Now that Aaron has this (ever-so-temporary) contract job, we thought it might be nice to have some health insurance again for the two of us. I researched all of the private insurance plans out there, mostly disgusted with 1. how expensive they were and 2. how little they covered. I finally chose one that seemed to be a good balance of cost vs. coverage.
When I first spoke with a customer service rep, I expressed concern that they would try to stick us with a bunch of riders to prevent coverage for anything useful. She assured me that as long as Aaron and I were relatively healthy people, there probably would be few changes from our medical review.
Apparently we differ in our definition of “relatively healthy”.
I provided a very thorough medical history for both of us, leaving out nothing. Every detail was included, from lab values to drug lists. I considered us relatively healthy. I can’t remember the last time Aaron went to the doctor for something other than an annual physical. I’ve had some minor problems (moles removed, sinus surgery, etc.), and we’ve both had minor issues with depression.
They insisted on bloodwork for Aaron because it had been over a year since his last physical. A nice tech came out to our house to do the bloodwork, remaining vague on if we will ever see the numbers. After waiting two weeks to find out the state of our health insurance (while they were still taking money from our bank account, of course), we finally received the offical certificate.
Included with the certificate were several riders. We were both denied any mental health coverage, including medications. (Note to others: if your doctor offers you antidepressants for anything, give serious thought to taking them. If you’re ever forced to pay for private insurance, you might be denied or limited based on this one decision.) Anything dealing with previous conditions wouldn’t be covered for 6 months. I would have to pay a $500 deductible for any prescription medications instead of the standard $150. And Aaron was completely denied any prescription drug benefits.
That last one puzzled me, so I called for clarification. “Well, they probably denied him because he is taking a very expensive medication.”
“But he’s not taking anything at the moment.”
“Oh, well, he must have taken expensive medications in the past then.”
“Nope. He’s taken one prescription medication, and it’s the one I’m currently on, and I wasn’t denied.”
“Well, then, there must be some other reason that they determined he was a poor financial risk for prescription medications.”
“I’m confused. He doesn’t take any medications, and prefers to not take them unless necessary. My history, on the other hand, shows I’m a walking formulary of drugs, yet I’m still being offered benefits.”
She paused and I could hear the clicking of computer keys. “It’s possible he was denied prescription benefits based on his bloodwork.”
I explained that I needed to know the results of that test, and was promptly told no. I applied a little more pressure, and convinced her to at least tell me what values were outside of normal. But she would not give me the actual numbers, so really, the information was pretty useless. I mean, one point over normal is nothing but would still result in a high reading, but way over the normal values would be more serious.
I was told that I could submit $25 and a written request to a mailing address and might get a copy of the results. Apparently since they paid for the test, the insurance company isn’t required to release the results to us. Screwed up, isn’t it? I’m hoping we can get the results to determine if there’s anything we should be concerned about.
(Which, if he does have a problem, how jacked is our insurance system that they would rather treat more serious (or life-threatening) complications of a condition via hospitalization rather than pay for the medication to keep it from becoming serious?)
We decided after all of the limitations, we’d be paying $300 a month for practically nothing. I canceled the policy and will instead put that same amount of money into a savings account each month. Contrary to the insurance company’s belief, we’re both relatively healthy and will likely not need much in the next 6 months. (Knocking on wood furiously…) At that point I’ll graduate and will hopefully find a job with full benefits again. (Wait – need more wood to knock on now…)
If we do need anything, there are Minute Clinics and the like that charge a small amount to get minor illnesses taken care of. Our doctors will also accept a smaller cash payment to be seen.
I never thought buying private health insurance would be so difficult. Makes nationalized health care look dreamy. (I’m looking at you, Canada.) Here’s hoping the next administration can figure out a solution – or at least the beginning of a solution – to our screwed up system.
There are so many things wrong with this that I don’t know where to begin. The big one is withholding the test results from you. That is a HUGE no no. Heck, I had a doctor’s office refuse to tell me results, and I told them I no longer needed their services.
I’m not sure which agency this sort of shenanigans gets reported to, but I’d look into it. Good luck guys.
HEAR, HEAR! I’m assuming you’ve seen the movie “Sicko”? By Michael Moore. If you haven’t you must. It’s like you said, you’re not even sick and you are being denied coverages. I’m rooting for national health care, too.
Hopefully the Mental Health Parity law that was passed recently will make health insurance for mental illness more equal and reasonable. Private health insurance is so messed up. I had a friend denied because she was taking birth control pills to regulate her period, but wasn’t having sex so they denied her.
I so understand. My husband is self-employed so we have been dealing with private insurance for 5 years. We recently switched this month to a High Deductible plan which has saved us quite a bit on monthly premiums. However, our 2 year old has a speech delay (like Mira) and has had 6 months of speech therapy provided through the state. When I filled out our insurance application last month I was honest and mentioned this. Now we have a rider on our policy that he won’t receive any insurance coverage towards his speech therapy for 2 years. Love that they would rather wait to pay on a bigger problem than pay out on something that can be treated more easily at an early age! Not that we will stop therapy since we won’t have coverage on it. Unlike the insurance company, we have our child’s best interest in mind.
Yup, Canada rocks in this area. Mind you, our system does have it’s problems…like it’s IMPOSSIBLE to find a doctor taking patients when yours goes on her 1 year long mat leave…and even if you’re practically dying you can wait 24 hours in the ER before being seen by a doctor….but yeah, the part that it’s free and you don’t have to think twice about going to a doctor (if you have one) when you’re sick is definitely a bonus.
Definitely look into the benefit of putting the money into a health savings account. Helps tax-wise when you do get stuck with medical bills. The only caveat? You must spend the money in the calendar year. (This is my laywoman’s view of the thing.)
Crazy.
Here’s to your good health! The good news is that nurses are so in demand – you’ve picked a great field.
My parents have been self employed for over 20 years and are virtually uninsurable now that they’re both in their 60s and have some genuine health problems. It infuriates me that they have to keep working well past the age they planned to retire just to stock away money to pay for their future insurance.
I really hope that 2009 is a much better year for you and Aaron, starting with insurance coverage!
What a joke! They’re perfectly okay with stealing your money and covering nothing. So glad you canceled, but I’m sorry you had to waste valuable time (and money!) on a screwy policy to begin with.
We pay for our own health insurance because my husband works for a small company. We pay $730 a month for medical & dental for us and our son. If we didn’t, maybe we wouldn’t have had to declare bankruptcy this year.
Oy. We pay for hospitalization through one policy and have some other wacky thing that’s supposed to reduce the cost of doctor visits but it’s so confusing I wish we’d never signed up.
We’re still untangling bills from my miscarriage earlier in the year, and boy, don’t I wish I didn’t have to think about THAT every week when I get another 2nd, 3rd, notice in the mail!
Otherwise we do the same as you– just save up for the occasional visit to the urgent-care clinic.
I’m Canadian and our system is pretty good. But it’s not perfect. Yes, we get to see a doctor/go to the hospital for free. But prescription drugs aren’t covered unless your on welfare, disability or on old age pension. Otherwise you need a drug plan to pay for that. Most workplaces have something in place, but not all.
As such, when my Mom had cancer, she had to pay for any drug that came in a pill form herself (chemo was paid for because it was administer at the hospital). My Mom pays almost 10% in any given year on drugs — which she can then claim on her income taxes. But if she paid only 5% — she’d be out in the cold completely.
And I agree with a previous commenter that finding a doctor is almost impossible. I have one — but only because I’ve had him since I was two (and I have to travel 45 minutes each way to see him). My husband’s family moved around a lot and he nows has no family doctor. He has to take his chances at a clinic. Which means there’s no continuity of care at all.
That being said — I’m keeping my fingers crossed for your family. Hopefully 6 months of health living are coming your way!!
i certainly feel lucky to live in canada right now. it’s not a perfect system…but it sure makes life a little easier.
hugs, friend 🙂
Is there anything to say besides OMG?
It’s true; the Canadian system only covers drugs for low-income families, but I think we even have a higher standard (lower?) for that, and no doubt, as a student with an unemployed husband, you would indeed qualify. My mother did, when she did not work for a year due to depression, and my father did when he was laid off.
Barack Obama, we’re lookin at you, man.
I just want to second (third, fourth, fifth) opening a health savings account. I have money put into one automatically each month and you would be amazed at how quickly it adds up!
I’m so frustrated for you guys. I’ve been pissed at our insurance and it’s lack of coverage on so many things, but I should be thankful that we HAVE it.
Hope everything works out for you guys!
Good Lord, that’s scary… Crossing my fingers for a healthy 6 months for you all. And that we will all find a smarter way to manage health care SOON.
So many inexcusably bad things about this scenario. Every time I turn around, someone else has a horrific insurance story to share. What a real shame that health care has come to this. (And YES, primary care is so much more cost effective.)