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 12th, 2005 at 8:11 pm
Al,
That makes no sense.
Does that mean that if you don’t agree with any of the laws in this country, you should leave, too?
By the way, 60-70% of Americans say that they want to universal health care as long as they don’t have less access to doctors than they have today (which, would be pretty hard to do).
So that would mean you are in the minority and should probably be looking into buying luggage.
December 12th, 2005 at 9:14 pm
Hibiscusfire - Where did you find that 60%-70% statistic? Just curious.
Speaking of statistics/leaving the country… I’d like to know how many people actually left the country (like they said they would) after the 2000 & 2004 election.
December 12th, 2005 at 10:29 pm
Marcus,
Here’s the link:
http://abcnews.go.com/sections/living/US/healthcare031020_poll.html
As I said, 60-70% as long as they don’t see a decrease in access to care. (Numbers drop if people are told that they will have less access.)
You can get a lot more info on different universal health models (contrary to common beliefs, they are all very different), if you google “2003 Commonwealth Fund International Health Policy Survey”.
December 12th, 2005 at 11:39 pm
Hibiscusfire,
Since the information on that site is a little over 2 years old… I wonder if the numbers would be the same now. Plus, only 1,000 people were polled. 1,000 out of a country of (as of 7/1/03) 290,788,976 people*. I wonder what the other 290,787,976 people think about it.
I’m not trying to argue or discredit anything but polls shouldn’t be taken as the gospel truth. Especially when they only poll 1,000 out of a popultaion of 290,788,976. Besides statistics can (and usually will) be manipulated to show whatever the people gathering them want them to say.
Anyway, I really do appreciate the fact that you were able to back up what you said. A lot of people do nothing more than just talk and cannot produce the facts to back up what they say. I’m glad you were able to.
“This ABCNEWS/Washington Post poll was conducted by telephone Oct. 9-13, 2003, among a random national sample of 1,000 adults. The results have a three-point error margin. Fieldwork was conducted by TNS Intersearch of Horsham, Pa.”
* http://tinyurl.com/dzwsz
Merry Christmas!
Oh, and I hope Tookie rots in Hell. (sorry for straying off topic)
December 13th, 2005 at 3:10 am
Marcus,
I could wager a guess what 45 million* or so think about it.
Happy Holidays.
(I believe Christmas is on the 25th?)
(Or maybe executions bring out your holiday cheer?)
*http://www.uschamber.com/publications/weekly/update/040831.htm
December 13th, 2005 at 7:28 am
Had to share my two cents, as I am in a unique position with regard to health insurance coverage. I work for the State of Wisconsin, which has OUTSTANDING health insurance coverage. $55/month for family coverage, only out of pocket is a co-pay for emergency visits and minimal drug co-pays. I have a 2 year old daughter whose entire delivery (emergency c-section) and pyleoplasty (removal of blockage in kidney) were COMPLETELY COVERED BY OUR INSURANCE. My husband’s cataract surgery a couple years ago was also COMPLETELY COVERED BY OUR INSURANCE. All my doctor visits related to depression are COMPLETELY COVERED BY OUR INSURANCE. It is a blessing that has become increasingly valued as our family has grown. I recently changed jobs to spend more time at home with my daughter; I now work part time, still for the state, and am able to retain my insurance coverage with no changes in premium or benefits. It is the best gig out there, by far.
However, when my husband and I attempted to get life insurance for our daughter outside of what was offered by our employers, it was denied. By Gerber, the famous $1 a month premium life insurance company. Also by Minnesota Life. The reason for the denial was her pyleoplasty, despite the fact that she was fully recovered and there are no anticipated problems in the future resulting from the condition. This was a wake up call for us, and made us realize that if it is this hard to get life insurance, it must be nearly impossible to get and/or afford health insurance with ANY pre-existing conditions at all.
Furthermore, my mother recently was laid off and my father is self-employed. They have been paying over $1000 a month in health insurance premiums while my mother is trying to find a job with benefits. What a crummy situation to be in. While I would love to be able to quit my job and stay at home full time with my daughter, this will never happen as we simply cannot afford to give up the health insurance benefits that we have.
This is a huge issue for our country and one that needs to be dealt with by our leaders immediately. Until then, Jon & Heather, see what kind of bennies the State of Utah offers; perhaps one of you could get a part-time position with benefits? Alternatively, and this isn’t a great option but one my mother is considering, get a part time job anywhere (gas station, McDonalds, etc) that offers benefits. While it may be demeaning, the benefits may outweigh the negative aspects.
Lots of love and good luck.
December 13th, 2005 at 11:53 pm
I guess Jon nuked my response to Hibiscufire (comment #130). I’m not complaining though. It did stray a little from the original topic.
It was a marvelous response though… (Good thing I still have a copy of it.)
December 14th, 2005 at 1:35 pm
I had a similar situation, only I was flat out denied ANY coverage. I finally got a plan with Blue Cross, but I had to agree to forego coverage for any medications. I totally agree with your rant and we need a BIG time revamping of health care in the US (super power…yea, right).
December 14th, 2005 at 3:58 pm
Hey, I’m diabetic … but I should be able to get coverage, as should someone with cancer. What we need is a health care system, not better or more widely available health insurance, though that would be a start.
December 15th, 2005 at 6:22 am
I see you already have a couple of comments from/about Norway. I am an American who has lived in Norway for most of her life. When I talk to my American relatives about nationalized health care, they balk, and they worry about germs, waiting lines, and TAXES.
Norwegian hospitals are clean, friendly and efficient, and the corridors we stick our patients in have paintings on the walls. But you get in. Free. And if it’s an emergency, there’s no waiting. The 40-50% taxes mentioned are not just income tax, but also miscellaneous fees and a sales tax of 25%. It’s not like you walk home with only half your paycheck.
I wish Americans would get over their fear of letting the government handle some things (like ensuring its entire population can actually read and write, and has good health; that would benefit employers, too). Think about it: Spending a lot of $$ on health insurance you may or may not get or that requires you have a (full-time) job out of your own pocket, or paying a bit more in taxes and being guaranteed a bed in a hospital and subsidized meds for chronic illnesses.
I’m happy to see this discussion. I think it’s about time the US stopped acting like a third-world country. That said, I was struck by the ingenuity and creativity in many of the suggestions given for how to manage the current situation, as well as all the sympathy.
Stay well, no matter what, ‘K?
December 16th, 2005 at 12:46 am
Wow…it’s quite unfortunate that there are so many others like myself fighting the neverending insurance battles. As I sit here reading almost every blog posted, I begin realizing just how problematic medical insurance can be on all different levels.
I actually came onto this site to seek advice, but have yet to come across a situation similar to mine. Here’s my current dilemma…I’m a 24 yr old female who has never went without medical insurance, UNTIL december of 2004 when I left my employer to go back to school full time. Before that, Kaiser remained consistent as my health care provider while under my mom’s policy and when I switched on my own. Unfortunately, I overlooked the need to keep an insurance plan while in school-Bad thinking on my end. In result, my mother had no choice but to pick me up under her insurance, but we all know how long that process takes for benefits to kick in…90 days or longer! January 1st 2006 is when I will be officially insured in Kaiser’s records! Sounds soon enough right? WRONG!!!
This past Saturday the 10th, I experienced thee most excruciating abdominal pain i’ve ever felt before. A friend rushed me to Kaiser Permanente where my mother frantically awaited our arrival. We then preceded to the emergency room to check in, which at that time was a few minutes after 6:00pm. By 10:45pm I was in a gown, waiting in a room for a doctor to see me. After a couple IV’s, a CATSCAN, an ultrasound, a vaginal exam, some morphine, and 3 doctors later I was finally told that I had a 7cm cyst on my right ovary causing the ovary to twist & lose oxygen.
Surgery was the only given option in order to salvage my ovary so indeed my mother agreed to it. No more than a few seconds after the doctor left the room, we were hit by an onslaught of paperwork which stated our obligation/responsibility to pay all entire hospital fees including surgery of course.
Now this absolutely kills me…please explain to me how the hospital already has all my current information including insurance membership identification # stored in its computer, BUT due to the fact that it says “pending till January 1st 2006″ they can’t honor it???? C’mon people, it’s less than a month away and it was clearly an emergency, it’s not like I was impatiently scheduling an appointment for this month! What can be done in a situation like this? This bill is not going to be cheap whatsoever. Merry Christmas to me huh?