My personal health care reform story

31
Aug
2009

A friend sent me the following question in an email today:

out of curiosity, who do you get your medical insurance through? every so often i toy with taking time off and the thing that always stops me dead in my tracks is insurance… i’m kinda curious how coverage works when you’re not with a company that picks it up for you…

My poor friend ┬áprobably didn’t realize what a touchy subject this was for me. My response to him I thought was worth sharing, so here it is:

In short:

If money is not a big issue, it is straightforward and easy to get.

If you don’t particularly feel like shelling out 700 plus dollars a month (or can’t) it is a Byzantine nightmare.

It took me many months of research and hassle to even be able to qualify for (much less afford) insurance. I finally settled on the least bad of any plan I could find, a place called Freelancers Insurance Company. They pool a bunch of freelancers into a group for better buying rates. I had to prove a certain amount of freelance work and have several clients verify with signed forms before I could even get coverage from them. I currently pay 266 dollars a month which includes vision and dental. While this is easily the best rate for the most coverage I could find, there are many things left out and I have a crazy high yearly out of pocket (something like 13K) should I need a hospital stay for example. My copays for a regular doc visit are 30 bucks (in network) and 50 bucks for a specialist (also in network).

If I had been able to afford more coverage, it would have been preferable, but alas this year as I am building a client list I have really not made much money at all. This process has been enlightening however, and made me realize how much the working poor (which sadly includes me at the moment) are screwed over in this country when it comes to health care. Being freelance adds and extra dollop of bend-over-and-take-it to the mix, because so much of our health care costs are hidden in the (even poor) health benefits that many employers extend to their staff.

Still, I was happy to finally have health care. That was, until I decided to actually use it recently. On my very first doctor visit after having coverage, I went to go see an in-network specialist (for a somewhat unpleasant problem I won’t bore you with), gave them my insurance card, got a consultation, paid my 50 dollars and left, thinking that was that. A couple of weeks later I received a notice in the mail from my insurer telling me that this may be considered a pre-existing condition and they may refuse coverage. I was pissed, and dutifully send them back all documentation that I had, and am still waiting to see if they will cover me. ┬áPeople who truly do have pre-existing conditions are (again) SCREWED in this country. The fact that it is even legal to deny such coverage is in my mind one of the great evils of our current system. I am in an especially shitty position because I had a coverage gap while I was traveling and trying to qualify for insurance here in NYC. Insurers love to mess with you on that score as well (although not before taking several months of your premium payments).

Btw, while I was investigating the charge the specialist made to the insurance company, I was gobsmacked to discover that his charge to them for a 15 minute consultation was 900 bucks! I have no idea how much of this is overhead to an insurer, how much is just what they can get away with, but jeez really? I would LOVE to be able to bill at that rate. People have no idea how much doctors and hospitals charge back for services, but they should. In any event, this guy is competent and is on my insurers list of in-network, approved physicians, so they should be covering me without hassle and negotiating better rates with the doctors themselves.

Ultimately, I have become convinced that some things, like police protection and health care, should not be run as for-profit operations. They must be fair and available to everyone. The people that think we have the greatest health care system in the world are the ones that can afford the best coverage. That won’t change in a single payer system (France for instance covers everyone quite nicely and some people have add-on insurance called mutuals for things the system won’t cover) but there should be a minimum level that all citizens are entitled to. People who say we will have health care rationing under single payer are crazy if they think it isn’t rationed already: It is rationed on the ability to pay.

Hope this helps. It made me feel better putting it down on paper. :) Feel free to call me directly with any questions.