A Mommy Story

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.