Friday, November 6, 2009

Reform

I've been getting questions about the insurance and I want to tell you the story of how a family can very quickly get into an insurance mess.  By the way, insurance is very messy and sticky, no matter how you look at it.  Just when you think everything is fine, the rug gets pulled up from under your feet.

Our insurance thought process over the last 18 months...

May, '08: I'll quit my job, stay at home with my daughter and work part time or work full time somewhere with better pay to afford day-care.
June, '08: Hooray!  A part time job that provides insurance and allows me to stay at home with Lilla.  All we have to do is pay $80 per person per month!  Great!  Lil and I are covered for only $160/month.
August, '08:  We'd like our children to be close in age.  Maybe we should have another one.  Let's call the insurance and see what they think.  I call my insurance, they say they cover pregnancy 80/20 (we pay 20%, they pay 80%).  This is the same deal we had under my full time job insurance coverage!  Awesome.
January, '09: Suddenly, we begin receiving notices from Aetna that our pregnancy bills are not covered.  We talk to ObGyn office.  We call Aetna.  We call ObGyn office.  We call Aetna.  And so on.  Apparently, we are not covered at 80/20.  This came as a surprise to us and our ObGyn office who was also told by the insurance company that we are covered 80/20.
January 31, '09:  We all get food poisoning.  Will this hurt the baby?  I call my doctor's office.  They tell me to go to the hospital because it might be early delivery.  We go to hospital, have tests run, and 5 hours later go home with an a-okay from the doctor.
February, '09:  We get a bill from the hospital.  It's $3000 and the insurance will pay nothing.  I call insurance company demanding an explanation.  They blame the hospital for not billing it correctly.  I call the hospital, they say insurance refuses to pay.  I call Aetna....you get the point.
February, '09:  At this point my pregnancy hormones are in FULL force.  I have to protect my family somehow.  I start looking into Medicaid because we can't pay for the recent hospital bill and a delivery out of pocket.  As it turns out, we are eligible for Medicaid.  I drop Aetna immediately.  Why pay $160/month if they aren't covering anything?  The children and I are now on Medicaid, which covers our unpaid hospital bill and our future pregnancy related bills.  I'm humiliated that we have to go this route, but relieved.
June, '09: Baby is born.  He is admitted to the NICU for breathing problems.  Thankfully, Medicaid covers the whole experience.  My Medicaid coverage ends 60 days after his birth.  We're feeling pretty good because what else would I need coverage for?  I'm healthy.  I'm young.  I'll wait to get insurance in August...or whenever we can pay for it.
June, '09:  Two weeks after delivery we discover the brain tumor.  Surgery is scheduled.  State of panic sets in.
September 1, '09:  Medicaid coverage ends.  We decide to sign me up under hubby's health insurance (Blue Cross).  They say that as long as I have no breaks in coverage, they will cover my brain tumor related bills.
October, '09:  Blue Cross says I'm not eligible for brain tumor related coverage because they have no proof that I was insured.  Adam fights the entire month of October (making phone calls, leaving messages, faxing evidence, emailing, etc.) to rectify this.
November, '09: I am finally fully covered under Blue Cross for just a "measly" $670/month.  And then we pay 20%.  And deductibles.  Which, did you know there are numerous deductibles under one plan?

As a back up plan, I also signed up for non-pregnancy related Medicaid--just in case Blue Cross would not cover me.  Medicaid is now my secondary form of insurance.

I cannot believe how incredibly blessed we have been.  Shhhh!  Don't tell the hospital--we have not seen one single bill from my surgery or any of the doctor appointments involving it.   We believe that Medicaid is covering it all from when I was covered with my pregnancy.  Thank God.

And now I pose a question to you, do we need health care reform in this country?

1 comment:

Ms. Joanna said...

Hmmmmmmmmm.................. Good question. Computer says yes.