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Health Insurance Headaches

October 8th, 2008

Warning – Full blown rant ahead.  I am so upset I can hardly stand it.  I think my head may explode.  I know I have criticized the media for using Migraine loosely to describe a hassle, but I’m using it literally here.  My health insurance company, which is supposed to guard and foster my health, is about to give me a bona fide Migraine!  Adrenaline triggered, high blood pressure triggered, crying triggered, you name it.  And then they won’t want to pay for my medication.

I just received a notice that as of November 1, my health insurance premiums will go up by over 60%.  I receive group insurance through a professional association, and so I am one of those self-employed small business owners who is paying for my own premiums.  These are the group rates, mind you, if I tried to get my own insurance outside the group the premiums would be even higher.  Our health care is already the one of the largest costs in our budget, after shelter.  Higher than utilities, auto fuel, higher than food.  The monthly premium for our family of four will go up about $800, to over $2000.  And that’s just the beginning.  We already have:

• a $30 co-pay for doctor visits;
• a $50 specialist co-pay (“specialist” includes physical therapy for headache prevention – $50 out of pocket every time I go – my neurologist wants me going twice a week, I manage twice a month at those rates);
• most of the medications our family uses are considered “Tier 3” and have a $50 co-pay as well, so that’s a good $400 at the pharmacy every month;
• we have a $2000 deductible for out of network doctors (and we do use some of the same doctors who we like and trust and have used for years – silly us – so picky, huh?);
• after we’ve forked out that $2000 deductible, we have a 30% co-pay for out-of-network; and
• all claims must be submitted in 90 days or they are rejected.

That last is a doozy – take someone who is chronically ill and has trouble keeping up with paperwork, and you have a perfect formula to never have to pay on some large proportion of their claims.  Every previous insurance company I’ve had gave you 6 months to a year to submit claims.

Oh, and I almost forgot.  This company routinely loses about 1/3 of everything I send them.  So I have to keep to a very strict schedule to get everything in, then I send the claims, get nothing back, call them, they have no record, and they tell me, “Oh, if our scanner can’t read it, it’s destroyed.”  Destroyed.  I pay these people over $15,000 a year, soon to be over $24,000 and they destroy my paperwork?  Then I have to dig out my copies, send another set with a cover letter, and guess what, they send half of those back saying they weren’t submitted within 90 days.

To all the costs above, let’s add that I spend a good 2 days of my time every other month dealing with my health insurance claims, mostly with their screw-ups, uncompensated, of course, taking time away from earning my living.

I’m naming names here.  It’s Oxford Health Insurance, a United Healthcare Company.  They grant me the privilege of paying them an additional 60% for this abuse starting next month.  The reason?  Our group has a higher than average rate of claim submission!  Aha!  So, let’s analyze this – first of all, this is a group of coaches, whose job is to get people organized and on track to achieve their goals – maybe we have a higher than average ability to actually find our way through the impossible obstacle course that Oxford has set up to keep people from submitting claims!

But then, remind me, what’s the insurance for?  Call me naive, I thought it was there so I could afford health care!  I didn’t realize it was for the profit of the insurance company, first, foremost, and exclusively!  I’ve got no problem with business, I’m in business myself, but I do have a problem with the profit motive here, where it’s destroying the very purpose of the product!  Dare I suggest a single-payer system?  This is not auto insurance.  You raise rates on bad drivers, to give people an incentive to be good drivers.  So you raise rates on sick people to do what?  Punish them for being sick?  It is wrong to refuse insurance for pre-existing conditions.  It is also wrong to make insurance unaffordable for people who happen to use it.  That’s just a sneaky way to try not to cover conditions whether pre-existing or new.

A few days ago I said I would be non-partisan in this blog, and I don’t want to alienate anyone.  Please feel free to come here for help and support and ideas about managing life with Migraines regardless of your politics.  But I’m sorry, I can’t stay neutral here.  We have a chance to finally make a difference with our votes, a difference we sorely need.  McCain is proposing a $5000 tax credit to go straight to the insurance companies.  That won’t even pay for this premium increase, let alone make me any better off.  Does Oxford deserve even more of my money after all they already manage to take?  McCain is proposing deregulating health insurance further and encouraging more competition, letting the market take care of it.  The market is taking care of it by raising my health insurance premiums by over $9000 a year, because I have the gall to actually use my insurance!  What exactly is my family supposed to give up to pay for our health care?  Food?  Heat?

We need comprehensive, affordable health care available to all of us.  We need insurers to give sick people coverage without penalizing them.  We need this desperately.  People are being driven into ill health and poverty in this country by lack of coverage.  Barack Obama’s health care plan goes a long way down the road towards the coverage we need.  I need his plan now.  I think we all do.

– Megan Oltman

Exploding head courtesy of Alexander Iezzi.

Tags: affordable healthcare, Barack Obama, health insurance, healthcare, migraine
Posted in Advocacy, Rant | Comments (4)