Ranting About The Health Insurance Industry

It's Thursday morning and I'm in the mood for a rant!

Seriously, I am a bit annoyed!

My COBRA coverage (through Mr. B's former employer) runs out 2/28. It's been pretty decent coverage through Aetna but it's also been awful having to pay the monthly premium (Mr. B is covered through his current employer at no cost to him which is nice but to cover me would be real expensive).

Maybe two months ago, I began exploring options for my medical coverage. I'll tell you, it is a confusing process. There are so many plans, levels, options, caveats, etc. I finally decided to utilize eHealthInsurance.com to help me weed through it all.

I plugged in my basic information and up popped several different insurance companies each with several plans (e.g., lower monthly cost but higher deductible, office visits covered before deductible or not, etc., etc.)

I decided on one from United Health Insurance as it fit my needs pretty well (and my doctors are in their network, which is pretty important to me). The monthly premium is actually less than what I'm currently paying (albeit the plan itself isn't quite as comprehensive but good enough).

They required a three month premium be submitted with the application (refundable, of course, if the application was denied).

Last Saturday I got a call from them wanting to know about my prescription for Clarinex; the dose, how much I take, how long I've been taking it, etc. Well, gee (I thought), if that is all they have questions about, I'm set.

Today I got word that I'd been approved BUT the premium would be more than they originally quoted me PLUS there were certain restrictions. What restrictions? Oh, and the email said someone would call me within three weeks to see if I'd accept the terms.

Say what? Three weeks? Sounds like a hostage situation to me since my other coverage runs out in three weeks!

Thankfully, I'd kept the number from last Saturday's call on the answering machine. I called them and, after a LONG hold period (I'm sure they do this on purpose in hopes people simply give up and hang up), I talked to a representative.

This is what she told me. They'd moved me from preferred premium to standard, which meant another $25 a month (not awful; still cheaper than what I am currently paying). And, they assigned a $1,200 deductible for brand drugs. It was $1,000 before. So, in essence what they had done was change it so they would never pay for the Clarinex (a brand drug; can't get it generic). There is no deductible for generic drugs, just a $15 co-pay. As for the premium, she told me that all on-line applications are automatically given the premium rate but almost everyone moves to the standard (more expensive) rate after going through underwriting. As for me, she said since I had an on-going prescription, that meant an automatic move to standard rate because it indicated I had some sort of medical history.

Well, no shit, Sherlock; I'm 45 years old; of course I'm gonna have some sort of medical history!

Anyway, I told Mr. B, fine, I'll get around this by having my doctor write me a prescription for some sort of allergy medication that can be had in generic form. I'm not married to Clarinex; it's just what I was first prescribed and it worked so I stuck with it. I'm sure Allegra or some other such medication will also be fine. And then they'll have to pay for it.

I'm ranting about me, of course, but whenever something like this happens, it always makes me think about all those people out there who cannot afford their medication (and cannot easily switch it or simply stop taking it). It is against the law (now) to not cover a preexisting condition (so long as a person has been continually insured) BUT it's not against the law, apparently, to put a high deductible on brand drugs before they are covered; so high, in fact, that they are NEVER covered. I know a lot of certain medications that people need TO STAY ALIVE are not in generic form. I know there are a few prescriptions that I've received of late for "menopausal" issues that are still under patent and therefore there are no generic forms of them and I'll be stuck paying full price (good thing I loaded up on them this week while they are still covered by my current insurance company).

It infuriates me, is all.

It also brings to mind how much more people who have no insurance have to pay for services.

A few years ago, there was a blip in my coverage right at the time I had to go to the ER for a minor thing. So, I got all of the bills; from the hospital, from the doctor, from the lab.

If I'd have paid those bills, I would have been out over $2,000 (including $50 for one antibiotic pill and over $350 for a doctor's assistant who came and told me I had a UTI and that's it).

Since my insurance ultimately paid it, I didn't pay a dime. What did the insurance company pay? Well under $500 for the whole sha-bang. That's because the insurance company had agreed to pricing with the doctor, hospital, etc. So, they charge one thing knowing the insurance company will only pay half of it.

But, the poor sap without insurance is stuck paying the higher amount.

Good luck to President Obama in trying to fix this God Damn mess!

Mrs. B