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American Healthcare on Hold: A Year of Health Insurance

By Wardrobeoxygen @wardrobe_oxygen
American Healthcare on Hold: A Year of Health Insurance

Healthcare wasn't something I thought about; it was something I took for granted. My father worked for the government, so growing up we had great insurance. When I went to college, the ACA and its policy to have young adults covered by parental policies didn't exist so I was kicked off my parent's healthcare. I got health insurance through a program for college students which had any services from the campus health center 100% covered, emergency rooms completely or almost completely covered, and other services... well, I never found out because I only used the coverage for sinus infections, birth control, and one time when I thought I truly injured myself but actually just pulled a muscle from coughing.

After college, I got on whatever insurance my job provided and it seemed fine because I was fine. Annual visits with my gynecologist, the occasional health center to X-ray a twisted ankle, nothing major. When Karl and I married, I got on his work insurance which was low-cost and high reward.

I didn't start thinking about insurance until my husband quit his job and it became my responsibility to protect us. My current job had insurance that was twice as expensive as what my husband paid and offered maybe a quarter of the benefits. I had to visit one of their health centers instead of the general physician I saw for years. It didn't cover my gynecologist, the closest one that took my policy and didn't have horrible reviews was a 25-minute drive away.

Healthcare Issues in Corporate America

I changed jobs, and one reason was insurance. Health insurance was a factor determining if I would apply, and health insurance was the deciding factor in choosing my new position. With my new job's insurance, I could see my old favorite doctors, go to a high-rated hospital if need be, and since we were thinking about having a child, I saw I could see midwives and go to a birthing center and my insurance would cover it.

And it was great insurance; I didn't pay a single dime through the whole pregnancy or the birth, even with it taking four days and multiple specialists to get Emerson into the world. A friend had a baby a month after I did; I was at her house when she got the bill for her hospital stay. After insurance, she still had to pay almost $3,000 and she was only in labor for a couple hours without any intervention. I was grateful for having great insurance.

And then our company changed insurance plans. Now, we had "patient-managed" plans. We had a buffet of options - HMO, PPO, varying deductible rates, varying needs. It was incredibly confusing and HR didn't know much more than I did. I did research, made calls to the company, and chose a plan that seemed as close to my old one with Blue Cross/Blue Shield though it cost me twice as much per month. We now had a child to care for, I didn't want to go bankrupt if she had some medical issue and I didn't want to have to take her to a lower-quality hospital or doctor because our insurance limited us.

Luckily, our child didn't have a health issue so she didn't use the insurance past annual visits, vaccines, the occasional cold, and dental appointments. Even so, we paid anywhere from $35 to $100 out of pocket for an appointment that wasn't her annual visit, including vaccinations. I had strep throat, went to my GP essentially to get a prescription for antibiotics. Out of pocket, I paid $85 for the visit and $45 for the medicine. Running to catch the Metro, I tore my calf muscle; it cost me almost $300. Annual mammogram? $350 out of pocket. I wondered if I made the wrong decision with insurance and should have just gone with a cheaper plan that had fewer options and benefits.

Health Insurance and a Medical Crisis

Then I broke my right arm slipping on ice. I went to the in-network emergency room closest to my home, had the surgery done by an in-network orthopedist, follow-up appointments at his in-network office two towns away. Even so, each month I was getting bills after insurance did their part for at least $100. I reached my high deductible in just two months. This was a good thing as insurance covers everything after the deductible is met.

And then my arm broke again due to the in-network doctor and hospital making mistakes. Come to find out, insurance is able to decide what they think is essential and what isn't. Many of my procedures and appointments to repair this damage was considered "not essential" and I paid out of pocket. And then the new year happened and I had to again make my deductible for insurance to cover anything, including the twice-weekly physical therapy sessions to get my arm and hand working again.

At the end of all my arm surgeries, therapy, and appointments I paid out of pocket over $22,000. I wiped out most of my savings, put essentials like gas and groceries on credit cards so I could have enough to pay the monthly bills. I delve more into my healthcare issues and costs with my arm in this blog post from 2015.

Last year, overwhelmed at my job and with the blog, I thought a therapist could help. I searched for an in-network therapist that took my insurance and found one... an hour away. My insurance informed me I could go to a therapist on a list they provided, submit the bills myself and be reimbursed for part of the cost. I found a therapist so close to my office I could visit on my lunch hour. I got my bill, submitted it, and was told oh sure, they would reimburse 50%... after I met my deductible. That was not explained on that first call. After two visits and $450 out of pocket, I quit my therapist.

Healthcare Issues when Self-Employed

A few months later, I quit my job. The biggest fear I had of doing that was insurance; I knew it was so expensive when you were on your own. A friend recommended an insurance broker; I shared with her my current job insurance, how much I paid, and my deductible. She recommended I get on COBRA, a federal act that extends an employee's insurance for up to 18 months after leaving a job. Thing is, with COBRA your old job doesn't pay a portion of your healthcare. I'd pay over $1,400 a month to continue this mediocre insurance. Anything cheaper available through the ACA was what is called "catastrophic care," or "the basics so you don't die and don't go bankrupt" care.

This first year of self-employment went without major health issues. My daughter got braces which isn't cheap, but COBRA dental covered a portion and the orthodontist has an interest-free payment plan. Insurance continued as before, even with the same insurance cards. Payments just now went to a different place.

Early November, my husband had a dental issue. He went to pay and found he was no longer on the family dental plan. He paid $275 out of pocket for the visit. I called our insurance, they said November 1st my policy switched from a family plan to an individual plan. Then I called COBRA, they said I was still paying a family rate and said the insurance was wrong. It took a week on the phone and at the local Staples becoming BFFs with their fax machine to find out when my COBRA renewed November 1, some idiot typed it in wrong and removed my husband and daughter from our dental plan. Over two months with weekly calls and still no resolution. In fact, I am writing this while on hold with COBRA.

When Open Enrollment began for the ACA, I took a look. I found that rates were far more reasonable than the previous year. We found a plan essentially the same as our current one, but almost $300 less each month. It only took about 30 minutes to register. My state's site for the ACA was a bit clunky but the process was easy and clear.

Taking Insurance for Granted

When you work for Corporate America, it's easy to take insurance for granted. It's also easy to judge those who do not have insurance. But acquiring insurance in the United States isn't always easy, and the monthly cost is more than many can afford. Even if you have insurance, it doesn't protect you from crippling debt, lifelong health issues, or bankruptcy. American healthcare stories often focus on those below the poverty line, but many successful business people are uninsured because they can't afford the monthly fee. I know many who "suck it up" when sick or injured because they can't afford the cost for an appointment or prescription.

I wanted to share my experience to show that the American healthcare issues aren't affecting just one demographic. Some with great jobs and insurance are still crushed by medical costs. You can start your own business and be successful with it and still not be able to afford insurance. And you can write over 2,000 words about insurance during the time you are on hold with your insurance company. Something NEEDS to change.

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