The Disaster That Is Health Insurance

obamacare-2By – Maegan Williams Polak

We are a married couple in our late 50s who have worked all our lives and have two children. We have been married 35 years and tried to make a life together that would provide a decent, if modest life for our children and save some money for our retirement. The story I am about to relate is what is happening to many people our age who have been involuntarily downsized and subsequently lost their group health insurance coverage, just as they are coming into the years where healthcare could be quite an expense, possibly a catastrophic expense for someone uninsured. We had never been without health insurance and what we found happening in the individual healthcare coverage racket leading up to and immediately after the passing of what is laughably called the Affordable Care Act was infuriating, confusing and almost amusing by turns.

During the time we had group health insurance through my husband’s employer, my high school age daughter was diagnosed with cancer and it took many consultations with specialists to find a surgeon and then several surgeries to remove all of the cancer. Coordinating a doctor who took our very good healthcare plan with a hospital that was also in the plan seemed needlessly complicated and lengthy, meanwhile the lump on her leg grew some more. The fact that she had cancer in her teens is relevant to the story, just as it is relevant that I was diagnosed many years ago as bipolar with manic tendencies and a whole host of alphabet psychiatric issues, a/k/a Preexisting Conditions, the kiss of death for anyone aspiring to purchase individual heath insurance coverage. I might be diagnostically crazy but I’m not stupid and I used to work in healthcare accounting, so I know a fair amount about how healthcare is supposed to work, at least from an insurance billing point of view and what my rights of appeal may be. This is my story of how the current health insurance situation doesn’t work and a short rant regarding the obscene expense of coverage. It is my feeling that if we can’t rein in healthcare costs, there will be a time of reckoning between the people and the insurance companies. I, myself, might consider bringing a pitchfork and a torch to that confrontation. None of the people in office that could help to legislate better protection against these armed robbers in three piece suits only thinly disguised as insurance companies, seem willing to step up for us; they are too busy pointing fingers and looting the pockets of the middle class, and accepting campaign donations from the medical insurance industry and the pharmaceutical companies. Perhaps the health insurance industry does not realize exactly how much hatred and distrust there is of them and their business model, as well as the overt dislike of their intrepid sidekick, Big Pharma and their own outrageous price gouging, or maybe they do know how much contempt with which we view them, and they don’t care. Evidently they can afford to feel that way.

When we were young, it was the 1980s and we had employer based health insurance, and we were encouraged to look after our physical and mental health, rather like the way one takes their car in for preventative maintenance. I used our insurance and thought I was looking after my health, just like the insurance companies pretend they want you to, pay for an office visit now, avoid a costly hospital stay down the road. I did not know until it was too late, just how much my seeking mental health treatment would count so heavily against me.
Just as my spouse hit his peak earning years, having spent 33 years with the same company, his job was gone and when you’re out of work in your 50s and have only worked one place for your entire working life, it is rather difficult to find employment that pays one third as well as your previous job, much less a full time job with actual benefits. We kept our health insurance during that period by paying the seemingly ludicrous premium of $1398.42 every month for COBRA coverage. Just bleeding cash. Before our COBRA benefits ran out, I started shopping for health insurance for the three of us. This happened before Marketplace insurance, when insurance companies could still refuse coverage to teenaged children who were cancer free and other seemingly arbitrary and sometimes capricious reasons.
Shopping for insurance was a time sucking, pointless and ultimately futile exercise. Every single application we made would result in an offer to cover only my husband because of Cancer Girl and Bipolar Mom. Every insurance company we applied to demanded the first month’s premium BEFORE they decided if they would deign to cover us. I gave one unnamed insurance company a month’s premium with the assurance that if they declined to cover all of us, that we would get our money back the same way they deducted it, quickly and through an EFT transfer. That didn’t happen. That company, like every other one, rejected everyone but my spouse and not only didn’t refund our first month’s premium, they lifted another payment from our bank account for the following month! It took me 45 days, several letters and some threats to take my complaint to the Insurance Board before they relented and gave me back my money. The money they were never entitled to in the first place.

We were fortunate during the half year or so that we couldn’t get insurance that nothing catastrophic happened and the following year when the Marketplace opened for health insurance coverage, I tried to wade through the myriad offers of plans that seemed to be low or mediocre quality but with premium quality rates, and statements of coverage that seemed deliberately confusing and downright disingenuous. So I found an agent who helped us sign up for the best insurance we could afford, not the platinum coverage, but not bronze coverage either. At the time of sign up, I thought our family to be in reasonably good health, certainly none of us drank, smoked or were overweight. The sticker shock for what was loosely termed “coverage” was immediate and huge; whoever decided to call the insurance law the Affordable Care Act must have had more money than God. Because as it turned out, it was neither affordable nor did it provide much actual healthcare coverage. But our family likes to eat once in a while and have electricity, a few of the basic necessities of life, so I picked a plan provided by a Great Big Insurance Company, lulled by their familiar logo and cute commercials that promised to “be there for you,” as well as recalling dealings with them when they provided us with group coverage and asked myself how awful could it be, such a reputable company and all. As it turned out, group insurance with the Great Big Insurance Company was a completely different thing than the individual plan we were offered and suddenly we went from Valued Customer to Obamacare dog poop.

There was a payment mixup with this company, too; I made a phone payment for the premium and the company also helped themselves to the same amount from my bank account without authorization on the following day, thereby running our rickety checking account into the red and resulting in our incurring $100 in overdraft fees. When I complained via telephone, some nice woman told me to fax the information to their office and they would reimburse me for that $100. Three weeks later, when I heard nothing from them, I called back and suddenly they changed their tune, they weren’t liable, but they were very sorry, was there anything else they could help me with that day? I pointed out that so far that day, they had helped me with exactly nothing and said I would take the issue up with the Illinois Insurance Board if they didn’t refund my $100 as they originally promised to do by Mrs. So and So at This Time on This Day. I take excellent notes when dealing with anything to do wi th insurance, as it often appears that when their lips are moving, they are lying. I also said I would tell the BBB and if that didn’t work, I would be happy to sit in their fancy lobby and let everyone know how this Giant Insurance Company tried to cheat a poor old woman out of $100. A week later I received a check in the mail for $90.00 Who knew there was a $10 copay to write a refund check to a customer?

The insurance was bad. Very bad. I couldn’t see the doctor I had been seeing for years, a caring man I trusted who has seen more than several members of my family pass from one side of life to the other, and I recognized exactly none of the providers in this plan. As I checked the approved list of physicians in my plan, seeking someone else, the choices were abysmal and the online reviews of many of them were dismal and unflattering. So on the few occasions it was unavoidable for me to see a doctor, I paid my own doctor for the office visit out of my pocket because the premiums I was paying did not cover his services. We limped along like this for a year, paying the insurance premium that gave us about as much coverage as a stripper’s g-string, and also forking over additional out of pocket payment for my psychiatrist’s monthly visits because, surprise, she was not covered in this Plan of Exclusion either. But we managed to keep our heads above water, even tho ugh that nigh onto useless insurance was expensive, subsidized or not. But it was most certainly mandatory.
The following year we rolled over into the same plan we’d had the previous year, continuing to pay for medical professionals of our choice out of our own pockets, people that we knew and trusted in addition to the insurance that seemed to be mostly insurance against us filing a legitimate claim with them. We were still managing, but there were leaks appearing in our financial lifeboat, and with health insurance taking roughly one third of our net income each month, it was not easy.

That was the year I found out how dreadful the coverage we were sold really was. One September evening I was quietly reading a book on my couch and the next moment I was on the ground clutching my chest. Classic STEMI, 100% blockage on one side. The paramedics came and I remember very little for some hours except a transfer to two different hospitals and, some undetermined time later, coming up from the anaesthesia when they were putting four stents in my heart, feeling them snaking the wire up my groin and them telling me to hold still. As if. It was a several day stay in ICU, and my husband had just gotten laid off from the job that paid him less than half of what he used to make (and that did not provide health insurance) and I couldn’t see how we were going to be able to pay for much of anything at all, let alone keep up with the payment for health insurance. Just a little added stress.
Before they discharged me, I was told that I must wear this external defibrillator when I left the hospital, it was for my own good and absolutely medically necessary, and I would have to wear it day and night for 90 days, because it might prevent me from falling over dead, as it would shock me if I fell unconscious or my heart rhythm became abnormal. Upon inquiring if this was covered by insurance, I was assured it would be. So I agreed to wear it. Imagine my shock (no pun intended) when I discovered that the life vest company billed my insurance company and the insurance company said that I would have to pay the entire bill for that medical device since I hadn’t yet met my deductible for the year. It was September already! Following a hugely expensive cardiac stay at the hospital! The cost of that cursed vest was $100 per day. For a month.

Then came the bill from the cardiologist. It came with a large note that said, “We don’t take your insurance, we’re not billing your insurance and you owe us $5600.00. It might be worth mentioning here that if we could barely afford the cost of the fairly useless insurance we had purchased, that chances were excellent that we also couldn’t afford the additional $12000.00+ we owed on copays, deductibles, uncovered services, and so on ad infinitum.
In light of what happened that year, the following year I asked my agent to find us some real health insurance for just my husband and myself, something that was not that marketplace-poor excuse for coverage. Forget the subsidy, we’ll bite the bullet, we said. And he found us some. The cost of health insurance now ate up more than half of our monthly net income, the premium amount being equal to double the mortgage payment on our home when we bought it. This year’s insurance costs an excess of $1600 per month. Had anyone told me, even ten years ago that we would be in this financial situation at our age, over the cost of health insurance, medical bills not covered, and how much an insurance company would have the license to gouge an individual policy holder, I would have laughed with incredulity.

When we initially applied for marketplace insurance, we received a letter from the marketplace asking for all three of us to provide documentation that we were citizens of the United States and therefore eligible for an insurance subsidy. I found this to be a redundant request, pardon me, but if the government is enforcing this fiasco through the IRS, it would seem to me that they would darned well know if we were citizens. Nevertheless, I sent the required documentation off to them certified, return receipt requested, though I protested mightily. And I counted it a victory not to get a request for citizenship status from them the following year.

At the end my disastrous and expensive year of medical bills, it was time to file our income taxes. I received not one but two 1095A forms, since Marketplace had adjusted our meager subsidy in February. The top of this form says quite clearly, “Marketplace Insurance Statement.” I submitted our return electronically and sat back and waited for our refund to come. When one is unemployed or underemployed, that refund money can be critical. I received notice that I had gotten a deposit from the IRS, but I also noted it was several thousand dollars less that what the total on the 1040A showed when I had completed our return. About a week later, I received correspondence from the IRS telling me that their records showed that I did not buy marketplace insurance, and if we would just agree to drop the matter, there would be no further consequences or penalties for us, and by the way, please send us copies of your 1095A forms. So I did. Certified. Return receipt requested . Their brilliant decision, heedless of the clear evidence on the requested tax form, was that I did not buy marketplace insurance, never mind the name of the 1095A had Marketplace Insurance Tax Form plastered across the top, they were disallowing the deduction and I could sue them in Federal Court in Washington DC if I didn’t like it. We are still negotiating this matter.

The final straw came from a letter sent to me by Marketplace regarding our 2016 insurance. This notice said if we didn’t comply with the requests outlined in the enclosed letter, that we would lose our tax subsidy for this year. For the second time in three years, they wanted proof of my husband’s citizenship, that very same proof I sent certified mail two years ago. Surely they did not think he defected within the last two years……

So I called them. And politely explained to them that we bought non-marketplace insurance this year, due to the fantastically dreadful outcome of using marketplace the previous year, so basically, they were threatening to take away a subsidy we weren’t getting for buying the marketplace insurance we didn’t purchase, did I get that right, and could they please tell me how their requests made any sense whatsoever and by the way I am NOT going to be sending proof of my husband’s citizenship again, since I sent it requiring proof of delivery two years ago so I knew they had it. Her response was , “Never mind. Those are randomly generated letters.” to which my retort was, “Well, random might be a polite word for it, but I respectfully refuse to comply.”

To sum up; We’re in our late 50’s. 2008 smacked our retirement investments hard. Job loss and the subsequent lack of health insurance cratered our savings. My health isn’t good and my husband is unemployed at the moment. We expect next year’s health insurance to cost us somewhere around $27,000.00 That amount is more than I made some entire years of my working life! How is this right? Or moral, much less within financial reach of ordinary people who also have house payments, children they would like to help put through college, in addition to the everyday costs of just existing. We will not speak of property taxes at this time. We have exhausted our savings and liquidated investments in order to keep paying for insurance coverage on a policy that actually pays claims and doesn’t put us any further into Deductible and Noncovered Hell. Any money we have left after 5 years of COBRA payments, “affordable” care premiums and privately purcha sed pricey insurance is in my husband’s 401(k), and in order to make those insurance payments until Medicare kicks in for us, we will have to do a hardship withdrawal from money we had put away for our later years. We didn’t spend our money foolishly when we were young, buy a huge house or spend it on expensive hobbies, vacations, or cars, much less let it piddle away from us by using drugs or alcohol. We tried to take care of ourselves. But at this point in our lives, we are one furnace repair away from disaster and I find it most discouraging, nay, I despair that we are in this situation.

There are many people just like us in this country that have similar circumstances and issues. Issues of affordability, of declining health with signs we are aging starting to show up in our medical bills. We have no lifeline, we’ve already paid out as much rope as we have. And to foist off marketplace insurance as anything that can remotely be called “coverage” on people who have worked hard and suddenly found themselves on the “liabilities” side of the corporate balance sheet because of their length of service with a company and cut loose through no fault of their own is reprehensible and shameful.

In the years leading up to and at the inception of the Affordable Care Act, my experiences dealing with the issues arising from having such shoddy coverage at so large a cost, and the small indignities of the bureaucracy itself (please prove you are a citizen of this country not just once, but twice) makes me think that the entire marketplace exchange thing was just a charade enacted by the insurance companies and their minions to further extort the maximum amount possible from the pockets of the middle class. And after they have extracted the entirety of your savings, they demand more. And when you tell them you have no more, they shrug and point you to your state Medicaid program, a plan with a dearth of providers and wait times for procedures or tests that will probably exceed your life expectancy. But that’s all right, because you don’t have any money anyway.

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