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 6:59 pm
I think it would be helpful for Dems and Independents and maybe “moderate republicans” to rally around this issue and get this done. There are many social justice issues to support and the shotgun approach just won’t work.
December 10th, 2005 at 7:18 pm
I have a great health plan. Easy premiums. No deductible. Guaranteed coverage. It’s called being a Canadian.
My daughter–who is eactly 1 month younger than Leta–was diagnosed with a 12 cm tumour in her abdomen 1 week after her 1st birthday. The day after the ultrasound revealed this beast, were were admitted to pediatric oncology at our regional Children’s hospital. No wait time. Within 3 weeks of the discover of the tumour, she’d had all the necessary test and the debulking surgery. She had an MRI, a CT Scan, and a bone scan and major abdominal surgery. No one once asked me “And how will you be paying for this?”
December 10th, 2005 at 7:36 pm
Our country is in a health-insurance crisis. Premiums are too high, coverages are too low, reimbursements to providers are too low. Too often people are denied even the most basic of coverage and care at anything even approaching affordable. I spent 2 hours on the phone this morning unsuccessfully trying to find a home health care company which would accept a patients insurance to set up home phototherapy for a newborn with elevated bilirubins. This patient has Blue Cross Blue Shield HMO. Not some po-dunk company no one has ever heard of. No home health care companies accept it. Undoubtedly due to low reimbursments.
December 10th, 2005 at 8:15 pm
Was the insurance company called IHC? I hear from the In-Laws that live in SLC that they own everything, and are building a massive hospital in Utah…furthering their wish to take over the world. If it was IHC, it sounds just like them–ruthless…
December 10th, 2005 at 8:37 pm
Welcome to my world and so, SO sorry you’ve had to join our little group rafting down a river called “denial.” Try being a lesbian in the heartland and getting your employer to go with a healthcare provider that will offer coverage to your “domestic partner.”
Hmmm, when you tally up all these “groups” that are denied healthcare, I think you might just about be flipping over into majority rather than minority territory. Mebbe we need a march for healthcare…
December 10th, 2005 at 8:44 pm
Jon,
You might want to check Artist’s Health Insurance Resource Center - http://www.actorsfund.org/ahirc/
What a crappy situation. I’ve been in the no-health-insurance boat for most of my post-school years, and was lucky enough to not need it, but it’s a little scary to have to go without.
Good luck.
December 10th, 2005 at 8:45 pm
A lot of great comments and suggestions. Here is another to help you solve your problem. Think about joining the local Chamber of Commerce. My wife is an underwriter for an HMO and she writes a bunch of group policies for Chambers. I know, before I married her I used to have one because I was self employed.
Many times you just have to join (usual cost should be dues of around $300 a year) and then you qualify for their group policy.
Also, I just checked and you can get group discounts if you are a member of the National Association of Photoshop Professionals. You can join at http://www.photoshopusers.com. Dues are $99 a year.
Good luck.
December 10th, 2005 at 8:55 pm
You guys need to incorporate, and make Leta and Chuck employees
Maybe if Canada ever gets its act together with re-designing its health care system, our big brother will follow suit. (Yeah, right.)
December 10th, 2005 at 8:59 pm
I’m starting to understand how lucky I am… I was born in Norway and I’ve lived there my entire life. And DAMN does the state look after us. Health care is pretty much free (we pay a small amount every time we go to the doctor, but that’s about it.) Serious injuries and hospital stays are always covered.
The Norwegian government is run by a strong “equality principle”: everyone has the right to attend the best universities (we don’t pay to go there) and everyone has the same right to get the best medical treatment. The downside is the approx 40-50% income tax we pay. I prefer that.
Guess this is not much help to you.:-/ Keep on fighting though. It’s tragic that the US doesn’t have a better health care system.
December 10th, 2005 at 9:47 pm
Jon,
I am sorry to hear this very sad news. It is unbelievlable that we face these problems in the good ol’ US of A. If we lived in Malaysia we would have free Dental and Health insurance provided for free but then we could also be publicly whipped for littering.
I work for an insurance company in their wonderful IT department and I can feel your pain. I see how broken the system is and hope that things change soon.
I wanted to let you know that although we only offer coverage in our local area you might check smaller insurance companies who offer individual coverage. Our company offers a plan for kids only, with low deductibles. I wish you all the best in finding a solution.
December 10th, 2005 at 10:36 pm
Is it possible to file an appeal to the insurance company? I am a former pediatric nurse. One of the main reasons I quit and won’t go back is because most of the hospitals and clinics in this state are owned by one company. (Can you say “monopoly”?) Not only that, they also own one of the major HMO’s in this area. Call me a skeptic, but I think that sounds like a conflict of interest. I couldn’t handle the manner in which we were told not only by the insurance companies, but also by our own bosses, who owned the insurance companies, how to treat our patients. I don’t know what the answer is, all I know that like most on here, I think that the whole thing SUCKS!
December 11th, 2005 at 1:23 am
amen! As a post-college student who does not yet have a full time job, I’m paying $130 per month for a semi-decent plan that will allow me to visit a doctor on occasion. It’s a PITA, and I’m jealous of my European friends who have socialized health care. I think we need that in America, and we also need rich people who pay and stop whining.
December 11th, 2005 at 3:18 am
I was in pretty much the same situation….self-employed, history of depression, etc. Here in New York State you can join a local Chamber of Commerce and they HAVE to allow you to buy group health insurance. I’ve got top notch coverage just like a real person.
December 11th, 2005 at 5:38 am
Wow, stressful. Unfortunately I have no helpful suggestions other than to ask if Utah has legislation requiring state paid medical insurance for children like we have here in Massachusetts.
As to the cost, I know it’s sticker shock to find out the real cost of health insurance (ie what our employers actually pay versus the tiny portion we contribute), but someone has to pay. When I was still living in Canada, I paid the same monthly premium that I do with my current job (yes, there are health care premiums in Canada) plus my total taxation burden was 55% (income taxes + sales taxes). And it took weeks to book an appointment with my doctor, months to see a specialist etc. My father’s family is Norwegian, and their socialized health care system also comes with user fees and an even greater taxation burden. The difference is that while they cost the same, no one can be denied access due to pre-existing conditions.
I believe whole-heartedly in equal access to health care for everyone, it’s the right thing to do in a civilized society. But we’ll all still have to cough up that “second mortgage payment” in one form or another whether it be through direct premiums or via taxation, because health care is expensive and someone has to pay for it.
And one tiny grumpy note: I find it really disturbing when people compare the cost of health care to the cost of cars or other consumer goods. No one needs two brand-new SUVs or Pottery Barn furniture, but everyone should be spared the burden of fear that they will get sick and have to declare bankruptcy.
December 11th, 2005 at 7:09 am
I’ve been a bit of a lurker, but I wanted to jump in on this one. First of all, congratulations on leaving your job. My husband was a freelance graphic designer when we got married, and I was a teacher’s aide (read: We were amazingly poor but happy). Then, we had a baby.
Fortunately, I had insurance through my job for this event. However, the coverage for myself and our one child was my entire paycheck. Plus, we just couldn’t make ourselves do the daycare route. We wanted to raise our child our way. So, we decided I would stay home and my husband would get a 9-5 job since he could make more money than me.
We tried very hard to find ways for my husband to continue to just freelance with me at home taking care of our baby, but we couldn’t really do it. I do recommend to you that you find an insurance broker who can shop around to many insurance companies and get you some different options. And, if worse comes to worse, you can get catastrophic health insurance. This is what my husband had while he was freelancing. He was a healthy guy, but he also skateboards. So, he needed some coverage. Catastrophic is easy to get. They don’t really any ask health questions.
Good luck. Insurance companies suck. We hate them too. Even though we were fully covered for the pregnancy and birth of our son, we still paid an arm and a leg.
December 11th, 2005 at 9:32 am
jon, this makes me cry.
i hope that you’re able to work things out and get some health coverage for a decent price. this whole thing is fcked beyond belief and it makes my liberal heart bleed a bit more.
December 11th, 2005 at 9:40 am
I read somewhere (sorry, no links I’m lazy) that most American bankrupcies are caused by health care costs. No surprise there.
That said, I have to echo the commenter who mentioned NASE. I used them for health insurance while I was freelancing, and while it ain’t cheap, it’s worth exploring.
December 11th, 2005 at 10:08 am
We pay $685/month here in NYC for a family of 3 and have had no claims at all other than office visits in 10 years, except one pregnancy.
I guess that’s 3 car payments tho, right?
December 11th, 2005 at 10:09 am
So sorry to hear your story, and unfortunately it’s all too common. I hear these stories almost daily from patients. I don’t know your history, but if you have any military service, you’ll be able to see someone at your local VA. (Sometimes patients forget about this.)
There appears to be a free clinic in Ogden: Floyd W. Seager, MD Memorial Clinic. And here’s the association of community health clinics in Utah: http://www.auch.org/
December 11th, 2005 at 10:45 am
Regarding the realities of health care costs and the fact that someone has to pay for them–something I’d like to point out: while we don’t have a 50% taxation burden for health care, most of us pay a lot more in taxes than we can really afford, and where do they go? I think there would be fewer complaints if our taxes were going towards our own health care and education (read: our taxes would be benefiting us). The government takes about 30% of my 26K each years (and I don’t get nearly half that back)–it’s not cheap and I barely support myself (I do live in expensive area, not really by choice). But I’d be fine with that knowing that I don’t have to worry about extra, unexpected costs adding to the burden of living paycheck-to-paycheck. Wanting health care reform doesn’t mean not wanting to pay for health care at all; it means wanting our taxes to be used for us. Hell, I’d let the government take 40% of my paycheck if it meant things like universal health care or fewer people starving in this country. And since “somebody” has to pay for health care, isn’t it logical to say that those who have more money should be taxed more in order to pay for that health care? If the money is a need, and they have the money?
December 11th, 2005 at 10:58 am
I am truly a stalker, I have been living here all weekend…
Here’s the thing: we are in desperate need for tax reformation. The proportion of taxes paid by corporations has gone down by 2/3 since the 1950s, which has shifted the tax burden on to working people and small businesses. Yet we continue to give bizarre tax incentives to businesses so they can create more minimum wage jobs- most of which do not offer decent affordable health care! This has led to crumbling infrastructure in things like education and HEALTH CARE. This situation will not get better until the tax code is changed, period. And there is no reason that the typical 9-5 worker should have to pay a greater percentage of his/her paycheck- we all paid more than GM did last year. Not only that, we’re wasting $60+ billion per year on a futile, endless drug war and even more untold billions on a futile, endless war in Iraq.
Juli is absolutely right when she says we need a march for healthcare! That is the best idea I have heard in a long time. Obviously, there are a lot of people touched by this, so it doesn’t seem like it would be too hard to get enough people to D.C.
I bet we could get the Robert Wood Johnson Foundation to sponsor us…
December 11th, 2005 at 11:50 am
Two things:
1. I’m grateful to be Canadian.
2. This has the be the most useful comment run I’ve ever seen. You people rock! Hopefully something can be of use for your family, Jon.
December 11th, 2005 at 12:12 pm
My husband had back surgery 2 years ago which has prevented us from being able to gain health coverage.
What I have found to benefit us and help cover expenses for our prescriptions is International Benefits Association that’s brought our expense down to $35 per month for prescriptions. I am on one that costs $280 without insurance - husband’s cost $150 without insurance per month.
Other examples of what we’ve paid so far:
Doctors office visit - normally $98 - we pay $32
We have four kids between us - all are listed on our coverage. They don’t ask questions, pre-existing doesn’t matter. It’s a whopping $59 per month for this peace of mind.
It may not be the best, but it sure beats what we were paying.
You can find more on this coverage here:
http://www.bronsonhealth.com/content_long.asp?menu=A7
I highly recommend this coverage for anyone who has nothing or needs something to help offset their high deductables.
Hope this helps
Gayla
December 11th, 2005 at 12:35 pm
My only hopw is that the Baby Boomer generation, who is known for their “squeeky wheel” ways (I say that in a GOOD way) will be the driving force in changing the health care system. I believe that generation will not stand for the poor health care benfits that will beseige them in the near future…
December 11th, 2005 at 12:49 pm
Amen creativity and genius. Sacrifice, I’m not so sure about. I sacrifice more than enough to the government already, with litle in return.
I’m neither creative, nor a genius and am entirely unable to answer the questions below, but am going to pose them anyways:
- Who pays for the transition costs to whatever miracle universal health care plan? They will be enormous, putting the transition costs that were discussed earlier in the year regarding the partial privatization of social security to shame ($2 trillion).
- How do we ensure that we maintain the highest quality of care? Maintaining those high R&D levels will be tough for companies that know they’ll be receiving a big fat check from the government, as long as they maintain the minimum quality required by the government. It’ll become a volume operation.
- How is medical malpractice addressed? We can’t have our cake and eat it too. One of the primary contributors to rising health care costs are the high insurance premiums due to the plethora of malpractice suits. Additionally, the threat of malpractice ensures that doctors/hospitals run the entire gamut of tests, necessary or not, further increasing costs.
Again, no answers. Just questions. Is it needed, absolutely. Am I leery of anything that has the potential to increase the size and power of the government, hell yes.