Insurance Woes

[Phoebe]

Why do health insurance companies rake you over the coals? My husband finishes his fellowship on June 30th and his health insurance expires on the same day. His out-of-state job is putting him on the payroll for July 1st in order to get insurance coverage starting August 1st. We will have no insurance coverage for the month of July.

In order to be covered we have to purchase Cobra insurance through our current insurance company. I found out we have to purchase the most expensive policy which allows you to not designate a PCP and to be covered out of our "network" in Indiana where we are moving. It will cost us $700 for the policy and we have to pay a $1000 yearly deductible upfront, in order to be covered for one month. After the initial fee, our costs would be 30% out-of-pocket. I can't imagine not being covered since I will be in my third trimester and if our 18 month-old were to have an illness or injury.

I can't imagine how we are going to come up with the payment. I guess we better start saving now.

Jennifer

[houseelf]

Jennifer-

This is terrible! I believe that insurance companies are the root of all evil. What a trick bag for you all. Yuck!

Kelly

[SueC]

Oh my gosh--don't get me started on insurance companies!!! In my opinion, they are a bunch of crooks! I deal with them every day--they are in a contractual relationship with the patient and the doctor and they still randomly don't pay for things that are part of the contract. Then they make the doctor or the patient (or the biller in my case) jump through hoops to get the darn thing paid for! I think they do it hoping the doctor's office won't have time to dispute it and will just write it off, which happens way too often!

[DCJenn]

Jennifer-

Look in to coverage through the state. I'm serious. Several of my staff couldn't afford our pathetic insurance through work and were able to get coverage through the Texas Children's Health Insurance Plan. Depending on your income, you may also qualify for Medicaid. Yes, it's utterly ridiculous that our insurance system is so out of what that providers of health care qualify for assistance, but it's something worth looking in to.

Don't even think about being embarrassed, either- you all pay taxes, just like the rest of us.

Jenn

[peggyfromwastate]

the cost of insurance is a big reason why we are going with the military for the next several years. I see no solution to the insurance problems, and it seems that every region of the US is in crisis. The only ones profiting seem to be the HMOs. I agree WHOLEHEARTEDLY with Jenn- look at medicaid and state plans because to pay $1700 for one month is something I'm sure you don't need.

Peg

Jenn, that is a great idea.
I would look into your state's Child Health Plan. Some states are more generous than others but the feds require the plans to cover families up to 185% of federal poverty level. You should count for 2 because you are pregnant -- 185% of FPL for a family of 4 is $2836/month. As I said, some states go to 200% or even 300% of FPL. You may qualify for coverage as well (your husband will not). You can subtract any child care, elder care, or medical expenses from your income if it is over the limit. Also, these figures are as of April. I can't remember during which month the FPL gets adjusted.
Insurance can sure be a pain in the a**!

[Cumberland]

not to add a new woe, but i was wondering.... is pregnancy a preexisting condition? i had thought it was, and that a new insurer will not cover an alredy diagnosed pregnancy. anyone know, or is it in my head?
sue anne

Yes, pregnancy is considered a pre-existing condition.

I also agree with Jenn, to check what the state has for children and to also check with Medicaid. Your family has been paying for it, if you need it, take advantage.

A little story about our first child...my wife was 3 months pregnant when the company I worked for filed chp 7 bankruptcy. She was in medical school so we were going to pay Cobra and it was going to hurt, but had to be done for the OB visits. The company I worked for was in charge of filing the paperwork to get you enrolled with Cobra and of course THEY missed the deadline that THEY had provided (read, with much bitterness). So, our only option was to go with Medicaid. It was quite an experience, DW had to attend state sponsored meetings about how to take care of your child. Some of the other women attending were high, skipping school (high school), or had 4 other kids tearing the place apart. We also qualified for WIC since our income was nothing. There were many times when we were looked down upon just for using WIC coupons to get food.
In the end it has helped DW because she HAS been on the governement service and she knows how it works.

I realize, Jennifer, that you are only looking at a month of uncoveredness(?). But again, you have been paying for it and if you need it there it is. It is better than the alternative.
Just my personal opinion, handed out for free!

Matt, that is great that your wife was able to go on Medicaid. A lot of states are more generous in the application process when a woman is pregnant.
Re: the pregnancy being a pre-existing condition. I would find out who your new insurer will be and call them to find if they have pre-existing condition clauses and how they apply to pregnancy. (There is some variation by insurance company and plan). When you are off of your current insurance, you *should* get a .....can't remember the name....certificate of insurance portability (a letter that says you were recently covered under group insurance coverage). That may help you with the new insurance company. Maybe. They really can be evil. If you have difficulties with this, let me know. A friend in the biz knows the ins and outs of the federal legislation concerning insurance portability.

Could your husband ask for an advance from his new job to cover the COBRA charge?

[Rapunzel]

Just a note: By law pregnancy cannot be considered a pre-existing condition by insurance companies in order to avoid paying for pregnancy and childbirth medical costs in Texas. It's a FABULOUS law and I hope there are other states with the same law ( I don't know of any off-hand). You might want to check into the laws of your state governing medical insurance to see if you have a law like the one in Texas. Also, I know that in Texas they will sign anyone who is pregnant (with proof of pregnancy) up for Medicaid - period. I would investigate that possibility as well.

[peggyfromwastate]

Rapunzel, that sounds similar to Washington. About 6 years ago the pre-existing clause for pregnancy was taken out. And we have lots of programs for pregnant women to ensure that they and their young children have health care. Our state plan is also readily accessible and you can be well above the poverty level to qualify.

Can you find any plans on-line? My sister went through this a couple of months ago, and she found a less-expensive Blue Cross plan on the internet...

[Phoebe]

Thank you for all the suggestions. We will definitely be looking into alternatives. I called HR about the insurance carriers. None of them categorize pregnancy as a "preexisting condition" so we don't have to worry about that.

Jennifer