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Three Things I Wish Someone Had Told Me About Health Insurance

1 Dec

My experience with Health Insurance companies for the last five years has been mildly benevolent, in that I made sure to pay them X amount a month and they made sure I was covered if my feet fell off. Things went decidedly south about 6 months ago when I decided to, god forbid, move.

Stern Looking Doctor
“Perhaps you shouldn’t have moved to Oregon, hippie.”

I’ve learned a lot of crappy things about the Health Insurance Industry in the last few months, and I feel like a lot of it was avoidable if I had known just a few key pieces of information before making some health related decisions. I’d like to share those lessons with you now so you can dodge some of these complications and headaches in your future dealings with the Healthcare system.

1. Health Insurance Companies Want to Eat Your Family.

After moving, I called my insurance broker and let her know my new address in Oregon. She went ahead and did her magic, and a month later I received my bill. Surprise (was it though?), my new premium for my wife and I just about doubled from $270 to $499.96 per month. I wanted to make sure my new donations were going to a good cause (like paying for the CEO’s stripper mistresses) so I called their customer service to find out what the deal was.

Turns out I was now out of network, so my premiums went up accordingly.

Customer Service Woman
I’d love to help you, but I’m kind of busy with my modeling career.

That would make sense, except that the quality of my plan went in the other direction (down). Since I was out of network, the percentages the insurance company contribute towards my expenses dropped from 80% to 25%. The 75% I was contributing was now going towards a deductible that had also doubled from $1500 to $3000.

In all fairness, all the info’s right there in the 60 page document they gave me when I signed up. I should have chosen to be a bit more curious and it’s all pretty standard operating procedure stuff for health insurance companies.

Piles of Paperwork - Lots of work
It was filed alphabetically between “Screw” and “You”.

Fine right? No worries, just switch your insurance to a company that considers Oregon in-network… This leads us to lesson 2:

2. Don’t You Ever, As Long As You Live, Switch Insurance Companies.

Remember that one time you went to the doctor to get that insignificant thing checked out? I know, it wasn’t a big deal, but you’re going to have to include it on the application.

Remember that application for coverage you just sent in? Yeah, it got rejected because of that thing.

Last August, I ruptured my eardrum while Scuba Diving (because I make terrible decisions). I went to the doctor so that he could verify that I was an idiot, and then I was all done because this is an injury that heals all by itself like a cut. While we were there, we decided to check out an issue my wife was having which was some blockage in her salivary duct. I know, way too much info. There’s a reason I’m telling you though. The doctor suggested we get a CT scan to pinpoint exactly what’s going on, and then we went on our merry way.

Like the honest folks we are, we mentioned both events on our application to ODS with some assurance from our broker that he never sees anyone get rejected for such small issues.

We were both promptly rejected for coverage.

What blows me away, is that my wife is 26 and I’m 28, we’re both in good health (we stay fit, we don’t smoke, don’t drink, don’t eat fast food, don’t have any chronic conditions), and we’re honest on our applications for coverage. What is the health insurance company looking for? I was rejected for a condition that was completely resolved.

Doctor looking in an ear
“I think I left my daughter’s tuition payment in there…”

We appealed the decision. I had to go back to the doctor so that he could verify that everything was fine with my ear (4 months after the accident) and I typed a 4 page document attached to the doctor’s chart notes to try and let the insurance company know that my ear was fine, and that my wife’s issue was a minor annoyance that occurred maybe twice a year.

They accepted me and rejected my wife.

We’re now going with the statewide insurance plan for my 26 year old healthy wife because ODS is not willing to cover her. This is the Oregon plan that is the failsafe for residents who cannot otherwise get health insurance.

We’re now in a bad position because we wanted to check out a minor concern with a preventative mindset (and we were already at the ENT Doctor) when we would’ve been better served just ignoring it.

This leads me to point 3…

3. Don’t Ever Tell the Truth About Anything, Ever.

Seriously. If there’s one take away from any of this, remember that everything you tell your doctor will get marked down forever on your chart notes. Some day, if you even get individual health insurance, when you’re arguing with the company about your claim, they’ll point to it and say you never told them, or alternatively, that it was a preexisting condition. So don’t tell anyone, anything, ever.

Black and white photo of dr. dre
Just don’t lie to this Dr.

I don’t actually know too much about the current state of the health care system, but I don’t think I ever realized how crippling the system is until I finally had to deal with a different side of it. I’ve always been healthy, employed, and stable, so this was never (selfishly) a concern to me. One of those things changed, so now I’m in a different boat. I’m very lucky that I have a variety of resources and a bit of income and savings to handle the complications, but I can only imagine how difficult this must be for someone in a different situation. How broken is a system when young healthy people can’t even get affordable health insurance?

My wife and I are incredibly lucky to be physically sound and capable, so I know there’s a light at the end of the tunnel for us. But I have no idea how people are dealing with similar situations who have actual problems that need actual care.

Clown Doctor - Humor
They go see this guy.

Knowing what I know now, I would be much more selective about what I would reveal to the health care system, which seems like a terrible solution to a ridiculous problem. I would rather risk my health by not getting something checked out than risk being denied in the future or seeing my rates jump astronomically.

Does that not sound crazy?

UPDATE (11/30/11 21:12): I’m incredibly blown away (sorry I keep using that phrase) by all of the comments! I’ve been a bit frustrated with my experience so far, but it’s certainly far more interesting to hear that it’s a commonly felt sentiment. And sad. Mostly sad.

It’s pretty striking that for such a developed country, we still have a healthcare system that seems to function pretty terribly, evidenced more by the disposition of the responses rather than the statistics you can find here or there. Originally, the post was meant to be a satirical look at what felt like a ridiculous situation, but I’m quickly finding that this story is hitting home for a ton of people, which again, blows me away. And again, feels pretty sad.

I started out trying to reply individually, but I’m quickly realizing that it’s a losing battle. Thank you so much for all the responses and I really appreciate everyone taking the time to read my blog, which I know is one of… Billions? I know there’s a lot of them, so I appreciate you spending some of your reading time with me. If you’d like to do it again sometime, please feel free to hit the follow button up top. Or alternatively, follow me on twitter, @MacsJF. (My apologies for the shameless self-promotion).

Thanks again!

-Max

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