Wednesday, November 17, 2010

Health Insurance 101

Hey, Rep. Andy Harris. I hear you're having a little trouble understanding why government-run health insurance is a good idea. Mostly because you had to wait 3o whole days for your guaranteed government health coverage to kick in.

I feel your pain. Health insurance IS hard. Let me see if I can enlighten you about how health insurance works.

I'm a 41-year-old woman. I have two kids. I'm separated from my husband but he's still on our group health insurance policy. I have a few pre-existing conditions, but hey, by the time you hit 40, who hasn't? Luckily, mine have nothing to do with a shitty heart, ongoing cancer, high cholesterol, or any of those bad things that often require expensive treatment or drugs. In the big scheme of things, the only bad thing about them is that they do require treatment at all.

I left my job in April and am now enjoying a thriving freelance career. If business keeps going as is, and I keep working this hard, I'll be matching the salary I made at my old job. But of course, there's no subsidized health insurance.

We pay COBRA through my old employer. We pay $1450.34 a month. That's right. EVERY MONTH.

Why on earth would anyone do that? Well, here's why.

In a quest for even slightly cheaper health insurance, I just applied for individual health coverage. As part of that coverage, my kids could be added to my policy for a slightly higher premium. My husband, who has enough pre-existing conditions and expensive prescriptions that an underwriter can't possibly stamp HELL NO on his application fast enough, qualifies to be insured under Colorado's high-risk insurance pool. It's fairly reasonably priced and actually, the coverage is not that bad. If I were to be accepted for individual coverage by a provider, at the very worst our combined cost would be roughly half of what we currently pay for COBRA.

I submitted applications, answered hours of questions, facilitated the gathering of medical records, pieced together documents from 11 years and two cities, let the insurance company take a chunk of money out of my bank account for the first premium. These are all hoops that you have to jump through to even be considered for health insurance. I spent 30 minutes on the phone today tracking down medical records for a doctor that I haven't even seen since 2006, just so they could see evidence that I was 90 percent perfectly healthy during that time.

Let me reiterate: I exercise regularly. I wear sunscreen. My cholesterol, heart rate, and blood pressure are a cardiologist's wet dream. I control any health issues I have proactively with inexpensive medication and regular checkups. I've had exactly one surgery in my life. I have never smoked. I wear a seat belt. I don't eat white flour or refined sugar. I drink in moderation a few times a week. I have regular well-visit checkups. I've never had an abnormal pap smear. The last serious health issue I had was a one-time deal, 11 years ago, well past your statute of uninsurability. I have no allergies. I've never had a cavity.

And today, I was declined for health insurance. Why? Because of one pesky condition that requires (again, INEXPENSIVE) prescription treatment. Once again, people who control their health issues so they don't turn into bigger health issues get reamed.

Consequently, my perfectly healthy kids were declined for health insurance, too.

I'm eligible for the high-risk pool now. Which is good news. But here's the thing: I can't insure my kids. Because there is no rider in the high-risk pool for kids. And in response to the recent health care reform that went into effect, insurance companies would rather not insure kids at all, rather than being forced to ensure kids despite pre-existing conditions. Which, I repeat, my kids don't have.

So what are my options? Well, I could keep applying and applying for individual coverage, which is kind of like applying to get kicked in the nuts repeatedly. I could boot my husband off of COBRA and he could do Cover Colorado for a microscopically slightly cheaper total monthly cost. Always good for maintaining amicable relationships, and financial savings really doesn't balance out that cost. Or, and this is most likely what we'll do, we can stay on COBRA as-is. Which goes up next year to $1522.86. Of course, that will run out in a year or so. But then, I can always just give up my flexible, lucrative, satisfying freelance career and get a shit job so we can have the health coverage. LIVIN' THE DREAM, man.

Anyway, my little doctor Republican Congressman friend, THAT is how motherfuckin' health coverage works. Really, what's not to love? If you need me, I'm moving to Sweden.

Try not to catch a cold in the next 30 days.

2 comments:

amakice said...

I'm terrified of having to apply for health insurance- sure I'll be denied for similar, stupidass reasons. We pay about 1500.00 less per year than IU pays Kevin to be an AI to insure our kids and me. Even after paying that, Aetna routinely denies everything the first pass through their system and then denies it the second time because it has become and "untimely" filing in that time.

Health insurance is probably the single biggest stressor our family faces. I hope the guy gets some horrible STD during his 30 days.

claudiaputnam said...

Even if you could pay half of this thru regular insurance, it would still be a lot, when you consider that this money could otherwise be going toward retirement savings or a college fund. What is it that gov't wants to encourage? If they complain about a lack of savings they can't be expecting people to pay mortgage equivalents for healthcare.