Health Insurance Hoop Jumping

I was thrilled to find out earlier this week that a health insurance claim that had been pending for nearly a year was finally being processed.

Yes, eleven months and a week to process one claim. Crazy, right?

The claim was for a test I had done last October after my doctor was concerned with some odd symptoms I had recently experienced. She recommended an abdominal ultrasound to rule out ovarian cancer. (Spoiler: everything was normal, other than a slightly out-of-position ovary. Yay!) Trusting my doctor, of course I had the test done.

At that time we had only recently obtained health insurance. Since we were uninsured before that, we had a one year waiting period for any “pre-existing conditions” and when we signed up for insurance had to provide the names of any health provider we had visited in the last year so they could obtain our medical records to determine what pre-existing conditions we might have.

Since I had never experienced anything like this before, I wasn’t too worried. Our insurance sent a letter shortly after the test stating they needed me to sign another permission slip to obtain my records before they could process the claim. I authorized all of it again and considered it done.

Then I began getting letters from the outpatient center at the hospital where I had the test done, asking me to follow up with my insurance because the claim still hadn’t been settled. When I checked with my insurance, they told me they were waiting on my records from a grocery store clinic where I was treated for strep throat once. I again authorized them to send another request for my records, and also pointed out that these grocery store clinics couldn’t diagnose anything that would be relevant to the test I had done.

This entire scenario repeated two more times. Maybe three. I lost count.

Over the summer, I then received a bill from the hospital, telling me they had received three denials from insurance due to missing information and so would start the billing clock against me. I owed $2,097 for an ultrasound, and please pay within 30 days.

A flurry of calls to the insurance company started again, asking why this still hasn’t been processed. They told me they were still waiting on my records from my strep throat visit before they could declare that I wasn’t trying to get coverage for a pre-existing condition. I was so upset at this point. What did I have to hide? I signed away all of my rights so the insurance company could dig up any medical info on me that they wanted to – how was it my fault that the clinic wasn’t complying with their request?

I was angry and scared at this point. Angry that the processing of a claim could be held up due to a strep throat visit and angry that I even had to deal with a pre-existing conditions clause when we pay a large premium every month just to then have a $1000 deductible per person. (Well, it was $1000. It’s $2500 now.) And I was scared that the insurance company would continue to hold up the process and refuse to pay, which would leave us in the position of accepting the entire bill or possibly going into collections and hurting our credit score while we continued to wait.

The customer service reps at the insurance company were very understanding, I will admit. They agreed it was ridiculous and wanted to help however they could. Finally, last month one rep looked through the history of this claim and said, “You know what? I’m going to send this on to claims processing again, and I’ll put a note on it pointing out that the grocery clinic can only handle minor illnesses anyway. Let’s see if we can get them to forget this and get it processed.”

It took nearly a month, but then I looked at my online account and saw it had FINALLY been processed.

It’s not a perfect happy ending, of course. Insurance declared that the “allowable” part of the bill was only $964.62 and so that became the new total. Of that total, they paid $111.78 and left me with a bill for $852.84, the remainder of my deductible from that year. We’ll still have to set up payments with the hospital for that amount, but at least it isn’t as bad as $2,097.

What really drives me crazy is the new bill after the insurance processed it. Because I had insurance, the hospital is accepting $964.62 as the total bill for the procedure. But had I not been insured, I would have been responsible for more than twice that amount.

So those unable to get insurance are not only afraid of ever getting sick or hurt because they have no safety net in place to help cover those bills, but when they do need care they’re hit with a bill that is much larger than what the provider will get from someone with insurance.

I’m so glad that my tests were normal. I can’t imagine how much worse this would be had I been sick and needed treatment, all while trying to fight for coverage. And that’s WITH insurance. My experience is completely how the old system works – the Affordable Care Act (aka “Obamacare”) provisions that relate to this story have yet to go into effect, although I can’t wait until they do. Our daughters are already seeing the benefits from it, and I’m looking forward to those same benefits and protections.

I know there are good people who do good work at health insurance companies. But I still believe that a health insurance company cannot provide effective medical coverage of their members when they have profits to make each year and shareholders to please. It’s an unpopular belief to many, but I don’t believe health insurance should be a for-profit industry.

While I’d prefer universal health care, I’m willing to accept the idea of private, universally non-profit health insurance companies, where any profits beyond operating costs are rolled back into health education and research, programs providing new ways to encourage preventative care, decreased premiums and incentives for proper maintenance of health conditions. (This would be the nurse in me speaking.)

I know health care is a hot button topic during this election year, but I believe it’s far more than a talking point. Whether you’re a fan of the Affordable Care Act or not, I think we can all agree the old system is not effective and needs reform. I’m not 100% happy with the new system being rolled out, but I’m ready to give it a chance over dealing with the current one.



I Am Not An Island (And Neither Are You)

I’ve tried to avoid writing all week about the Mitt Romney secret tapes where he essentially stated that nearly half of this country are freeloader victims looking for nothing but a handout. I’ve been engrossed in reading the stories of others, how they represent the 47%, how they have had to rely on assistance at some point or another in their lives, and how it has helped them reach a better place.

I guess this is as good a time as ever for one more story.

There are no tales of being on assistance when I was growing up. We didn’t have much, but my mom worked extremely hard for every penny and we got by. There were some very slim moments, but she was always fully employed and her employer provided very good health insurance for us.

I went to college with the assistance of federal loans and grants, in addition to scholarships I had earned for an excellent academic record and an allowance each year of money that my family had saved for my college education. I needed all of it, and even then I still worked all the way through college to afford a few of the beyond basic items, like a night at the movies or dinner out with friends. Without the federal grants and loans, which covered more than half of the costs of my in-state public school education (go Miami!), I would never have been able to fully afford my college degree.

After college I worked continuously until Mira was born. (That’s nine years from when I graduated college, for reference.) At that point, Aaron had a good job and benefits, and I was making a decent part-time freelance income as a blogger, so I quit my day job to focus on Mira, and on attending nursing school.

And then the summer of 2008 hit, and Aaron was laid off.

Of course, he applied for unemployment. Each of us had worked for most of 13 years at that point, paying our taxes with each paycheck. We couldn’t feel too bad about using the unemployment insurance we had paid into for so many years.

It wasn’t a lot of money, though, and our emergency savings soon ran as dry as the job prospects. We didn’t want to apply for more help, but we had no choice. Our children needed health insurance. We needed food, but also needed money to keep our house and not fall behind on bill payments. We were sinking fast.

And so we applied for food stamps, WIC and Medicaid. There may be several stories out there about people abusing the system and getting benefits they don’t quality for. From our experience, I’d call most of them myths. Never before have we had to produce so much documentation for our situation and jump through so many hoops.

In some ways, we felt glad that the system was set up to make sure it wasn’t grossly abused. On the other hand, it was tremendously difficult to get approved. We were held up several times for missing paperwork, or not enough documentation, or because we were required to visit the office in person, with the children, and wait in a crowded waiting room, to even have a chance at being considered. How much harder would it have been if we were poorer to begin with, without a car or without all of our income documentation?

Aaron’s unemployment and my small part-time blogging income disqualified the entire family for Medicaid, but we still made little enough for only the kids to be covered. The food stamps and WIC covered a large part of our monthly grocery bill, freeing up what little money we had to pay for our mortgage. We made about $1200 a month with Aaron’s unemployment and my freelance income. Our mortgage was $1100 a month.

If it wasn’t for that help, we would have lost everything: our house, our cars, our dignity, our hope. It would have been hard to get a new job with no permanent address or transportation to make it to the interview. Instead, we found ourselves in the safety net provided by our government, dangerously close to the pit beneath us, and looking for a way to climb up and out.

No one wants to stay in that position. Before that, we had been living a semi-secure middle-class life (I’d call it lower middle-class, honestly), and we only wanted to return to that life. And it’s no surprise that for two years, our income was low enough that we paid nothing in income taxes. We were the 47% – we made too little to pay taxes, and we needed government support services to keep our family fed, healthy, and keep the house we were so proud to buy back in 2004.

Did we feel “entitled” to all of this? We didn’t want to be in the position to accept help, but we took it. And I can’t speak for Aaron, but yes, I did feel that I deserved help from my government, just as our taxes in years before were used to help others get back on their feet. I believe that a just and humane government looks out for all of its people, so that no one goes without basic necessities of food, shelter, and health care.

Of course, many of you know the next chapter of this story. The job market did improve, slowly, in 2009 and 2010, and Aaron and I both found jobs again. The first minute we could, we called the agencies and told them we no longer needed assistance. It felt great to do so. We had a hefty income tax bill last year, and we’ll have a smaller bill this year with our employment status changes. I guess that means we’re no longer in the 47% at the moment, but we’re also the exact same people who once were a part of it. Do we deserve to be treated differently because of our income now?

We – like many – didn’t want to be on assistance. It was barely enough to get by and we certainly didn’t live well during those times. The prejudices of strangers also made the emotional stress of a job loss even more difficult.

I will forever remember how I felt standing in the checkout line at Kroger, Cordy by my side and Mira (just a toddler) sitting in the cart, as I grouped the items on the belt to match up with my WIC checks. I was still carrying a little extra weight around the middle at the time, and I remember one older lady in line behind me talking to her friend – loudly enough that I could hear – saying how shameful it was that I was on assistance and had the nerve to have another child while on assistance, too.

Beyond being pissed off that she thought I was pregnant, I was so angry and embarrassed by her judgment of me, when she knew nothing about me or my family’s situation. Because my husband’s government job had been eliminated, and we needed help to cover the basics until he could find another job, we were suddenly a target for shaming, an acceptable demographic to judge and look down on.

I once held my own prejudices about people living off the system, too “lazy” to make an effort to better themselves. Our experience, as well as the experience of so many people that I met when I worked as a nurse, has changed much of my opinion.

The problem isn’t the system, the problem is being off the system. It’s hard to consider taking a job that will pay just enough to remove that safety net from under you, but will still pay so little that you end up being even closer to losing it all. It’s hard to apply for jobs and be told you’re not being considered because you have a college degree and therefore are overqualified, no matter how much you assure them you’re committed, you’ll work hard, and you need the job to support your family.

None of us are an island. We are part of a society, and one purpose of that society should be to ensure a basic standard for all people in that society and work together towards a greater good. (In fact, the definition of society is “a highly structured system of human organization for large-scale community living that normally furnishes protection, continuity, security, and a national identity for its members.”) We depend on each other, and we help each other. I don’t believe this means that some can’t have more than others, but there needs to be a system in place to provide a minimum standard of living. A line in the sand that declares that this society will work together to ensure no child goes without food, or a safe place to sleep, or lose all they have just because of a layoff or a health crisis. 

Just as in a marriage, it’s never an even 50-50 split. Sometimes you’re contributing, sometimes you’re the one needing the contributions. If you have never needed any help from anyone at all, well, I don’t believe you. Everyone needs help from someone else at some point.

If you’ve never needed government assistance, then be thankful instead of bitter that others have needed that assistance that you – and millions of others – help pay for, and pray that karma never finds a way to humble you. Because if karma finds you on that little tropical island for one that you defend so fiercely, you may find yourself eating your words when you can’t afford food.

Photo credit: Wikimedia Commons



Did I Mention How Much I Dislike Uncertainty?

So remember how I said Aaron was being laid off at the end of May? Yeah, that. Well, he’s not quite laid off yet. He didn’t work on Friday, but yesterday was back in the office. Confused? Me too.

Seems that one of the vice presidents of the company reaching his boiling point at having his ideas ignored while the owner continued to mismanage everything, so he quit. With his leaving, the owner decided he wouldn’t re-hire for that position, leaving more money in the budget from the lack of one salary. Another VP then saw an opening and begged to have his team back together in some way. So their only human relations employee – also the receptionist – was brought back from part-time to full-time again, and Aaron found himself putting his unemployment application on hold.

He’ll only be working 25 hours a week at the moment, hourly now instead of salaried. But the bonus is they are allowing us to keep our health insurance. The premiums will eat up a large chunk of his part-time pay, but we’re not looking at this stay-of-execution as a long-term plan, so we’ll keep cutting back and make due with what we have. There’s a chance they’ll bring him back to full-time if they are awarded a new contract for a job, but either way Aaron has lost any trust in the company owner and plans to continue job hunting as if he was unemployed.

There was one snag, however. Aaron was supposed to be paid on the last day of May, like everyone else in the company. An email sent out late the night before informed everyone that a few payments from vendors were late, and as a result they had to make the choice to delay the pay for a few people. Aaron was one of them, of course. Never mind that we had bills to pay, or that at the time we were expecting this to be his last paycheck and needed that money. As of today, he still hasn’t be paid for the last half of May. Good thing I didn’t schedule any bills to be paid yet. Grrr.

Thankfully I still have my job, and we’re busier than ever. Last week truly was a blur to me. I was going full-steam for so long that by Saturday night I felt lost without something to do. This week is the same, and I’m working on perfecting my ability to keep as many balls in the air as possible. I’m still dropping a few, but I’m doing my best to pick them right back up and keep going. It’s fun and works well with my ADD nature – I never have to stay focused on one thing for long.

I’ve also had some great local opportunities in the past week. On Wednesday I shared a delicious lunch and even better conversation with Chef Dan, the head chef for McDonald’s, and on Saturday I had the opportunity to be one of the first of the public to tour our new Nationwide Children’s Hospital. More on those soon.

My goal for this week is just to get through it. Summer camp doesn’t begin until next week, so Cordy is home with me each day. Yesterday she gave me a math quiz on fractions using Draw with Stars on the iPad while I worked. Today she says she has a spelling test planned for me. I hope I pass.



Brought To You By The Letter D (for Depressing)

No one likes to read bad news, and I don’t really like writing about depressing things. But my little family has had our fair share of setbacks over the past few years, and sadly another one popped up recently. I considered not writing about it, although of course it then wouldn’t leave my brain to let me write about anything else. So here it is, and I’m only letting myself feel down about it in this one post and nothing more. If I get mopey in a future post, feel free to tell me to snap out of it.

Aaron got the bad news last week that his company is cutting him loose at the end of this month. He was told that it has nothing to do with his work, and everything to do with the president of the company choosing to run on a cash system – so if there’s a lull in contracts, like at the moment, he lets people go so he doesn’t run a debt. It’s a small company that depends on government contracts, and even though they recently won several contracts that should be coming soon, the money hasn’t arrived for them yet.

Aside from the head of the company, the VP’s and the project managers and everyone else he works with would rather he not leave. He’s the only writer they have, and his leaving means that the documentation for their projects – including an enormous user guide needed for a government agency software project due soon – will fall to, uh, someone else. Probably a project manager who isn’t exactly the best fit for something like that and would rather not do it and won’t do as well at it.

But despite objections from everyone else, the company president is focused on cutting expenses, even if it means cutting out staff who are vital to the development of the project. Not the wisest move in my eyes, but what do I know about business?

There is still talk of having Aaron stay as a contractor, with varying hours available to him, but that hasn’t been confirmed yet. Either way, we know that his steady income and all of our health benefits are out the door on May 31. He’s already updated his resume and has started networking. We know from experience that job hunting is rarely a short endeavor.

He’s angry, of course. Angry that he’s done everything right, has gone above-and-beyond for the company and has been praised over and over for his efforts, and gets rewarded by being laid off. It’s no wonder that loyalty towards a company by employees has been steadily declining – when treated like that, how can you do anything but constantly wonder when your employer will decide you’re not worth it? Too often now, an employee is just a set of skills to be used and discarded, and not a real person with a life and family and a relationship with the company. Mutual respect is gone.

I’m upset that we’re losing our health insurance again and hoping it will only be a short lapse. Why this country should continue to tie a family’s health insurance to their employment is beyond me. When people worked at the same company for 30 years, it made some sense for health insurance to be something shared between employer and employee as a benefit.

Now it’s just a cruel joke – if you work for the right company, you can get great insurance. Switch employers and it’s a gamble if your insurance could be worse in coverage and/or cost more. Your health didn’t change, and your need for certain coverage didn’t change, but because your job changed, your benefits and the amount you pay can drastically change. Lose your job with no ability to pay COBRA, and you have no coverage at all. What kind of a screwed up system is this? Why should a person’s job with a specific company dictate what kind of health care they can receive?

Not to get too political with this, but how is this a stable system for supporting the health of the country? A single payer system would be far more stable. Even if you don’t agree with a single-payer system, then it’s time to stop including health insurance as part of employment compensation plans entirely, raise the take-home pay for everyone and cap premiums from the profit-heavy insurance companies.

Stepping down from my soapbox now and returning to us: it’s obvious we’re scared and angry and frustrated, but we’ll be OK. I have a job at the moment that I love, so we do have some income. Aaron will qualify for unemployment if needed and has a lot of people trying to help him find another position.

It sucks to take a big step back financially (again), but money is just money. We may not be able to do or buy as much, but it can’t take away our family, our friends, or our determination to succeed.

And moments like this piss me off enough to push us to succeed, just to spite those who set us back. The best revenge is success.



Setting Up A Token System

In the past week I’ve described the token system we use for chores and good behavior for the kids to three different people, so I thought why not share it with everyone? We don’t give an allowance weekly at this point because neither of our girls have a strong enough grasp of money, and because many of the things they want aren’t things at all but privileges that have little to no cost to us.

We reward Cordy and Mira for good behavior and for helping around the house with doubloons. The idea was originally given to us by one of Cordy’s therapists, suggesting a token system can work well for kids with high-functioning autism, as they can see a concrete reward for tasks they accomplish and then use those tokens to “purchase” the perks they want.

The idea for using doubloons came from Jake and the Neverland Pirates last fall. Cordy saw it on TV and loved how the pirates collected doubloons for solving problems throughout the show. At the same time, Cordy was obsessed with dressing as a pirate princess for Halloween. Aaron realized that would be the perfect token system, so he bought a big bag of plastic gold coins, grabbed a mug for each kid (from our renaissance festival days) and we started to plan the system.

I think they’re Greek coins instead of pirate doubloons. Eh, they don’t know the difference.

You can make the system as loose or rigid as you like. We’re somewhere in-between. There are daily tasks that they know they earn doubloons for – these are often tasks that they have trouble remembering to do, or are difficult things we want them to master.

For example, Cordy has trouble remembering to turn off her bedroom light each morning. She gets one doubloon for remembering to do it each morning. She also has to take a pill each morning, which she doesn’t like to do, so she gets a doubloon for doing that, too.

When the task can be done without reminder and without the need for a reward, we phase out the doubloon reward and find other routine tasks to reward for. They get doubloons for helping Aaron or I without complaining (like helping us load/unload the dishwasher or take out the recycling) and for assigned chores that they complete.

We also award them doubloons for good behavior. If they’re playing well together, or if they spontaneously do something helpful, they can get bonus doubloons. 

They keep their coins in the mugs and then use them to buy privileges. Some of the privileges they can choose from:

  • Extra 20 min on the computer/iPad – 1 coin
  • A treat of 1 piece of candy – 3 coins
  • Staying up an extra 30 min after normal bedtime – 5 coins
  • Getting fast food for dinner – 5 coins
  • A trip out to the zoo or another fun place (if we didn’t already plan for it & time allowing) – 10 coins

Of course, anything that Aaron or I decide to offer to them doesn’t cost anything. If we plan to go to the zoo one Saturday, they aren’t required to pay. If they want something that isn’t on our list, we can assign a doubloon value to it. Mira once wanted a Happy Napper toy, but she had no money. We set a value of 20 doubloons for it, and she saved her coins until she could cash them in to buy her toy.

We like using this system at the moment because the coins have no actual money value (other than the few dollars it cost to buy the bag of them), so they can use them for non-money privileges like extra computer time or staying up late. Many times these privileges are just as valuable to them as anything they could buy. When they’re older we can move to an allowance instead of tokens, but at this age it works very well.

The system works well because it is flexible and can be adapted for nearly any family. You can set your own guidelines on how tokens are earned and cashed in, and you can adjust the rewards and tasks that earn tokens as a child grows and masters new skills. It’s a fun system that lets kids earn their privileges and gives parents a chance to set non-monetary rewards for good behavior. Win-win.

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