking 2+ years for each.
Obviously your insurance is better than your husbands company or you would use his.
Until every one stands up and says, this system is wrong and we aren’t going to take it anymore, be happy you have the coverage you do. Its better than most.
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I’m not sure if I read it wrong, or if it was written wrong, but I am the husband. Also, my wife doesn’t work so no we don’t use her insurance. It would actually A.) cost more for her to work due to getting an extra car, daycare, etc, or B.) we’d never see each other. Neither of which are tolerable. Also, she enjoys staying at home raising our kids.
I agree, though, that it’s something we need to all stand up. I never understood the idea behind what’s going on in the extreme right. Instead of pulling everyone else up, it seems to be pull the rest of the middle class down.
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Thanks for sharing your story, J.D.! Hope you’re feeling better.
I suspect most health care systems are broken in one way or another, but it’s startling to see how countries/insurance providers decide who gets what coverage and why.
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Just as financial companies rely on “credit reports” to establish credit for customers, insurance companies utilize “medical report” files to assess the health, insurability, and price ratings for individual health insurance applicants. The Federal laws FCRA and FACTA, which govern the credit bureaus Experian, Equifax, and TransUnion, also regulate the nationwide specialty insurance reporting agencies the Medical Information Bureau Inc (MIB), Ingenix Inc., and Milliman Inc.
Failing to check your medical report can be costly; errors or omissions within individual medical report files can cause applicants to be rejected outright, pay higher policy premiums, or suffer outright rescission of coverage!
The Medical Information Bureau Inc. (MIB) , operates the most extensive database of medical information on individuals who have previously applied for health, life, disability income, critical illness and long-term care insurance in North America. The Federal Trade Commission warns that your medical report files may include both medical and non-medical information about you. For instance, personal data collected by the MIB includes medical conditions, your credit report history, driving records, criminal activity, drug use, sexual orientation, lifestyle activities, international travel, participation in hazardous sports, and personal or family genetic history.
To make your annual consumer requests, you’ll need to contact the consumer reporting agency directly. See, “Do a Total Background Check on Yourself”
http://bit.ly/awqDyS
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I have been paying well over $10,000 a year for family health insurance through the spouse’s employer. Once upon a time, the employer’s health coverage was free – we didn’t even have a co-pay – but over time, the employer’s health benefit has become more and more expensive. This year, at open enrollment, our usual option is even more expensive which has led us to conclude that a CDHP would make better sense for us right now. At just over $1000 a year, it is a big savings. The coverage with this CDHP plan is not so different from the full octane coverage we have been buying since …forever. There are differences, of course, but it makes better sense to us to pay more out of pocket right now.
An aside about socialized medicine. I have been on both sides of this fence (UK). It is NOT the answer that everyone here in the US seems to think it is. My father, for example, has been walking around with skin cancer for the past five months while the Health Service sends authorization letters here, there and everywhere. A surgeon will not touch him until that letter of authorization is in hand. My father has already been diagnosed and that took several specialist visits which, again, required letters of authorization. At this rate, he could be dead before he ever gets the cancer removed.
In the UK, while I was in labor with my first baby, I was left alone for HOURS. I was induced and left to my own devices which could have been catastrophic. As it was, panic ensued when the night nurse finally thought to check up on me and found me about to deliver in the bathroom. Nightmare.
My sister had kidney problems which required specialist treatment. She NEVER heard back from the health service. Luckily for her, the problems went away on their own.
My UK family live in one of the most expensive countries in the world. Taxes are sky high in order to fund this ‘socialized’ health care. Many would say that the health care system is broken there too.
From a personal point of view, I am going to say that I much prefer the american system. At least I can see a doctor or specialist quickly instead of constantly being given the run around. If you want socialized medicine, be prepared to pay inevitably much higher taxes and endure longer waits to see a specialist.
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But Hawaii has more strict laws pertaining to health insurance coverage, resulting in almost everybody being covered based on state law mandates. Its health care is better overall, its citizens live longer, AND it has the lowest cost for Medicare in the nation–with $3,000 lower than the national average.
I don’t believe that requiring universal coverage overall means that our health care system will suddenly look like another country’s system. Not to mention, that leaves out important differences between our countries like the legal system, the education system training doctors, and the disciplinary system that oversees doctors–all of which vastly affect the kind of medical treatment we receive.
It sounds like in the UK, problems stem from having procedures pre-authorized by the gov’t, which has nothing to do with requiring all who will receive health care in this country (i.e. everybody) to pay for it first through health care coverage.
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I can totally understand your frustration at the experiences you mentioned with the NHS because I know of situations like those that have happened here in America, too.
My mother has been fighting Cancer for the past two years, but her real battle has been with her insurance company. (This Onion article is a bit too on the nose: http://www.theonion.com/articles/man-succumbs-to-7year-battle-with-health-insurance,2536/).
The waiting for approval for procedures, visiting specialists, and necessary physical therapy is here, too. Seeing friends without insurance and the frustration grows further because you know the “approval letter” is never coming.
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Yes on the taxes! I cringe every time I hear an American say we get “free health care” in Canada.
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The UK isn’t the only country with national health care. I have had (almost) nothing but good experiences in my life and I have rheumatoid arthritis, a thyroid condition and I am hard of hearing. I live in Germany.
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My bil sat in an emergency room with his eye dislodged from cancer. He had excellent health care coverage- but lived in a state that had flooded emergency rooms because we do not have a proper system to cover everyone. He did die- eventually.
I labored in the hall for several hours because rooms were full. I was checked occasionally until I was ready to deliver . It was a busy day.
My nephew went bankrupt over a chronic illness.
My father went a year before he could get into a specialist for Parkinson’s.
Your stories of the evil UK system- of waiting- happen here as well. At least
you don’t go bankrupt while waiting.
The US places all of their healthcare big bucks into the few who are dieing instead of the many who are living.
The system is broke.
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What I want to know is who makes it to 40 without a “preexisting” condition? Practically everyone in their 30s and 40s has “something”–asthma, depression, thyroid issues, cholesterol, blood pressure, whatever. I know many, many hardworking people without health insurance, and I know others who are staying in their jobs solely for that reason.
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This is precisely one of the points necessitating reform.
I’ve had several “mole checks” through my dermatologist over the years. Never has a spot been cancerous (even benignly so) but if any HAD been, whammo, there’s my pre-existing condition.
I know many, many people – who work full time, pay their taxes, and pay their insurance premiums – who simply don’t go to get treatment because they don’t want a procedure or prescription on the record.
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J.D. said that COBRA was very expensive. But please note that the COBRA cost is what his health insurance costs while covered through his wife’s employer’s plan, plus a 2% administrative fee that the employer can add.
What I am saying is that most people don’t appreciate the total cost to provide their employer sponsored health insurance, because the employer is picking up such a large amount of the cost. (On average the employer picks up about 75%.) Regardless of which pocket the cost/premium comes from, employer group health plans cost a lot of money. If the employer were not paying these large sums, they would have more dollars available to increase wages. (I understand that not all employers would choose to do that and that offering health insurance is often necessary to attract a highly skilled work force, but as an employer, I would rather that people obtained their health coverage through the government.)
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Yes, for all the people who complain that COBRA ‘is soooo expensive’ it is just that. It’s what your employer was picking up for you + their administartive costs. which are on the order of a couple %. So, your healthcare isn’t any cheaper through the employer – it’s just you’re not paying it out of pocket. the biggest probelm with COBRA is it’s not a long term insurance. It really just meant as a bridge till you next your next employer sponsored health plan
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Yes, a thousand times yes! We own a business with seven full time employees. Our health insurance costs for our employees are three times our rent, and one of our largest expenses.
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Thank you for posting this type of story. My mom had a similar experience (the only pre-existing condition she has is the very beginning stage of osteoporosis and she didn’t care if that was uncovered). A friend of mine could not find insurance because of her weight.
I know a TON of small business owners, all who have no health insurance. I seriously doubt they have sufficient emergency funds to fund a real health emergency. The costs are crazy.
We really need a system where we all contribute and we are all covered.
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I was pregnant last year without maternity coverage and we negotiated with the hospital and doctor’s office to pay a reduced cash price. We wound up losing the baby around 19 weeks. My doctor’s office and hospital were GREAT about the charges, but the specialist’s office I had to visit wouldn’t budge, and of course neither would the labs. Our total out of pocket cost was about $10k, with half of that going for some very expensive lab work and ONE visit to the specialist. We’re expecting again now, and I’m now covered on my husband’s policy through work, but it’s costing us a fortune – about $650/month to include me on his policy. When our child is born in a few weeks, it will be yet another $650/month to add her. So we’re looking at about $1300/month for two people. I tried to secure a private policy for myself and the baby (actually cheaper) for after she’s born, but was denied because guess what? I’m expecting! I spoke to an agent and explained that I already have maternity coverage through another insurer and just wanted regular coverage for afterward, and I apparently have to wait until I’ve given birth, at which time I will no longer have the “preexisting condition” of pregnancy – never mind that pregnancy is NOT considered a preexisting condition in my state (how is it even legal to deny me on those grounds??). This whole thing is just ludicrous.
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Depending on who the health insurance coverage is through, state law may not matter. My baby was born at home and my health insurance does not cover homebirths or any of the prenatal appointment if you are planning a homebirth. However, our state requires by law that insurances cover homebirths. When I called our health insurance broker, she said that our insurance company is only subject to federal law and is not bound by state law, so they didn’t have to cover my homebirth. So if federal law doesn’t exclude pregnancy from being considered a pre-existing condition, then the insurance company doesn’t have to cover it.
I knew that was what I wanted, so we’d saved up for it, but I still think it’s shortsighted. The cost for ALL of my prenatal visits, the birth, and 6 weeks of antenatal care (baby and me) for my midwife and an assistant was $3800. That’s it. At least the insurance company covered the lab tests.
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While you are correct that the cost of a healthy homebirth is low, the insurance companies have significant data regarding the home births that do NOT result in a healthy baby or mother. The costs for a child who had complications at home and then is brought to the hospital after complications is mind-boggling. Not that these costs don’t happen in hospital births too, but there is a transportation time factor. Insurance companies base such decisions on percentages and likelihoods.
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That may be true, but that wasn’t the reason cited by my insurance company in their homebirth coverage policy. The percentage of homebirths in this country is so low, that I have a hard time believing that the costs arising from the number of instances where transportation is required outweighs the costs of most of the unnecessary, CYA procedures that take place in a hospital birth. I would love to see some data and actual costs.
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I’m sorry for your loss. It boggles my mind that bringing a new person into the world is considered a “pre-existing condition” not worthy of coverage.
Doesn’t it make sense to ensure mothers-to-be have good health care?
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Now I want to google a list of pre-existing conditions to see if I or my boyfriend have any…. I may end up working for “the man” just for health insurance :/
And I am blessed to work for the man and receive top tier health insurance. I never have a concern about getting a prescription filled, a doctor’s appointment paid for, and last week I discovered that now there’s no co-pay for preventive care! (Which, imo, is the way it SHOULD be.) At least that’s with my medical insurance. My dental insurance, even though it’s the top plan my company offers, is more of a headache… And I am LUCKY to have dental!!!!!
But the system is just plain MESSED UP. My mother is self-employed, and when she first had to start with the colonoscopy every ten years she had a bad plan. I base this on the fact that her insurance at the time wouldn’t pay for her colonoscopy because it wasn’t urgent!!!! As if any doctor in his or her right mind would tell a 50 year-old woman with a family history of cancer, and colon cancer at that, “No, you don’t really need to get a colonpscopy.” She has since found a better plan.
And my dad is a pharmacist who has gotten fed up with dealing with the insurance companies to get paid. I remember a few years ago PA, where he lives, had some sort of massive hiccup with its Medicare/Medicaid(?) program so the insurance coverage of many of his older customers was effectively suspended. He and my step-mom sent out a letter reassuring them that they would still fill the prescriptions while the state sorted itself out. But, of course, it would be the drug stores that bore the financial brunt of filling those prescriptions in the meantime… Unless, of course, a drug store refused to fill the prescription :/
And my boyfriend’s father is a retired PCP who, in end, got absolutely fed up with dealing with the insurance companies. From what I’ve read, the PCPs spend an inordinate amount of time chasing after their payments from the insurance companies when they really want to be treating patients!! Or, to make enough money for their practices to survive, their offices turn into practical medical factories where doctors see patients non-stop for 8 or more hours. It’s insane.
And, you know something’s messed up when you could get an associate’s DEGREE in medical billing!
I would happily pay more in taxes if it meant everyone could get healthcare, especially preventive healthcare.
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My husband had the same problem. He was on a self-employed policy, during which he was diagnosed with high blood pressure. After we got married, he cancelled it to get added to my health insurance. My employer said, “Hold on to that application, we’re switching insurance companies this week.” Fine, I thought, no big deal. Turns out that was was going to cost $300/month to add a spouse was now going to cost $750/month, and there was no way we could afford that. So my husband went back to his prior insurer and applied again. (This is only catastrophic, remember.) They denied him, too, based on pre-existing conditions. He was denied by almost everyone. He ended up paying about what you are per month for coverage in only the most extreme cases, and negotiated any doctor’s/dentist’s/optometrists fees down.
Fast forward 4 years and a different job where he is now covered under my insurance once again. Since his job prospects are still going to be self-employment, I *have* to keep a job that provides health insurance for both of us. Even though I’d like to go back to school, or become a stay-at-home mom, or help him in his business. But I feel stuck. Something has to change.
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On the ‘health insurance issue,’ Americans can be divided into two camps: Those who’ve never been without insurance (and like the current system), and those who’ve tried on their own to buy private health insurance after suffering anything more severe than a mild cold (and think the current system is lousy). Congratulation on your transition to the latter.
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Get the Republican health care plan.
“Don’t get sick and if you do die quick”
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Furthermore, how come the government funded health care plan is good for the Republican congressmen but not good for the rest of us?
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I honestly don’t know how anyone can read JD’s post and the stories in the comments and not think that the system we have in this country is beyond broken and needs a complete overhaul. The biggest problem–as I see it–is that those who haven’t had a problem (yet) with their insurance appear to outnumber those who have had a problem. Thus, nothing really gets fixed.
Count me among those who give the President credit for at least trying to address this mess.
Glad you were able to get some coverage JD. Please keep in mind all of those who are not so fortunate, including many, many of your cohort of the self-employed.
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I have to agree. Also, It seems the people who want so badly to kill any so-called “Obama care” initiatives don’t have much to offer as an alternative.
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I could tell a long sad story about getting health insurance after my husband was laid off and COBRA expired (yeah, we paid the COBRA, outrageous as it was due to a past history of cancer, now totally in remission). We lucked out because we live in Colorado and they had a state program for folks turned down (like my son who was rejected because two years earlier his acne was treated with a course of Accutane). We’re employed again and covered, thank goodness.
But I wanted to say: you are lucky that Kim was looking out for you and made you deal with the insurance issue — or you would have been without insurance (hey, it’s such a pain, I’m betting you would not have concluded the issue if she hadn’t been stubborn about it).
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I am sorry for your aggravation. At the same time, I am grateful for any attention that is put on this issue. As a caregiver for an elderly family member, I have to have personal coverage. In Jersey, the el cheapo plan is $312 a month, lots of limitations and no prescription coverage. But I am grateful even for that—–and NJ has a law that a person CANNOT be denied for pre-existing conditions. We pay a higher price, but you just sign your name and you are in. I believe that this will go nationwide under Obamacare. Now you see why it is needed.
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“But it’s good to know that if I do need medical help, I have the insurance situation sorted out.”
You should have ended the article with an additional sentence: “Thanks, Kris.”
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In order for our system to work it needs three things:
1) No one can be turned down for pre-existing conditions
2) Everyone must buy health insurance (preferably through a payroll deduction)
3) There must be a government payer option (preferably allow people to buy into Medicare early). This would eventually force private insurance more or less out of the market, but it would allow the process to occur slowly and force them to have competitive prices.
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In case anyone is interested – I am 64, always uninsured and, on no medications, no conditions, etc. I eat all organic, mostly from the plant kingdom, a lot homegrown, some weeds, always get some sun. I avoid stress, which means most jobs, spend very little time in a car, and avoid having anything in my house that off-gases (plastics, particle boardoard, synthetics, plywood). Call me crazy, but after reading the above, I feel much more sane.
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Gee, how nice for you. I was born with asthma, made worse by my father’s smoking, and a predisposition towards mental illness on both sides of the family. I also eat almost entirely organic, I’m vegan so my diet consists mostly of vegetables, I execise frequently, I avoid stress (I have no choice, as it makes both of my health problems worse), and I don’t own a car. I can be and have been denied health insurance because of the preexisting conditions I’ve had since childhood, and that won’t change no matter how well I take care of myself. I’m glad you’ve been so lucky, but please understand that it *is* just luck, and not the way you’ve chosen to live.
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I’m an unemployed Californian, was on COBRA, exhausted the COBRA coverage at 18 months and am now on HIPAA. If you can afford it, you can get pretty good coverage mandated by the U.S. govt through HIPAA after you exhaust COBRA. But it will cost you. I’m a single female, 49, and pay $640/per month for a good Aetna plan with a $2,500 deductible. So I pay $7680 per year for a plan I barely use. I’m very healthy but do not qualify for any private individual plan due to you guessed it…an old pre-existing condition.
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Re: the thousands you pay for an Aetna policy you never use:
The value of Aetna Chairman and CEO Mark Bertolini’s compensation package in 2011 was nearly $11 million (source: Dow Jones Newswires).
“Aetna’s results were strong last year, with operating earnings climbing 26%. Its profit in the fourth quarter surged as the insurer continues to benefit from light medical costs and sparse patient visits to hospitals and doctors’ offices, effects of the weak economy and high joblessness.” Yes, you read that right — “the insurer continues to benefit from … sparse patient visits to hospitals and doctors offices .. (due to) the weak economy and high joblessness.”
GRRRRR!!!
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Very thankful I live in Canada, not the best, but better than this
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My husband and I moved to Ireland less than a year ago from the US and we were strongly advised, even by Canadian friends who seem to have a strong inborn belief in socialized medicine, to buy private coverage. We are still scratching our heads over how the public/private system works and since the economy tanked here in 2008, everything is under flux. As much as people gripe about the system, there is a basic safety net even in this country with its recession and hard economic times. I do wonder what will happen to us if/when we move back to the U.S.
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In most cases, we think that the free market and competition will drive prices down in every market, but healthcare is one of the cases where it has not. Costs have actually gone up.
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Well and part of the reason is the way health care works for insurance. The larger pool of people, the cheaper it will be because you have more people to draw from. It may not be as efficient (then again, I’d argue anyone who says the current system is very efficient hasn’t haggled with their insurance lately), but it is cheaper to have less competition.
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Healthcare is no where close to a free market.
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That’s because health insurance markets naturally lead to market failure because of adverse selection.
Mechanically, perfect competition can’t work in insurance markets because there’s an incentive for only sick people to want to buy health insruance at cost which drives costs up leading to only really sick people wanting to buy it at that cost and so on. That’s why the private market is broken, and why Gruber argues for an individual mandate (Cutler says all you need is to subsidize coverage “enough” to get over that downward spiral).
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I am very excited to see these conversations, being a physician practicing in US.
It is pathetic and funny to realize that we have no control over this thing. We deal with 400 insurance companies, Insurance companies have different contracts with different physicians and hospitals. Each event (like seeing a patient for physical or minor surgery) is billed differently under different scenarios, like: Seeing a patient in my personal office vs hospital based office, NYC vs rural town in texas, weekday vs weekend, etc etc.
As physicians, it frustrates us the most as we have no clue how much we will be paid for any service, let alone letting patient know how much they will be charged.
My last comment is about pre-existing coverage. We deal with it every single day. Patients ask us what should they do if they are loosing their job or any other issues where they would be loosing insurance. It is impossible for us to guide them as insurance companies would invariably deny coverage.
I agree that we need some “fix” so that everyone can get insurance.
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