Denied
December 10th, 2005We’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?
December 10th, 2005 at 9:33 am
First, for Leta
http://www.cms.hhs.gov/schip/stateplans/state.asp?state=ut
This falls under the Medicaid program and insures children under 19. No cost to you and the co-pays are usually $2-5.
For you and Heather, an association might be the best way to go, but will still be expensive. I suggest you work with a high deductible plan, perhaps an HSA. Consider excluding pre-existing conditions from your coverage (PPD and the cornea transplant) to see if can get your rates down.
You’re both writers, look into writing grants for health insurance. How about a part time job that offers benefits? Our local grocery chain offers health insurance to part-time checkers and baggers.
Or you could move to Canada. Or join Scientology, you KNOW all you need is the right vitamins.
December 10th, 2005 at 10:06 am
Ooooh, what a subject. This one boils in my gut every time I think about it.
I’m essentially uninsurable (chronic — not terminal — illnesses do that) so I’m going to be stuck in corporate hell for the rest of my life or at least until something is done about the insurance situation in America. My wife and I have already been turned down for life insurance, and if I ever go more than 30 days without health insurance it’s pretty much guaranteed I’ll never be insured again unless I can trick a company into hiring me without revealing my illness. With so much “innocent, just for information purposes” questioning of health during job interviews nowadays I think I may be screwed. Even HIPAA isn’t going to help me.
If it costs three car payments to pay for insurance, sock away two car payments a month into a money market account (I recommend virtualbank.com) and after you have a decent amount built up start socking money away in investments that either mature quickly or can be liquidated with minimal fees. It’s time to get creative with health care $$.
But hey, as long as we can pay billions to keep killing people in a pointless war, who cares how badly we rot at home? It’s all worth it… Universal health care isn’t anywhere near as important as chasing ghosts.
..cough…
December 10th, 2005 at 10:29 am
Jon–I agree with mamapajama about the HSA + the high deductible plan…it is a viable option as long as you qualify for the high deductible plan. We decided to go that route while my husband was self-employed and I was working in an hourly wage no benis job. My son and I qualified but my husband who had surgery on his shoulder after being injured in a car accident (it just so happened that it was within a year of us applying for coverage), didn’t qualify. He went without insurance for a year until I found a position where my benefits covered him. Scary…especially since our deductible for our family (me + baby) was $4000. Gulp. It is completely ridiculus that is has to be such a gamble.
Despite now having a secure position at a small liberal arts college where life usually seems blissful, the conversation of health care costs rattles the campus every year. This past year our premiums were initially proposed to go up 24%. The college expects an 8% increase yearly so the difference falls to us and straight out of our paychecks. Luckily there was some successful wrangling and the premium increase was negotiated down to 10%. Geez only 10%..for family coverage that is an extra $1200/year.
Best of luck.
December 10th, 2005 at 10:58 am
Don’t laugh, but Sam’s Club (WalMart) DOES offer health insurance. I had trouble getting coverage that was affordable in Texas and found the best plans through the Sam’s Club web site.
As someone with chronic illness…I agree with your comments.
Good luck!
December 10th, 2005 at 11:03 am
As long as you set yourself up legally as a small business, you can generally find coverage among groups that specialize in bringing small business people together into insurable employed groups. Ask your friends who are musicians or self-employed - they know all the tricks. I got mine through a company called SBSC, but this is in New England. They didn’t ask for any prior medical info or medical recrods. I just had to join the small business association, plunk down my premium ($250 a month for a single healthy 30 y/o woman!), pick a PCP, and I was covered under a major plan.
The ones that don’t cover meds are much cheaper, btw, but depending on the meds needed… it may be worthwhile to cough up the extra. However, I’m a psychiatrist, so I’ve worked a lot with patients in getting the free medicine from the companies, and as long as your insurance doesn’t cover meds and your income is below 150% of the poverty level (you can subtract medical costs and prescription drug costs from your income to get below the 150% level if you don’t make it there on your own) you will get free meds. The bummer is most of the companies have separate paperwork and systems with similar guidelines, and it takes tons of paperwork from your doctor, which you don’t really get if you are uninsured, so it doesn’t quite make sense, but that’s not unusual.
December 10th, 2005 at 11:08 am
Hi Jon–
I am sorry to hear about your situation. The previous posters have great suggestions. I am a physician, and I have uninsured patients see me all the time. This is what I do for them: I try and get them free meds, Pfizer has great programs as do other major companies. I am inundated with samples that I end up tossing because they expire. Don’t be shy in asking for free meds. All I ask from the people is a quarterly office visit to document the need for the meds.
As far as insurance coverage, I pay an arm and a leg for Blue Cross PPO insurance. But it is so worth it. We are a healthy family too, and rarely utilize our benefits. But, in a way, I feel my thousand+ premium IS paying for those who need it, the other members.
Anyway, if there is any information I can help you with, please email me.
December 10th, 2005 at 11:11 am
Being uninsured sucks…I have been uninsured/underinsured on and off for the last 4 years. When I did have insurance I used to joke that it was “lion tamer” insurance because it basically only covered lian attacks.
Anyway, I don’t know a lot about health insurance, but I do know a little bit about incorporation, being an unemployed attorney and all. If you want to look into incorporating, check out findlaw.com. They have a whole section for small businesses, including I believe, forms. To incorporate in Utah, go to http://www.utah.gov/services/business.html. Also, some law schools may have business law clinics that can help small businesses wade through the forms and red tape. You usually have to pay a small fee, but the students deal with all the government bull shit, so it may be worth it.
Good Luck
December 10th, 2005 at 11:16 am
Your post resuscitated a lot of rage in my household about this topic!
I’m in the same boat as you: left my last job voluntarily, opted not to pay the exhorbitant COBRA rates, and now without coverage because I was denied when I applied for an individual policy. I recently learned that California is, in insurance terms, an all-or-nothing state, meaning that an insurer can’t say “we’ll cover you for everything except A or B” like they can in some states. They have to cover you for everything, and if they don’t wish to they may deny coverage. So the stories like yours (and mine) abound. I just learned that my doctor’s husband was denied coverage because he was treated for a kidney stone several years ago. A kidney stone. Otherwise completely healthy.
What was equally upsetting to me is that if I apply to another carrier for coverage I now have to declare that I’ve been denied insurance. Most carriers give you an opportunity to offer an explanation of the denial, but the fact remains that I’ve got the equivalent of a stain on my insurance record, because my doctor prescribed a medication for my migraines that works but is expensive and raises a red flag for insurers.
The other comment I wanted to make is that some freelancer organizations do offer insurance coverage, but that offer isn’t a guarantee of coverage like one might get with an employer. All their “offer” means is that IF you pass muster with the insurance company you may be eligible for the group rates.
It’s a huge mess. I’m lucky to have doctors who are just as outraged as I am and who have given me rather steep discounts after I told them that I’m covering my own costs. You might discuss this with your medical providers, too.
December 10th, 2005 at 11:44 am
Dude,
Add me in as another voice in the “MuthaF***rs!” chorus - The difference being that I suckled from the teat of the devil, so to speak, for five and a half years (helped people get health/car/home insurance that was better, not good, but better, for them). Believe me when I say that a) I’ve seen this happen to many, many families like yours, which SUCKS ASS b) look into the option of starting a “small business”/group plan - they actually have to take you, regardless of your health. Oh, and c) it is much, much worse when you KNOW how evil they are - they truly do NOT care about people - so many times I’d be “fighting” for my clients with these brainless corporate idiots who would read off Section 2343A over and over, without having a friggin’ CLUE what the hell that would mean for my clients. A few times I just said, “DO YOU REALIZE YOU ARE TALKING ABOUT A HUMAN BEING?” - sometimes it helped. You might also want to see if you can get on some sort of temporary (short-term) plan just as a CYA until you get the real thing.
Oh, and one more thing: YEAH HEATHER! I told my husband that we must pick up this month’s Glamour asap.
December 10th, 2005 at 11:49 am
Wow - this is so scary. In Canada, a recent Supreme Court decision (Chaoulli v. Quebec) said that privatising health care might make it more accessible. I wish someone could forward them your story.
December 10th, 2005 at 12:07 pm
You may not need to go through the expense and hassle of incorporating (although being an S corp does offer certain legal advantages if you’re ever sued). Take a look at the sole proprietorship structure. It’s relatively cheap and easy, and you can always convert to an S corp later. List Heather as the principal & that might open up other association options like the National Association of Women Business Owners. HTH!
December 10th, 2005 at 12:28 pm
Wow. I didn’t realize how many people were going through this. I’ve just been denied by Blue Cross and Kaiser and am currently writing an appeal. The reasons I was denied? Depression and polycystic ovarian syndrome. The depression has been successfully treated for two years and my meds are generic. Everyone and their mother has PCOS and all it really means is that one needs birth control to regulate things (because, I’m twelve, and “period” just sounds like a dirty word). I read an article recently about depression being the number one thing that individual insurance companies won’t cover–in fact, even if you had a prescription for prozac ten years ago and aren’t on it currently, they’re likely to deny you. They don’t want any history of it because you know, depressed people are crazy, and fundamentally not good people. Appeal letters do often work if your doctor provides the right documentation–I’m crossing my fingers. I would try writing an appeal if I were you–it can’t hurt.
I don’t mean to start on a negative note–rather, I’m just empathizing with you. And the fear for you must be greater because you have a child. I’ll be joining you in writing my state.
I do have short-term catastrophic insurance which isn’t cheap, but it’s doable. And, given that I needed stitches two weeks ago and my catastrophic insurance covered them entirely, I’m glad I have it (it would have been $700 otherwise).
I’m not so sure you’re in the minority so much as the majority doesn’t hold the power in this country. Isn’t there any way of organizing something like a grassroots letter-writing project through the internet? Seriously, you have a ton of readers and things get linked all the time–and there are A LOT of us in this country who don’t have health care and want it. Especially those who don’t have health insurance but work full time and aren’t self-employed (read: I’m an adjunct–great profession!–I have no options). What if we were all writing even just one letter a week? I know it takes time but…is it worth a shot?
Anyway, perhaps I’m young and idealistic but what if all of us who read your website starting writing letters, and what if all of us who had webpages linked to your website? And good old-fashioned word-of-mouth should work too. It’s not as though change would come quickly but even if it takes fifty years, isn’t it worth the effort?
December 10th, 2005 at 12:45 pm
I have no insurance. My kids do, and that is only because NYC is part of New York. I pay $18 a month to make sure my kids can see a doctor, which is nice. The only insurance I qualify for (free or low enough for me to afford) is either family planning or pre-natal care. I got a tubal ligation and no longer can get insurance. the only time I have been insured is if I was knocked up. That is almost an incentive. Almost.
Insurance is a whole bunch of bullshit, for the people the doctors…everyone BUT the dudes sitting in those big leather chairs collecting a big check. AAAAHHHHH America. land of the free and fuck you if your not rich.
December 10th, 2005 at 2:25 pm
Because I was signed up for graduate school, my surprise gallbladder attack and subsequent removal cost me and my parents NOTHING (might be that great UAW-negotiated healthcare GM complains about). Had I not been signed up for school “in case” I couldn’t find a job, it would have been upwards of $15,000.
A dear friend, only 22 and recently booted off of TennCare, broke his leg right before Thanksgiving and the outpatient repair a week later cost him $45,000.
Health insurance is crazy. Leta likely has options with the state, so I’d look into those. If BYU doesn’t offer alumni plans, BCBS seems like a good, basic plan to go with but be forewarned that they want nothing to do with Heather’s reproductive system.
Best of luck.
December 10th, 2005 at 2:46 pm
Not to throw gas on the fire but there is another battle front that requires serious attention.
In California (possibly other states), companies have been firing employees who have refused to quit smoking. Non-smokers have been FOOLISHLY applauding this as if it will never affect them.
What they don’t seem to grasp is the official reasoning behind being fired: it’s not to create a smoke free environment, but instead it’s because smokers may cost the company more in insurance premiums if they don’t quit. This is not conjecture, it’s the official reason given for dismissal.
Basically it boils down to this: you can be fired if you’re going to use your health insurance for more than just routine checkups. Considering that gainful employment is probably the #1 source of “affordable” health care, this should get EVERYONE’S panties in a serious wad, even those worn by non-smokers.
If anyone out there lives in an area where things like this are happening, raise hell.
December 10th, 2005 at 3:22 pm
As a Canadian who continues to enjoy universal health care, you have my utmost sympathies. The Canadian government is hell bent on privatizing health care and this scares me to no end because the doctors of course support this…it means a lot more money for them and insurance companies are salivating at the prospect of making billions here. We’ve already privatized alot of the non-medical health care services and we’re finding these private companies really suck at cleaning, making hospital food, laundering, etc. Hospitals are becoming filthy places. Workers are no longer unionized and they are underpaid and furious. As long as I’m alive I’ll fight to save the universal health care system. I sure don’t want to face what you’re going through down there.
December 10th, 2005 at 3:33 pm
This may be outlandish - or just ahead of it’s time, but:
Bloggers are organizing more and more, coming together, developing professional relationships - thus establishing this as a valid profession.
Now, what would it take for professional bloggers to establish their own organization (functioning like the actors guild) something that could eventually provide reasonable benefits for working bloggers?
Neccessity is the mother of invention, no?
December 10th, 2005 at 3:38 pm
P.S. I pay $35 a month in an insurance premium to the province I live in. My employer matches that contribution. This amount provides me with total medical coverage for all basic care (which is pretty much everything except cosmetic related surgeries or interventions) and 80% coverage for all my prescription drugs, physiotherapy, massage, chiropractic, naturopathy, and some alternative medical interventions (like acupuncture). If I get pregnant, I’m not paying to have my baby. If I have a heart attack, I’m not paying any more to have the surgery, but I may have to pay something for the after care…depending. If, at the end of the year, I find I have paid 3% or more of my gross income on medical expenses that aren’t covered by the plan (like aftercare, for example), I can claim it as a tax deduction. When my mother was dying of cancer, she not only received palliative care at home, but phenomenal in-hospice care. All of this was covered by Ontario health care plan. In the hospice she had four doctors and five nurses attending her. The hospice also provided social workers, a priest, counselling psychologists, and other services for the family. I was able to move in there and live there with my mother. I paid nothing for this. The gov’t covered it. This is the Canadian system. It’s also like this in the Norwegian countries and I believe England and Germany have similar programs. We pay higher taxes in Canada so that we can have decent education and good quality health care. People bitch about taxes but really, it’s a good deal in the long run and everyone benefits from it.
December 10th, 2005 at 3:39 pm
on incorporating - i hear that you can benefit more from doing so in certain states and i believe Texas is one of them. i don’t know what that would take, but it might be worth looking into.
December 10th, 2005 at 4:21 pm
The whole concept of insurance will inevitably lead to the debacle one sees here. Any industry that is infiltrated by insurance INEVITABLY ends up with a product that is
a. Too expensive for a regular person to afford because
b. Prices shoot up enormously as every person in the chain from you to the product cashes in
How is this system sustained? On the backs of those who pay more than they get out of the system. Multiplied by MILLIONS of policy holders this translates to BILLIONS of dollars of profits into the hands of: doctors - hospitals - medical equipment manufacturers - pharmaceutical companies
What is the cure? Nothing less than ABOLISHING insurance. There are no “tweaks” that will make the problem solvable in the long term. Canada has it good for now but their system will break down too.
If insurance was abolished:
1. Almost nobody could afford to go to the doctor
2. Doctors and hospitals would start to go bankrupt
3. Pharmaceutical companies would start to go bankrupt
4. Medical equipment manufacturers would start to go bankrupt
…
5. People would start to change their lifestyles - more exercise, less fat, fewer chronic “rich fat person” diseases
6. Doctors would lower their fees
7. Hospitals would lower their fees
8. Medicine prices would plummet
9. Prescriptions would be required only for the most dangerous drugs
10. Billions of dollars would be back in the hands of millions of people and out of the hands of a few thousand fat-cats (doctors, dentists, big pharma, insurance companies)
December 10th, 2005 at 4:36 pm
From 1984 to 1996 I tried my hardest to afford health insurance for my only child…. and myself…. While I worked at home. We were turned down by EVERYONE…. then Oct. 29th 1997 she died of a heart attack…. from a genetic heart defect…. Because we did NOT have health insurance doctors wouldn’t run test to find out why she kept having “seizures”. I remember the “Clinton” days and his promises… which amounted to NOTHING! I dislike, no hate insurance companies! I hope one day there is health insurances for all Americans…. no questions asked…. Good Luck!
December 10th, 2005 at 5:22 pm
Sam’s Club offers health insurance, although I am not sure if you have to have just the Sam’s Advantage Plus card or just the normal one.
Also, Blue Cross/Blue Shield used to have a PPO program tailored for the self/independently employed. Coverage for The Boy and I ran $150/mo., and covered his excessive shots, which was all I was interested in at the time.
I kid you not.
On the first day of school, when you have to bring copies of your child’s birth certificate and shot record, all the other mothers had an index card listing their kids’ immunizations. The Boy and I had TWO 8 1/2 x 11 sheets of paper, with listings on three sides.
Our pediatrician is neurotic, apparently.
December 10th, 2005 at 5:26 pm
Oh! And I almost forgot!
You might also look into Utah’s version of CHIPS, the federally subsidized children’s insurance.
Even if you are denied, they provide a list of lower-cost insurance options you could explore as options for Heather and Leta, at least.
It’s sad that insurance in general, but health insurance in particular, has become a form of legal organized crime. ** sigh **
December 10th, 2005 at 5:34 pm
Correction on my earlier post - it’s the National Association of Female
Executives that offers a variety of insurance benefits to members, not NAWBO.
My apologies. Gotta lay off the eggnog.
December 10th, 2005 at 6:43 pm
This is something I’ve been worried about for a long time and I grow more worried by the day. My husband and i are doing FINE financially and are insured thru his employer. But I am 38, and in the last 10 years we have had SEVERAL catastrophic illnesses that could have been the difference between making it and declaring bankruptcy: preemie twins, Hep C treatment, a huge spine surgery (the latter 2 as a result of a scoli surgery in the 80’s). We’re unusual in that we’ve suffered all this so close together and so young, but also in that we have been able to deal, so far. It is sheer luck that we have been able to take out loans to cover the difference in what was covered by insurance (lots) and what we owed (also lots).
I can’t even get started on the “conservative” mindset on this– it’s more expensive for everyone to fix illnesses rather than pay for preventive care.
Thanks for the post.