Wednesday, November 30, 2011

Let's Name Numbers

Well, hey there, you who have been so kind as to come by and read me all month. This was fun! And here's a thing: today was not only the last day of my Month-Long Blogging Festival, it was the last day of the six months that I have had no health insurance, the six months that I needed to have no health insurance in order to be eligible for the federal government's Pre-Existing Condition Insurance Plan. 

Made it! Exhalation.

I feel like there are too few people here in the US who are willing to lay bare the details of this issue and how it actually works out in their lives. It is partly from a sense of shame, I think, or something that has us convinced that our insurance status and our insurability is a personal, private problem and not a social, structural one. That if you don't have insurance, you have failed. But hi, have we met? I'm willing to share, I certainly don't think Matt and I have failed, and I thought the details might be of interest to somebody.

At the beginning of 2009, Matt got some money from the sale of another company he'd worked for, and was able to leave the job he had here in Atlanta and start his own game company. We continued our family group medical and dental coverage through COBRA. For those who don't know, having COBRA coverage is like still being a member of your employer's group plan, only you pay the premium yourself, with no employer contribution. That cost $1100 a month for the four of us and lasted for eighteen months. Somewhere around the thirteenth month of that coverage, I got diagnosed with breast cancer and started the full ride of surgery and chemotherapy, paid for by insurance.

As the summer of 2010 wore on, and I finished my chemotherapy, we started to work on what to do about insurance when our COBRA ran out. I discovered that if Matt were to divorce me, it would extend my coverage another eighteen months. Yet we decided to stay married. He and his business partner got an insurance broker and shopped for small group plans to cover themselves, the kids, and any future employees. I stayed out of their group because I knew that, as small as the group was, with my medical history they would either be denied outright by the underwriters, or would be charged a jacked-up premium.

I figured that I was on my own, insurance-wise. I wanted to avoid the individual market like the plague, as it is not subject to even the meager regulations of group healthcare. (Of course, what I now know is that with a cancer diagnosis in my medical history, I am uninsurable on the individual market, for any amount of money.) Then I discovered HIPAA, the Health Insurance Portability and Accountability Act of 1996. 

Listen, 'cause you might need to know this, and nobody makes this info easy to find. What HIPAA meant in my case was that, because I had: a) been covered continuously for at least the previous 18 months, and; b) been last covered by an employer's group plan; and c) taken their COBRA coverage for as long as permitted, I was entitled to purchase an individual policy from the company who had been insuring me, as long as I converted to the individual policy within 63 days.

Do you get that? This is huge. If you are reaching the end of your COBRA coverage, your health insurer (or in some cases, the state you live in) is legally required to convert your group policy to an individual policy. And the premium they can charge you has some slight legal restriction upon it, it isn't completely unregulated like the pure individual market. So if you can pay, you will not lose your coverage.

BUT, and this is a big but, if you have anything wrong with you at all, they will not tell you about this HIPAA conversion, and when you call and ask about it, they will know nothing about it. That last part is not an act; the frontline customer service people will not know anything about this. If you are lucky, you may reach a department manager who might know what you're talking about, but they almost never deal with this, it seems. I understood why when I saw their rate sheet.

Lemme back up and tell you that the first time I called the insurance company and said I wanted to see about converting my COBRA into an individual policy, they said, "Okay, we'll send a conversion packet out to you!"

But they did not do that. Not the first through fifth times I called. Reader, I don't even remember the details of all the ways I escalated this. I do know that I emerged from all of it as some kind of hardy swashbuckler. At one point I got to someone semi-knowledgeable and she said, "Oh, the state of Georgia will handle your conversion policy," and I had to explain that yes, Georgia will do that if your previous employer group's benefits were self-funded. If not, as in our case, the conversion policy comes from the company that provided the group coverage. I had already talked to the state insurance commissioner's office, and I told the company this. They were like, OH, okay, right, got it!

What I thought, over and over again, was, "What do dumb people do?" Seriously, what if you don't have the time, wits, patience, and capacities to deal with this stuff? And I was feeling well. What if you are really suffering and vulnerable? This goes way, way beyond being your own advocate, like we're always told to do. I have asked that exact question, what do dumb people do, to a few different medical professionals. They all say some variation of, "It is a catastrophe and they die."

Okay, so finally, I extracted a heavily photocopied rate sheet for various individual coverage scenarios. Matt took one look at it and said, "Oh, these are the 'fuck you' prices." And they were. To continue our group coverage for the four of us would have cost over $3000 a month. It was clear, patently clear, that they don't expect anyone to buy these plans. No way. But with Matt and the kids safely enrolled in his company's new small-group policy, I ran my finger down the page and found an single individual option for just me. It cost $1368 a month, and I signed up.

During that period, I had radiation therapy and reconstructive surgery. We paid that premium until this summer, when I got notice that at my one-year coverage anniversary, it would go up to $1800 or so. If it continued. I had the feeling that they were constantly looking for a way to rescind the policy and end my coverage. And that $1300 a month, on top of everything else, was really hurting us.

I just thought, "How are people doing this?" I mean, Matt and I were not improvident, we were not reckless. One or both of us has always worked, and we have had continuous insurance coverage our entire lives. We are thrifty, brave, clean, and reverent. Also, and I'm no Max Weber, but by most any definition, we find ourselves in the upper middle class, and were lucky enough to afford the higher and higher rates that we had to pay to get this far. And yet, even though I don't think we made any "bad lifestyle choices," this situation was a total colossal fucking nightmare. I mean over and above the nightmare of life-threatening illness. So how are people doing this?

I've read that half of all Americans have what are considered pre-existing conditions that affect their insurability.

Around that time, my mother showed me an article about the PCIP part of the health reform act. I had looked at it before and noted that one of its eligibility requirements is that you have been uninsured for six months prior to enrollment. That always seemed wrong and unworkable to me. But I'd reached a point where my active treatment was over and my health was good. And I didn't know what else to do. I might have tried to get into Matt's small group plan, but even if I could have been added to it without waiting for open enrollment period, I thought that when their open enrollment came around, my medical history would swamp their little boat, and I didn't want to imperil the coverage they had found for their families.

So I stopped paying my continuation premium. I talked to Matt about it. I worried and sweated over it. Then I was like, well, I'm doing this. I checked to be sure there was a medical rider on our car insurance. Then I tried to stay healthy. I thought if I broke an ankle or something, if it amounted to less than the premiums would have been, we were ahead. And if the worst happened and my cancer came back, well, I thought, that's what bankruptcy is for.

And so far, knocking wood, nothing bad has happened.

So now I can apply to be covered in the pre-existing condition insurance pool in my state, and it will cost $264 a month for the standard plan or $356 for the extended plan. These PCIP pools are a temporary measure, designed to bridge the gap between now and 2014 with the health care exchanges are supposed to come into being. Don't know how that's gonna work.

Whew. Did anyone actually read this? That's my story. I don't actually know what to say by way of closure. I hope there was some helpful info in here if you are in a position to need it.

Love you guys,
b

59 comments:

nancyblackett said...

I read it. I read it and thought, how is that people think socialised medicine is anything other than a basic human right? Your experience shows we're not talking about a tiny safety net for the indigent but something to give ordinary people the healthcare they deserve at a price that is affordable. I'm lucky to have been brought up with free healthcare - I know it's not a cheap thing to offer people but it still remains a principle worth fighting for

Amy said...

Amen, Nancy. What she said.

Thanks for this, Becky! It's a lot to take in, and brava to you for being persistent and getting the insurance that you need. Like you said, though who will fight for those who are too sick or uninformed to get what they need?

Hmmm. Many feelings about this.

Marsha said...

For this post, you should be given the Blogger of the Year award, and perhaps one of the Nobels as well.

Bren said...

I wish my comment could be as eloquently written. But all I can think of is Right On, Sister.

delaine said...

Very well said. People need to know how broken our system is. And your story is only one of countless stories in this country! What are we as a people supposed to do? Oh wait, I know: get sick,stay sick, and finally die, thereby taking our selves off some company's loss/profit sheet. We are apparently without viable solutions. All our collective brainpower , can't solve this problem as a nation. Really? When President Obama tried his damnedest to provide health coverage, we all know how that turned out. We were told by the opposition party," oh, the private markets will solve this for us. Get out of the way for the Job Creators and Almighty Corporations! They will work as the Holy Private Market and we will be well. Except that at the heart of it, they knew that was and is a lie. People are out there every day sick and getting sicker while solutions appear beyond our reach. As you put it so well, most families are one serious illness away from bankruptcy and homelessness. As for those of us who actually have coverage, we watch the premiums, copays, deductibles continue to skyrocket. Our policy for the coming year has huge jumps in costs and will take a big bite out of our retirement dollars. And we HAVE coverage. God help us as a country! Rome is burning and the Neros in Congress still fiddle. What puzzles me the most is how the rank and file citizens support a party that works so assiduously against their best interests . The irony and the craziness of the whole situation makes my blood pressure go up. Sorry for this long comment, but ya know this issue pushes all my buttons! I thank God that your six month waiting period is over now!!

M said...

I bow to your wit and resolve and commend you for your steeliness and patience, made all the more remarkable by the health challenges you faced.

I keep wondering how much further we will sink into this healthcare morass before a critical mass of people decides that rampant and wholesale injustice is not just untenable but unforgivable.

Common Household Mom said...

I did read it all. I'm just flabbergasted. Not sure that is the right word. Appalled.

"What do dumb people do?" I have the same thought about Medicare, which I am trying to understand in order to help my elderly aunt manage her financial affairs. But the Medicare system is less confusing and overwhelming than what you describe here.

People who want health care to be simply provided by the free market do not understand that health care falls in an economic category that is different from most other economic goods. To treat it otherwise, we end up with ridiculous Catch-22 situations such as people who are sick not being able to get health insurance, and therefore getting less than adequate care.

I can't believe you lived like this for 6 months.

Outraged. That's the right word.

Monica said...

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Monica said...

Sorry about that - iPhone issue.

Our healthcare system is broken beyond words, but I don't believe socialized medicine is the solution. If you've discussed this issue with healthcare professionals and/or people who live or have lived in a country with socialized medicine, the majority of them agree. My father-in-law had the misfortune of becoming gravely ill while in Great Britain and he ultimately died due to what I call "DMV" medicine.

JLister said...

Wow. All I can say is wow. Our story is this: I've been a stay at home mom since 2004. The Lord has always been so faithful and provided since then and allowed me to stay home with my kids. In 2009 Chris became self employed, thus making more money, but losing our group coverage insurance. At first the girls and I qualified for state insurance and Chris had nothing. Starting January 2012 we now fall into the crack of he makes too much money for us to qualify but doesn't make near enough for a non-employer paid group plan for us which is around $600 month or so. It's quite nerve wracking knowing if my kids get sick now it will cost no less than $150 to take them to a "Doc in the box" urgent care place to see someone they don't know and get a prescription which you hope happens to be on the $4 list but never is. Not to mention the fact our middle daughter is hearing impaired and uses hearing aids which cost over $3000 a piece not to mention the dr appts she goes to to monitor her hearing status. Sigh.

Amy said...

Ditto what Marsha said. And Bren. I have no other comment beyond my deep conviction that insurance companies are truly an evil construct, and I mean that in the deepest and most fundamental sense of "evil." They are driven by a financial bottom line, yet they traffic in the most personal and basic of human needs and welfare... it's a sorry, sorry equation.

Hootie said...

I respect your perspective, Monica. (Which automatically sounds condescending, especially since you don't know me. I mean, who the hell am I?) And it's good to have an alternative voice in this discussion. But the solution is not an "either-or" solution. It's somewhere in between.

The thing that's so GD broken? The same thing that's broken in a lot of politics. The people making decisions on behalf of others don't have the interest of those "others" at heart. The insurance providers don't even pretend to be motivated by their clients' health. It wasn't always this bad, because the insurance companies didn't know they could get away with it so blatantly. But they've slowly proven to themselves that it's a simple thing... just like every other issue, pick a hot-button term like "socialized medicine" and demonize it. Or how about "Obamacare"? That goes beyond demonizing and becomes trivializing. Why is it so insidious? Because it works!

I'm with you that pure government takeover of healthcare is NOT the solution. But only an extreme minority of people think that IS the solution.

Who's got a story where the current US healthcare/insurance situation saved their bacon without fleecing them in the process? Anyone? And anyone out there coming at this from a physician's perspective? And how 'bout all them malpractice suits? What's up with that?

I've got more thoughts on this, but I've gotta go teach a class :)

Maureen said...

Becky,

Thanks for sharing! We have a child with a congenital condition and have faced all of the same hurdles. We currently pay $2700 a month for health coverage that comes with a $5000 deductible for our family of 5. Unfortunately, we had two surgeries this year and are still working to pay off those bills as there is still that 20%...
Every decision about employment in our home and budgets centers on health insurance.

Keely said...

Good grief. I was wondering how that was working for you.

See, I'd be one of those "dumb" people...I barely understood half of that. (Of course, I've never had to, so presumably if I had to navigate that system I'd be more savvy.)

Yesterday I was wondering how I'd be managing this shitshow that is my health if I actually had to PAY for it, and the answer I came up with was not ideal. I'm not sure socialized medicine is the answer, either, since many people fall through the cracks just waiting around to be seen. But I think it's an improvement on NOT GOING because you can't afford it.

Keely said...

Also, I am very glad you found a solution, because I'd like you to stick around for a while :)

Cassie said...

Becky. I am relating to you like crazy on every possible level here.

This post was so well-written and I agree with Marsha. You deserve a big fat award for this.

I love you now more than ever. And I did not think that was possible.

Beth said...

Really, someone needs to find this post and tweet the crap out of it. It needs a large audience!

I agree with pretty much everything everyone said. Here's a little anecdote to illustrate further how broken the system is. My husband is a bit of a hypochondriac, and since his father's recent death, he's been slightly obsessed with having everything and anything checked. So, he wanted to have his arteries checked for plaque. He's in perfect health, so insurance didn't cover it, but he was willing to pay the $800 out of pocket to have the procedure. Fine. Done. (By the way, he has ZERO per cent plaque in his cardiac arteries.)

But, BUT, then he gets some statement from the provider that happens to indicate what this $800 procedure would have cost had insurance paid for it: $3000. Yes, that's THREE THOUSAND DOLLARS. What is that? Either it costs $800, or it costs $3000. What is this charging more money when you know you can get more money? It's all such a scam.

Camp Papa said...

Well done, Becky.

Based only in part on Amy and family's experience in Australia, I'd say many, many Americans would would be far better off with the Aussie brand of socialized (Boo!) medicine.

Steve said...

The single payer system is the only way to go. Period.

America has the highest medical costs in the world and we also have some of the WORST outcomes in the world. Our infant mortality rate ranks 34th in the world. We are a collective mess largely because of our insurance company structure which is designed to favor shareholders.

The primary reason Obama didn't go for a single payer system is that the medical community warned him that they would withdraw support if that was the position he took. Sad, but true.

Ask any Canadian if they would prefer our system over theirs. Monica and many others would be surprised to hear the answer, I'm sure.

Allison said...

I read every single word, twice. Thank you for writing it.

AlGalMom said...

Powerfully spoken--I'm so glad that you're on the brink of being insured again. That must have been nerve wracking. I don't think it is only dumb people who suffer from the complexity of this situation--I am amazed at your tenacity!

Steve said...

Sorry, but in the interest of full disclosure, I forgot to mention that I have worked in the healthcare field for 20+ years, and am currently involved with developing continuing medical education programs for oncologists and hematologists. I work with big pharma in the development of these CME programs, primarily with their R&D and scientific departments (ie. pipeline). I work with many of the top thought leaders in oncology in the US, western Europe and a good portion of Asia.

I have been self-employed for the past 21 years, and know all too well the sting of healthcare premiums. Last year I got sick and required 3 CT scans (with contrast) to the tune of $14,000. That was just for a total of about 6 minutes worth of scan time. $14,000. Damn.

My sister is a naturalized Canadian citizen who also happens to be a US trained healthcare professional, having worked in the US healthcare system for 8 years prior to her move to Canada. She's been working in their single payer "socialized" system for the past 29 years. Her perspective is an interesting one, to be sure, and certainly doesn't jibe with the scare tactics coming out of Washington.

Monica, I'd be interested in knowing where you came up with your information other than your fathers unfortunate experience in the UK. You stated that the "majority agree"...with what?

catchupdaphne.com said...

I love your blog and look forward to your posts, even though I don't comment. But today, I couldn't hold back my applause. Thank you from the bottom of my heart. My family is every insurance company's nightmare. I have had thyroid cancer. My daughter was a preemie who was in the NICU for 5 months, then had heart surgery, and will need a kidney transplant. We are very expensive people but just like you we have jobs, take good care of ourselves, live within our means. I have the privilege of getting amazing health benefits through my job. My husband, however, is a free lancer. I have spent countless hours wondering what in the world we would do if we lost our coverage. So happy that your 6 months are up and you are healthy!

Cassi Renee said...

I read it too --carefully. It is very scary how difficult it is to navigate through the bureaucracy that is our health care system.

Yesterday a friend was watching a documentary on this issue and mentioned these facts:

"Every 90 seconds someone in America files for bankruptcy due to medical bills." and "And 45,000 Americans die each year from lack of health care."

The U.S. has a problem.

Hootie said...

@Beth: regarding the 800.00/3000.00 disparity... The hospital knows that the insurance company will only honor a minor percentage of most claims, so to get 800.00, they have to ask for a lot more. Sounds like a broken system to me...

Lisa Lilienthal said...

Bravo, Becky, for sharing (I know that was a hurdle) and for putting a face and a story on such an epidemic of a problem. I can't imagine the palpitations that came along with sweating out that six months -- what an asinine requirement. Kind of like the bank telling us that the only way we could get a loan mod was if we would stop paying our mortgage payments. Just doesn't make sense for anybody involved and will eventually cost us all in untold ways. I'm glad you are healthy AND smart!

Veronica said...

Glad you made it to the end of your six months. I'm glad you put this info out there! I hope we can get the single payer system back in the realm of possibility, and soon!!

David said...

I, too, am glad you're at the end of that ridiculous six months, dude. And hear, hear! for this post and all the comments.

I agree with Hootie: it's not either/or, and we need to stop swallowing all the garbage and rhetoric out there. Remember back when the majority of Americans wanted a single-payer public option, back before the shitstorm that was the fight over so-called "Obamacare"? Where the heck did *that* go? Seems like some heavy-duty wool-pulling had to be involved to convince us that up was down. And, despite the fact that "Obamacare" in its current form is clearly an inadequate solution, we're still being told it must be killed in its tracks so we can return to the "free market".

Shame.

Elle said...

Hey, doll. Nice finale. Well-struck.

You know, it isn't just "dumb" people, it's anyone who doesn't have the luxury of a full-time family manager, or anyone who doesn't feel elegible for the benefits and securities of a comfortable life, because the truth is, we in America do not have an infrastructure which provides equal protections, plus also is tight-fisted in its relinquishments, as you witnessed. It is scandalous to me, especially as so many of these greedy, legislative fucks have billed themselves as Christian and/or pro-life. It's like God doesn't want to take them and the Devil wants them here. Ugh.

I don't say that to chastise you for anything you said, but just to add to what there is.

I wanted to tweet about this when it happened but at >140, it came off too-too lady-of-the-manor, no matter how I tried: One of the women who works at the drycleaning storefront had been gone for some months. I knew the reason was "her husband was ill," and I knew they were in Korea. I presumed he was dying/dead all this time.

About a month ago -- it was when we got back from vacation -- she was back. I asked about how she had been, etc, I was silent for a long time, waiting for her to dish (thank God) before offering condolences or whatever, and her husband is fine! I was overjoyous & miraculous-y and she explained that he just went to get well. Because it was cheaper for them to quit work for months & fly back & forth from Korea for medical care than to do it here.

I goggled at her in some kind of plain shock & she shook her head, frowning & resolute: Here is too expensive. And they have a medical coverage; I know because I asked. Unreal.

Becky said...

Elle, the word "dumb" was a cavalier choice, you are right to clarify. (I think I was angry when I was writing this and it peeps through in places.) That is amazing about the dry cleaner.

I think that the idea that we have better medical care here than anywhere in the world is, sadly, outdated. And overdetermined.

So many of the stories here, I mean, !!! The way people are struggling, wow. Reading them, it reminds me of why I didn't make an overtly political argument in this post. There is no need to. The facts, for everybody, stand as they are with no embellishment.

Mainly I want to say, thank you for your words, guys. Thanks for coming around even when or if we don't agree. Hang in there.

Unknown said...

Really well done and important posting. I'm a single mom and have insurance through my job, but went without for a long while for my daughter and me. We were lucky then, but my job ends in a year and a half and all I can think about is the need for insurance looming. But something has to change in this system, because at some point soon we won't be able to afford it, even through work-place plans. Thank you for writing this. It's brave and might help people.

Nina said...

I actually read it too, and as usual when I read/hear anything about US medical insurance I was shocked and appalled. The British National Health Service has many flaws but nobody here ever spends even six months worrying that they won't be able to afford to go to hospital if they get sick or injured. Obviously we all pay for the NHS through taxes, but what you pay in tax is more or less related to how much you have, and none of us are paying anything close to $1100/month for a family of 4. That's insane. Great that you have shared this - not sure why your compatriots are so unwilling to discuss universal health care. And what a relief that you got through those 6 months in good health!

Nina said...

Btw, having just read the other comments, YES I would take our "socialized" health care system any day over the US system. The flaws I mentioned are mostly small and/or inevitable, the vast majority of people get great care for even very serious/rare conditions (in fact, I'd say the NHS is especially good on life-threatening and terminal conditions). One of my grandmothers lives in NY and has recently had a knee replacement operation, paid for by her insurance; the other grandmother lives here in the UK and had a hip replacement operation earlier in the year. Both operations were successful but the pre- and post-op care and home support that my UK grandmother got was far superior and all completely free to her (apart from that she pays taxes like the rest of us, of course). Also, because all the care comes from one organisation, everything like the physio, OT, etc, was organised for her without her having to make calls or compare prices or worry about what she could or could not afford. Absolutely no contest, in my view.

Michele said...

Amen sister!

I admire that you took the chance. When I moved from AZ to TX I had to wait 90 days for our insurance to kick in. I could have gone on COBRA at $1500 per month or gotten private insurance. TX would have paid $500 of private insurance. So I looked around. Turns out because of a pre-existing heart condition on my part I was uninsurable. JR could be insured but I couldn't pay for it out of my compensation package because I couldn't be insured. So I lost the $500 per month. We decided to just sweat it out. It worked out for us but I spent the whole time thinking about those people that didn't have this option or the ones that have gone years without insurance. I worry. I worry a lot about the millions of American that can't or don't have this choice. After I worry I get pissed off.

Becky said...

Me too Michele. Your story highlights part of what seems so absurd about our health care system--that your health insurance is tied to your job. I mean, we are so used to this, it's like a basic assumption that we don't question. But it is crazy.

Nina, that is interesting, your story of your two grandmothers. I'm convinced! And my sis has had two babies in Australia, and I was FLOORED by the amount of services and support that are routinely available to new mothers. Home visits, baby nurses, etc. Amy can be more specific. But wow, it was hard to not think, "Now THIS is what it means to value families, and to value life."

Art Teaching Diva said...

Becky - I am so glad that Amy posted this for a lot of reasons. But the biggest one is to know that you are doing well. Florida is going through crazy things with our health insurance. I pray that this holiday season keeps you and yours healthy and happy. Donna Harper

Elle said...

Not to mention, Becky, that besides revealing their life/family values rhetoric as a lie, their actions -- & the grim consequences for many American families -- fly in the face of their other closely-held issue -- national security. Because when you have a country half-full of people who can't afford to go to the doctor ... well? Spray some germs around! Go for it! Whatever, disgusting, ok, I'm going to stop typing now. Good night, beautiful!

Leanne said...

I read it and I feel for you. I only lived in the USA for seven years, had full coverage and at times I found that medical system totally over whelming with their paper work and yep, I'm bright and English is my first language and we were healthy. I can't imagine what you guys went through. Then we scurried back home to Canada where every one complains about our health care system, but hey, it works and it's open to everyone... No system is perfect though and I'm glad you've found a way to make yours work for you...

Veronica said...

You know, I was thinking of another related issue, though it's admittedly somewhat peripheral to what you're dealing with here... A friend of mine, a doctor, works at a low-income clinic near Sacramento. One of her specialties is working with people who are pre-diabetic, getting them on the right track with their eating, exercise, lifestyle, so that they might stay healthy -- she helps them make better grocery lists, and she even knows exactly what is available at what prices at all the cheapest grocery stores in the area. However, she gets paid significantly LESS for a meeting like this than she does for a 5-minute appointment in which she prescribes insulin. Just another way in which our system is broken -- not only do we pay too much, we are apparently paying too much for the wrong kind of care.

Elizabeth said...

This is EXACTLY what I've done with my disabled epileptic daughter's policy out here in California. The only trouble is that the rates DO go up quite steadily from that initial sweet under $300 price. I nodded my head throughout your post, having been down this road for nearly sixteen years. I always love the people who say "No government is going to come between me and my doctor!" They have no idea, no idea at all.

I'm glad you're not dumb. Sometimes, though, the energy expended on all of this makes me just wish I were dumb. And dead.

Michelle said...

Diagnosed with Congestive Heart Failure at age 30, I had a crash course in health insurance and the Social Security system. Luckily, I was employed at the time and had insurance, including long-term disability. But the hoops I jumped, the paperwork I filled out and followed up on, the countless phone calls, the trips to the Social Security office, the inability to return to my previous position, earning less than half my previous pay at a much lower position once they took me back, looking for another job that would have me, cashing out my 401k, paying for COBRA, worrying if I would make the cut-off date for insurance at my new job.... It was exhausting, and really still is. My family and I talk about it, how hard it is to decipher, and worry about others who may not be able to figure it all out. Who don't know the right questions to ask or have the time or energy or ability to sift through it all.

I know that there will come a day when I can't work again. That I will lose my insurance and will not qualify for anything. That my new 401k will not have enough in it. I know I might be one of the lost ones. I just hope I can stay healthy as long as possible and that something gets resolved before then. Because, as a country, we cannot continue this way. We must value all life and help protect it.

I will say this - I am thankful every day that I had that insurance. That I'm not paying over $200,000 OOP for all the procedures and surgery. I may not have cable. I may not be able to take a vacation. I may clip coupons and carry a generic purse, but I have health insurance. And in this country, it is worth every sacrifice to pay for it.

Sorry for the super-long comment, but I love that you wrote this post! It is so important. You have long been my favorite blogger, and I will refer others to this post. Just like I refer them to the ones about your Neighbors and feather wreaths!

(When signing in to publish my comment, I realize it's been almost 1 year since I last posted on my own blog. I may have my New Year's Resolution! Thanks! I think...)

Patience said...

I live in Canada and read all the comments in American news about how awful our system is. Well I have to say I think it's great. Great doctors; not really terrible waiting times and paid for my our taxes (which I believe in) Not believing in healthcare is to trust that you'll never really need it or to be shunned by insurance because you had cancer treatment. I guess the insurance and drug companies are pretty powerful and I feel bad for you guys. Taking my dd to a clinic next week; the only thing I'll pay is bus fare.

M said...

You mention a good point in your comment about the absurdity of health care tied to employment. I heard someone on NPR explain that this grew out of the early 20th c need to have health care for those in high-risk factory jobs where incurring injury and disability were likely. Other employers began offering it as a lure and it evolved into an expectation.

But as NPR pointed out,we require and provide public education for all to ensure an informed citizenry, why wouldn't we want them to be healthy as well? There are good holistic systems of healthcare already in place (Mayo Clinic, for example) that could be models for a different system of care.

Argh.

Michele R said...

ZOMG Becky you went ziplining! ;-)
First, I am so glad that you are healthy and had the moxie to get through all this these months.
Second, you have done a great job of taking the time to write out your story as I am sure it will help others even by just going to healthcare.gov to learn the state options. (i.e. California's open enrollment for children is Jan – March).
Third, you should totally get a GA Insurance license assigned to you since you have done so much research!
Everyone should demand a summary plan description from their employer if that is where they have insurance as it clearly states there may be a right to convert to a policy after COBRA. While under COBRA you had rights just as a similarly situated active employee which means people can ask whomever is administering the COBRA to help with answers or to use that firm’s broker for help.
There really has been such a divide between group and individual insurance. What is interesting is that of group plans, the majority are self insured which means the employer is paying the claims. There is no insurance company to get mad at if something is denied--the employer designs the plan and pays the insurance company to use its network of providers and/or to process and pay claims.
And then you entered the muddy waters of individual insurance with neither adult working for a firm (where you cannot be denied insurance as a new hire although a condition can be excluded for a year if you had a break in coverage(except for an HMO—no pre-ex applies). HIPAA passed in '96 to protect people with less than 63 days of a gap in coverage, group or individual.
Positive changes from the Affordable Care Act of 2010 include for plan renewals after 9/23/10 (for both individual and group plans), no one’s individual policy can be rescinded, there is no pre-ex for children, any working or sitting at home doing nothing even married child up to age 26 can be covered on parent’s plan. For adults, for plan years beginning after 1/1/14, there will be no pre-ex conditions anymore and the states will offer insurance and everyone is required to obtain it somewhere.
I get peeved at the Rx companies and the docs who quickly write the Rxs. We are such a pill popping country. Tell your doc you are blue after baby is born, you get an Rx and then it is on your history as having a pre-ex (which is n/a as mentioned after 2014). We also demand to be pain-free and turn childbirth into a right to have an epidural practically in the parking lot and c-sections are up to 35%. Ever notice how this doesn't happen as much in other countries and there are more midwives to actually care for the whole family experience....and less c-sections and outcomes are better.....

Steve said...

I know I've used up all my goodwill at this point, and at the risk of getting barred from commenting, thank you Michelle R for mentioning the ban on rescission as part of the Affordable Care Act of 2010. I think this is the single most important element of the bill. In the movie Sicko there is an interview with a former insurance investigator who was responsible for compiling evidence against people they wanted to kick off their plans. It will send chills down your spine.

Kelly said...

Great post B. And I agree with Keely- you better be around for a long, long time!!

Becky said...

Michele R, great review on the ACA, thanks. I do think it was a great start.

Steve, you haven't used up your goodwill with me!

Becky said...

Meant to say: thanks so much for sharing your stories. Elizabeth, Michelle, everybody. Michelle, I wish everybody could read what you wrote and the way you said, "We cannot continue this way." We really, really can't.

Sheila said...
This comment has been removed by the author.
Lecia B said...

Sub Mat, you have just given me the information I need for my mom's insurance (stage 4, metastasized to the brachial plexus in 2004---and still making feasts and folly for all in her world these many years later!) You have rocked our world today!!! Many, many thanks. I thought I loved you before but this is just making me want to slap you with happiness high five! Thank you!

Jane said...

A wonderful post, full of hugely helpful information. So glad you are through with those six months and can breathe a sigh of relief!

Rebekah said...

great post. I agree, this needs to be more of an open conversation using real people's stories in the USA. Keep up the great blogging! Glad you have coverage that is more affordable now.

CancerKicker said...

Dude, we need to connect on this topic. Thanks for publicly sharing this story for others to connect with.

My company is about to be acquired, where benefits (and possible employment) may be significantly impacted. This is suppose to happen by end of year.

I want to understand this: "Matt got some money from the sale of another company he'd worked for, and was able to leave the job he had here in Atlanta and start his own game company." I message you elsewhere to get more details.

Getting Multiple Myeloma (incurable blood cancer) at age 28 with a stay at home mommy-dominator with several kids makes my future insurances needs a nightmare without a PhD in this stuff. Too bad any didn't really like the studying part of college.

Keep dominating. -Phil

Star said...

Socialized medicine: amen.

Aimee said...

Good gracious, what a mess. I'm continually appalled at what passes for a healthcare system in our country. The people without a full-time person at home to deal with all of this? My gosh...yes, they get sick and die, because what choice do they have? Anything would be better. What the hell is so wrong with socializing anything, anyway? Sharing is a GOOD thing, isn't that what we're telling our tots?

kylydia said...

I read it and read it in complete fear. It is never more clear to me than when I read something like this that pretty much every American (maybe not the 1%) is one health disaster away from complete ruin. This goes way beyond being your own advocate and the whole process just stinks of "ignore that person and they'll just go away" kind of stuff.

I'm glad that you put this out there. I hope it helps someone.

Christian said...

BECAUSE YOU'VE DONE SO MUCH RESEARCH, YOU SHOULD BE A CONSULTANT. I'M READY TO PAY YOU FOR HELP WITH MY STUPID INSURANCE.

Ms. Connie said...

Wow! Way to be your own advocate! I applaud your persistence. Thanks for telling your story and shedding light on this messed-up system in our country.

Charity said...

I'm curious as to how the process worked after you submitted the application. Was it pretty easy or was there a bunch of remaining zigs and zags to navigate?