Denied

We’ve been refused health insurance from the monopoly health care provider in our state. All three of us were refused. Irony 1: This same company who covered my successful cornea transplant in 1998 used this against me and declined coverage. Irony 2: Heather’s post-partum depression being successfully treated was used against her and she was denied. Irony 3: Leta’s two MRIs, which proved she was healthy have been used against her. Denied.

I feared this might happen when I left my day job. But none of us has diabetes. Or cancer. So I naively figured we’d pick up an individual plan at a higher rate than we paid from my previous employer. I figured it might be as high as double or double and a half the amount with a higher deductible. Oh how wrong I was. COBRA was five times what I paid. Five. Per month. We could buy a second home for that amount of money. And furnish it entirely with Sasquatch-related paraphernalia.

I believe the United States is on the brink of a health care something. I read this piece in the Kansas City Star by Paul Krugman (which ran in the New York Times) about how the free market doesn’t work with health care. I couldn’t have stated it better. The “free market” for health insurance is subsidized by tax dollars and is geared to delivering coverage to those who don’t need it most. Insurance companies apparently only insure the healthy. Or those who work for companies with more than 3 employees (and who offer a group plan for employees). They spend great amounts of money and energy weeding out the sick and needy. It’s sheer insanity. I can hear the conservatives cracking their knuckles to comment now. Save it. As a small business person recently self-employed, all the Hannity in the world isn’t going to fix this problem. It’s going to take creativity, genius and sacrifice from every side.

We qualified for a state “high-risk” plan (Irony 4: it’s managed by the same monopoly company that denied us coverage), but the premiums are about three car payments a month. Two if it’s a really nice car. And that is with an enormous deductible. Enormous.

I’ve read where Costco is doing a test of offering it’s members health insurance in certain parts of California which was started this past summer. Since every state has different laws, Costco can’t just roll out a plan for all their members. How crazy is it that a company with millions of private members, who are ripe for health care coverage can’t offer a simple plan across state borders? What if Wal-Mart or Target started offering customers health coverage? I think we’d see some interesting options arise, but I don’t think that is going to solve the crisis.

I’m a believer in universal health care. Especially if the rich pay more. If I make a million bucks a year, I should have a portion of that money go to those who need it more than me, just for the opportunity of making that kind of money. I’d gladly pay it. GLADLY. Whether that’s in the form of a tax or part of my national insurance or whatever you want to call it, it would be wonderful to know that if I didn’t need the coverage, someone who did would get the benefit. I’m afraid I’m in the minority.

The biggest issues facing universal health care in the United States seem to be the powerful insurance lobby (remember the scary ads from the insurance companies in the 90s when Clinton wanted to give a health card to everybody?), the failed notion that free markets and competition will keep prices low and the paranoia that universal health care will somehow be a huge step towards socialism/communism. Add to this the decreasing employer contributions to health care for employees and in the next 5 to 10 yearsof continued inflation of health care costs this country will be in serious shit. I believe that it’s time to put some brain power into solving this issue. There has to be a better way. Creativity, genius and sacrifice.

I plan on writing my local and federal representatives about this situation, but I don’t have a lot of faith that I’ll be heard above the insurance lobby. Individuals who need health care coverage have little recourse. If I’m part of a group, I have guaranteed coverage, but guaranteed at what cost?

So anybody have a great health care plan that takes cornea transplant recipients, depression survivors and very cute toddlers that doesn’t cost three cars a month?

  • http://www.elwoods.org James

    I am so sorry to here this, I truly am. Honestly, this is the exact situation that keeps me a wage slave, and believe me I admire you for you courage to jump off the chain gang.

    The problem with health care in the free market is it is a conflict of interest; providing health care does not work well with the notion of profit. The moment you become profit centric you begin examining what elements of the equation can be eliminated in order to maximize returns. If you produce widgets you look to reduce inputs and boost efficiency and productivity. If you are an insurance company you look to build a subscriber base of non-claimants and should they file you make every effort not to pay that claim as well as explore options to raise their deductible or drop them all together.

    Profit + Health <> Chocolate + Peanut Butter

  • http://www.elwoods.org James

    Pffft! That last line should have read:
    Profit + Health (Does not equal) Chocolate + Peanut Butter
    :-p

  • HANK

    In my complete ignorance, I had no idea Americans dont have universal health cover. In Australia thats exactly what we have, and the fees to maintain health care for everyone (minus assylum seekers) is deducted weekly as tax(depandant on income). It works generally fine, we still have Private healthcare, which lets you skip the line for operations. But just this past week new Industrial Relations reforms were passed by our Senate modelled on the US, so i would bet our healthcare will be next. :( Im sure u could find a lot of people who will jump on the bandwagon.. good luck!

  • BeeJay

    You both write. If you could join a writers organization, or one for people who are self-employed, it might not be cheap, but you are guaranteed health insurance as members of the group.
    I’m middle aged and overweight, with perfect blood values and cardio tests and everything, have only been hospitalized for tonsillectomy and appendectomy, but because of my age and weight they deny me, too. It’s all paint by the number, and the bean counters are in charge of picking the numbers. Sucks.

  • http://www.bornpagan.com Heron

    Hi Jon,

    We are in the exact same situation, self-employed in Utah, and totally unable to take out a second mortgage just to buy health care insurance.
    We should set up a self-employed-digital-Utahns corporation just to get decent group coverage.

    So far, we’ve managed to get along on a lick and a prayer, but I dread the day that anyone in my family develops any serious health issues. If it happens, it will probably bankrupt us.

  • http://www.blurbomat.com Stuling

    About 15 years ago the business round table in NZ lobbied the government to remove pretty much everything in the way of protectionism to enable them to maximise their profits and basically have free reign. I found it deeply ironic that not two years later they were whining that it wasn’t working how they thought it would, and that overseas interests were impacting their abilities to make a profit.

    So. Big business is all for unfettered capitalism provided they’re the biggest (or only) fish in the pond.

    I used to work for a big Telco. It used to break my heart getting calls from the elderly from the phone booth down the street because their phone had been cut off. Usually they were only about $10 short on their monthly bill and it was their total lifeline to the outside world. Needless to say, if they couldn’t afford the $10, the $40 reconnection fee was going to be out of the ballpark.

    I absolutely agree with Jon. Pay more tax and provide everyone with critical services, healthcare and basic communication included. Profits don’t come before people. OK, that was the greenie/bleeding heart/liberal side talking, the more pragmatic part of me says the issues are much more complex (the aging of the general population and the decling birthrate impacting on the overall ability for the tax base to support itself) but there has to be a balance there somewhere.

  • http://www.dcsteve72.com Steve Phillips

    One thing that my partner and I did with our insurance was to setup a legit business and then cover us both. I too was trying to get covered as an individual but after checking into the business aspect, it was cheaper to cover us both instead of just me.

    This might be slightly different in your case, but you are in fact “a business” and could list both as employees. Leta could be an issue tho …

    In every major city there are companies that deal with this, usually insurance “wholesellers” of sorts — they deal with a LOT of different companies so they can search for you the ones that are more lenient on pre-existing conditions.

  • http://woundedhealer.blogspot.com/ Peter Eisenmann

    Jon,

    I did the same as Steve. In fact, my situation is complicated by the fact that my wife has Cystic Fibrosis and IS covered by Medicare/Medicaid – but only as a working employee.

    We started a corporation and I am paid by my employer to the corporation and NOT as an individual. The corporation pays my wife and I as employees – that corporation pays MY health insurance (or did until I started working for another company that had group coverage).

    You can, additionally, set up a medical savings account through an insurer and that may be a way to cover your high deductable policy, as well as get a tax break and have money for other health issues that are attached as riders on any new policy as exempt. The health savings account can be used to pay for anything health related NOT just insurable areas.

    A corporation can get insurance for the employees easier that an individual. Look into that as well as joining the Writers Organization.

    Feel free to email me for more info. I helped a number of employees get set up with a plan like this at the last project I had. And NO I am not a salesman, just a guy that has negotiated bullshit red tape in the healthcare realm for a few years.

    Hope all works out.

    Pete

  • http://www.masson.us/blog/baby/babyblog.html Amy

    I need to take a minute here to say one thing:

    HEALTH INSURANCE COMPANIES ARE MOTHER FUCKERS!

    When I stopped teaching school (yes, that was just written by a teacher) to be a SAHM, we had to buy private insurance. $2500 per person deductible etc. We opted not to buy maternity insurance, since it would increase our premium by a car payment and you had to have it for a year before you could even use it. Cheaper to just pay the doctor. Supposedly, complications are to be covered.

    One emergency c-section later, and the fuckers DENIED my claim. Repeatedly. “C-sections aren’t covered by your policy.” Okay, how is an emergency c-section not considered a complication?

    FUCKERS.

    (An aside, after a lengthy appeal, a letter from the doctor, and the threat of a lawsuit, they picked up the c-section minus the $2500 deductible and not including the $1200 nursery bill. Fuckers.)

  • http://bigdlittledmistatruffyandme.blogspot.com Karen Rani

    I’m sorry to hear this. I don’t have a solution for you though….I live in Canada where our government takes care of us in the medical sense, even though they are bending us over and making us take it in another sense. But I’m thankful to have the health care system we have. Hey…you guys like Vancouver….move to Canada! :)
    I hope some the commenters here have a few options for you!

  • http://gradualgardener.blogspot.com GG

    I live on the east coast, and don’t have employer-provided health insurance. I was able to get coverage through Blue Cross & Blue Sheild for myself and my husband for around $350/month, for an 80/20 plan with a $250 deductable. My husband has a seizure disorder, a result of a tramatic brain injury in 1999. We just got the coverage this past spring, so they do take pre-existing conditions. Our monthly premium is less than we would pay for his prescriptions without coverage. There is a state program for children here, so we have our daughter on that. I don’t know if Blue Cross writes insurance in your area, but if they do you should look into it. Or maybe move!

  • http://gradualgardener.blogspot.com GG

    Another idea would be to get coverage for your daughter separately. Most insurance companies have a single person rate, a “couple” rate, and a family rate. The family rate is generally the same whether you have one child or eight, which works out well for people with big families, but not so well for those with just one child. You could try to get a couple plan for the two of you, and put Leta on her own policy. There are companies out there that will sell polcies for children only, due to all the divorce cases where the non-custodial parent is required to provide the health coverage.

    In my prior life I was an insurance agent, before I wised up and got out!

  • http://www.117Hudson.blogspot.com Kizz

    Jon,
    Have you checked out http://www.FreelancersUnion.org? Here in NYC I have seen their advertisements but not done extensive research on what they offer.
    Good luck!
    Kizz

  • http://www.sharpcurvesahead.com Tina

    My roomate joined this organization and got health coverage at a fairly reasonable rate. It’s the National Association for the Self-Employed.

    http://www.nase.org/

    Also I found this link that claims to give you quotes from different groups. Not sure how reliable the answers are but thought it might help.

    http://tinyurl.com/7gsrv

  • http://backgroundnoise.typepad.com Jaeme

    I have to agree with the person who said that insurance companies are MOTHERFUCKERS. I was diagnosed with PPD and before they would agree to cover my high-priced, non-generic medicine (which, incidentally, turned out to be the magic cure for me) I had to try several generic alternatives first. Two of them made me feel even worse and almost put me in the hospital, where it would’ve cost them thousands more than if they would’ve just covered the medicine my doctor prescribed in the first place. It was only once my husband called the company and threatened legal action that they would cover the medication I needed.

    Just something to make you feel better, though, if you can’t solve the insurance problem…don’t worry too much about an emergency. I was uninsured when I had to have emergency surgery, and the bill ended up being over 10k for only three days in the hospital. Most hospitals have charity funds available and if you’re uninsured they will sometimes waive the bill. They did for me.

  • http://girlsetsfire.com renee

    This is the exact fear I have after I graduate college. I probably won’t get into graduate school right away and I doubt I will be able to find a salaried job with benefits. There is no way in hell any insurance company will want me unless it is some “high risk” plan, which in some ways I am (all mental health related which isn’t that costly to them since they barely cover you in those aspects anyway, or at least my plan doesn’t). I guess I will be learning how to sponge off the government or something if I don’t end up making too much or even qualify for CBH or something to begin with. Gah who knows. As if I need this added stress. Insurance is so not my friend. I was actually crying about this last night, heh.

  • http://www.monkeydojo.net Miko

    I still work for The Great Satan. I don’t work in medical insurance but it still sucks the soul out of me and makes me feel like a btich. ‘Scuse me, like a motherfucker. My partner just joined a union here in CA and looking at the benefits he gets vs. the benefits I get working for the damn insurance comapny makes me want to cry. They screw everybody—including their own employees.

    My heart goes out to you. Good luck.

  • Emily

    Jon:

    Thanks for posting this. Sorry for your situation. Have you checked into plans from your college alumni association? I’m a UW-Madison grad, and they offer that. I also like the idea from one poster about setting up a company. That whole thing (incorporating, the lawyers, etc.) might pay for itself very quickly vs. the premiums you’re forced to pay now.

    The whole system is fuookad, but there are people working on it.

    I’m working on a business plan right now that will allow me to devote my life to fixing at least one tiny piece of this. I’m presenting it next week. Keep thinking good thoughts for me. Us experienced web types are starting to flock to this – please don’t lose hope.

    Good luck. Keep us “posted!”

  • http://www.iprettymuchhateeverything.com Torrie

    Jon, I’m so sorry
    I wish I could do or say something to make it better.

  • http://www.sagara.org Jon Sagara

    Check out your local Farm Bureau.

    http://utfb.fb.org/Website/MemberBenefits.html

    I’m not sure what the differences are between UT and CA, but when I had to get my own health insurance for a brief period of time, the FB provided relatively affordable rates.

    Best of luck to you.

  • http://leta4chemyahoo.com Leta

    I’ve emailed Heather, but never commented here before…but I’m in public health and just had to comment today. First BRAVO! So many people will read your site and even if only 10% agree with what you wrote, it will do so much good. Second, immediately call your state Department of Human Services and inquire about SCHIP coverage for Leta. I have no idea what the regs are in Utah, but most states offer some type of Medicaid based coverage for uninsured children,and the family income limits are quite generous. I have no idea what you guys make, but most middle class people are permitted. You will have to pay for Leta’s coverage, but I have never heard of an SCHIP premium higher than $20 per month. Second, if you can afford nothing else, look into catastrophic coverage for yourself and Heather. For a healthy young couple, this is often reasonable. It will have a large deductible, but you should be able to find one with a manageable premium. Third, contact the drug manufacturer that makes Heather’s meds and see if they offer free or reduced price pills for the uninsured. (Do this with any other maintence drugs you guys take, too. Many drug co’s do this, not because they’re nice guys, but because they need the good PR.) Hopefully this will tide you over until you can work out some type of more comprehensive, permanant coverage. Sorry this comment was so long, but when you left your job, the first thing I thought was “Boy, what will they do for health insurance?” I now feel bad for my pessimism, and am trying to atone. I hope this helps, and good luck!

  • Stacey K.

    Ironically, a brilliant idea was suggested during a recent episode of “The West Wing.” Allow Medicare to be made available to anyone who wishes to enroll.

    Medicare actually sets the standard for all health insurance. Whenever Medicare makes a change, all private health insurers follow. Medicare is so finely tuned its hard to believe it is run by the U.S. government. It’s complicated, there is no doubt. But even though their administrative costs are low, Medicare provides customer service like you wouldn’t believe. The Medicare website (medicare.gov) contains every strand of information regarding how it works and what is covered and the telephone customer service is nothing less that outstanding. The Medicare system is fully able to be expanded to include uninsured Americans with no limit on pre-exisiting conditions.

    Ironically, Medicare cares for those 5% of Americans who require the most insurance. There are over 40 million people currently enrolled. I care for my 85 year old stepfather who suffers from gastric cancer, parkinsonism, diabetes, glaucoma and high blood pressure. We have easily spent over $100,000 just this year. Medicare is an 80/20 split, but you can buy Medi-Gap coverage which covers the difference of any approved Medicare expense. Additionally, Medicare comes in three parts, A (hospital coverage) and B (medical insurance) and now D (prescription drug insurance). Those over 65 can choose what coverage they want. Medicare doesn’t cover everything and is not perfect, but the system is in place. It works.

    Unfortunately, the health insurance lobby with their buddies the pharmaceutical lobby make the NRA look like amateurs.

    To answer your question Jon, if there is low cost health insurance out there, I haven’t found it yet. I haven’t had health insurance in 5 years. I take my own blood pressure, test my cholesterol myself and rely on the amazing Susan Komen Foundation to get annual mammograms and the equally amazing Planned Parenthood who provide low cost gyn exams. This is the thin tightrope I walk.

    An ounce of prevention is worth more than a pound of cure. It is obviously cost effective to provide the other 5% of Americans affordable health insurance. Thank you so much for your post and for actively joining the fight.

  • http://course.sunnipath.com/ProductInfo.aspx?productid=LA120 Muhammad

    Insurance in general is a legalized racket. Car insurance falls into the same category, it’s just that since the absolute amount is lower most people don’t notice. Until people feel a DIRECT, painful prick they continue to pay and pay and pay…

    Without insurance cars would be designed fundamentally differently.

    Without insurance car repairs wouldn’t cost an arm and a leg – and like computers you’d be able to install most worn-out parts yourself.

    Without insurance the medical industry would be structured differently

    Without insurance doctors wouldn’t be making 200k salaries and telling people to “come back for a checkup in 2 weeks JUST IN CASE”

    Without insurance caesarian births wouldn’t become the norm

  • http://swimmindustries.com Mike Swimm

    Jon,

    I have been reading both of your sites for a very long time but never posted.

    A few years ago when I first left college I came down with shingles (which is fairly minor) without any type of health insurance and had to give away nearly penny I had saved to cover the hospital bills and prescription costs. I feel terrible for you guys reading this post and can only imagine what it must be like to be responsible for a whole family.

    I think about how the hell this country is going to handle health care all the time and like everyone else I have not clue. The thing is although universal health care sounds great do you really want to trust our government to handle the health of your family? The same government that illegally invaded Iraq? The same government that refuses to acknowledge the damage that we are doing to the environment? The same government that endorses “Intelligent Design”? Their solution to depression is probably more church for crying out loud!

    My brother and I started our own business last year (I am a few years younger than Heather and he is four years younger than me) and we just hired our second full-time employee. Although it has been extremely tough we now provide health insurance for both of them (our first employee has a history of breast and bone cancer so you can imagine how that went). I really agree with many of the posters here that short of getting another job the only way to handle these costs is to incorporate the Blurbodoocery. Is it a pain in the ass? Yes. Is it fun/interesting? No Way. But my attitude is that we as Americans have to look out for ourselves as it has become abundantly clear that our government doesn’t give a damn about us.

    Since we set it all up ourselves we would be happy to help you guys out if you want to email me.

    Good luck man.
    Mike Swimm

  • http://dragonlady474.blogspot.com dragonlady474

    I second the motion on the Blue Cross coverage. That’s what we have and they have never hesitated in paying their portion. My Husband has allergies that require regular medication and when we got married they added me on with no problem considering I’ve had cysts and tumors removed AND a few operations. I’d definitely check them out if they are in your area. Also, check with your old insurance, sometimes they will cover you at an increased rate for up to 6 months after you no longer work there. This may or may not be a good deal, depending upon what the increased amount is.