Thursday, March 4, 2010

Quest for Health Insurance

This morning I heard six magic words, "We have received all your information."

These words signify the end of our frustrating journey to acquire health insurance. My husband began his self-employment about a year ago, and at that time we needed to begin providing our own health insurance. Now, I didn't look at this as a huge feat, as I worked for five years in the health insurance industry in a 'past life'. I figured I knew the lingo, I wouldn't get "duped". Ha! I was WRONG.

We found a plan with a relatively high deductible ($5,000), but the monthly payments were reasonable (just under $400 for family coverage) and I was assured that our prescriptions would count toward meeting our deductible. That's a pretty big deal for us, since my husband has asthma and allergies and we rack up quite the prescription costs each month. I quickly found out that what this company meant to say was, "Yes, your COVERED prescriptions will count toward your deductible."

Apparently said asthma and allergy medications were NOT covered. Meaning not only were we stuck paying for health insurance that covered basically nothing (since there was NO WAY we'd meet a $5,000 deductible without the help of those prescription expenses) we were also paying out of pocket for all of John's meds. I quickly called around to a few local pharmacies, hoping desperately to find one that priced our meds lower than our beloved (and convenient) Target pharmacy. Lo and behold I found just that at Sams Club. Their prices did allow us to save about $150-200 each month on our prescription costs. Well, that was something.

As the year progressed, money got tighter and let's be honest here...the Golden Rule Health Insurance Company was anything but what its name implied. We stopped paying for the health insurance on time, thinking we'd catch up on our missed payments later in the year as finances allowed. Well, no such luck and they canceled our coverage.

Along comes my pregnancy in October and subsequent miscarriage in November and TONS of LabCorp bills. We are SO in the wrong line of business. These suckers at LabCorp charge astronomical amounts for bloodwork. Most individual tests were $100-300, but they billed us for a prenatal panel (I'm sure this is the one for which they took like five vials of blood) that supposedly cost $900+. WHAT?!? A panel of freakin' blood tests?!? Almost $1,000?!? My sonogram at American Radiology only cost around $700 for heavens sake. LabCorp, you are a rip off. You should be ashamed of yourselves. What a racket.

This leads us to our current quest for a new health insurance plan. Which may cost more per month, but I wanted to make sure all of our needs would in fact be covered. I applied for coverage with CareFirst for our family. DENIED. Not based on my husband's pre-existing condition (asthma) alone, but get this, his asthma combined with his BMI. His body-mass index. A formula. For heavens sake! I estimated his weight - we don't even own a friggin' scale! I figure I could fight this decision, but that would mean sending him for a physical somewhere that of course, for which we'd have to pay out of pocket.

With our letter of denial came a suggestion to apply for MHIP - the Maryland Health Insurance Plan. Which is administered by CareFirst. Which means it's housed in the same building, uses the same formulary and network of providers that CareFirst uses, and likely is processed on the same computer system. So we applied. There are a couple qualifiers to apply for MHIP: 1) you must be denied coverage by another plan, and 2) you must be a MD resident for over six months. Ok. That's us.

We get a nice letter back saying that further information was needed. Apparently I forgot to check which plan we were choosing (oops!). Also, I included a copy of my husband's driver's license to show residency (please note that he's held a MD driver's license for over twenty years and has never lived in another state). What did I forget about the license? It had just been renewed at the end of September - therefore not showing six months of residence. Seriously? We have previously HAD CareFirst coverage with an employer in the past five about checking to see if we were already in your system folks? Anyway. Here's the real kicker though. They requested a letter from his doctor to prove that he has asthma. We were just denied coverage by the other folks working in your building and probably using the same computer system for having asthma. But now we need to prove it? Why on earth would someone lie about having a medical condition that would cause them to be denied health insurance coverage?!? And even better, CareFirst has provided coverage to him while he's had asthma while covered under an employer's group. Recently! And that information is probably all in the same freaking computer system!!!!

So what do I do? I send them what they want. I sent them our plan selection. I sent them a copy of John's voter registration card. I got the letter from his doctor. And get this...the letter didn't have the doctor's license number on it. Now I know that this doctor is a participating provider with CareFirst, and therefore MHIP. I know that to credential this doctor, someone had to have collected and entered his license number in THEIR system. But apparently folks, this doesn't matter. So I call the doctor's office, get the license number, fax it in. It's supposed to take three business days to process. I call back in three days, ready to drive a payment to their office to get our coverage made official so I could make my doctor appointment (since by now I know I'm pregnant again). They didn't receive the fax. Of course not. This time a nice lady gave me her fax to desktop number and I faxed it again. I called today to find out that yes, in fact, they have received all our information! The system should be updated with our approval by close of business tomorrow. Then they can process a payment letter to us.

I'm still going to the doctor next week - I'm not canceling another appointment because of lack of coverage. The nice thing is that our coverage will be retroactive to February 1st and I can submit claims for the prescriptions we've had to purchase and my doctor appointment independently and the cost of both will be applied to our deductible.

Anyway, I've been wanting to rant blog about this for a while, since I know we're not the only family who has dealt with this awesome (hear the sarcasm dripping?) health insurance system we have, and I know that our story is by far not the worst. We were lucky that we didn't have a catastrophic illness or accident to deal with while we lacked coverage. We were lucky that there's a pregnancy center locally that provided a pregnancy test and sonogram to me free of charge. We're lucky that we've been able to find some coverage that will be good coverage and is affordable. Despite the journey to get here, I feel like this issue is about to be resolved, and it feels good!


emk said...

so glad things have worked out!

Emily said...

I so feel your pain! I switched jobs at about 7/8 weeks pregnant with Jack. Matt was not allowed to change his self-only coverage mid-year and I was without insurance for a few weeks while everything processed. (I'm only talking a few weeks here, so experience pales in comparison.)

Also, those labcorp people and the sonogram people do like 30 seconds of work and that amounts to some INSANE bills. So. Not. Cool.

Healthcare should not be this complidated! But it definitely feels like there is no quick and easy solution!

I'm so glad things seem to be working out!

Cmaaarrr said...


Congratulations! I'll keep my fingers crossed that this was the worst of your insurance headaches...