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Healthcare Headache

My health insurance finally paid their share of the bill for my first visit with Psychiatrist B, which occurred 7 months ago to the day.

When I learned of this, I decided to (finally) look into options so I’ll have health insurance after my current plan – which is dependent on my being a full-time student – expires. There is an option through my current company. When I called for a quote, the person I spoke to was very nice! She asked a few questions and suggested a plan that costs – wait for it … – $400 per month! This is marketed to students who are between leaving school and receiving health care coverage from their employer, mind.

I took a look at the information she sent me and became quite concerned. One of the criteria that prompted her to suggest this plan instead of a less-expensive option was my need for prescription coverage. When she told me the benefits, I thought they included prescription coverage. But when I looked at the explanation of what the plan covers, it explicitly excluded all prescription drugs – even generic! It also explicitly excludes mental/behavioral health care.

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I thought, there has got to be something better out there! I searched for “affordable health insurance” and found ehealthinsurance.com. Through that site I was able to find a plan with a different company that costs $320 per month. Their prescription coverage includes a $15 copay for generics and coverage of 50% of the cost of brand-name drugs up to a certain limit. They also cover 70% of mental/behavioral health care, up to a certain limit. Sounds pretty good.

Except that, according to their brochure, I might not be able to switch companies and I might have to wait to enroll within a specific range of dates and I might have to go several months without coverage. I have no idea whether I’ll be able to find a psychiatrist who is in-network for both companies. “Long-term care” is on the list of services they don’t cover – I have no idea whether that applies to me or not or even what it means in terms of practical considerations.

Worst, I read a customer review by someone who said coverage was denied for treatment of a “pre-existing condition,” and ze had to fight for what coverage ze did receive! WTF?! I wouldn’t care so much about health insurance if I didn’t have a “pre-existing condition” that (likely) requires inhumanely expensive medication to treat! And there’s the nagging voice in the back of my head asking, am I really saving any money if my health insurance costs over $300 per month? That’s before the copay for the doctor’s visit, the copay for (or half the cost of) the prescription medication, and 30% the cost of any additional (limited to a certain number of visits) mental/behavioral health care I receive.

But then, I’m reminded of the first time I used my school’s insurance to help pay for a prescription. Long story short, I literally saved $100 on that month’s supply of the generic drug. Add the doctor’s visit that finally got paid for ($250, minus the $25 copay) and I’ve already saved $5. Never mind if I do need to go to the hospital, etc. And preventative health care … I have yet to compare insurance coverage vs. going to a low-cost clinic (e.g. Planned Parenthood), but there’s a decent chance I’d be saving money there, too – especially since companies are increasingly required to cover preventative care at no cost to the patient.

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Oh, I just took a look on Planned Parenthood’s website, which has a link to HealthCare.gov. Starting October 1st, I’ll be able to search for low-cost insurance options there, with coverage to begin in January. Yay, Affordable Care Act!!! Why, oh why couldn’t you be fully implemented immediately?! (I’ll refrain from soapboxing about what healthcare should look like in the US – and still won’t, come 2014 – … at least for now.)

Anyways, I still haven’t decided what I’m going to do about health insurance from mid-August (when my current plan expires) to January (when coverage begins for any low-cost plan I manage to find on Healthcare.gov). But at least I have hope that paying through the nose for whatever plan I do find (or going without insurance, as millions of Americans do) will be a short-term solution.

What’s your experience with health insurance, particularly trying to find an affordable plan? Any suggestions? International readers, how does access to affordable health insurance in your country compare to what I’ve described here?

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7 thoughts on “Healthcare Headache

  1. My partner, Goose, was voluntarily hospitalized and kept there for 3 days. Luckily, she had insurance at the time. Unfortunately, insurance companies do NOT want to pay. I called her insurance company so many times that I’m sure a little red flag popped up on their computer when they answered. They said they sent forms for doctors to fill out; the doctors never received the forms. When I demanded that they fax the forms to one of the doctors, the doctor in question immediately filled them out and mailed them back–and guess what? A month later the insurance company still claimed not to have received them. Eventually I bullied them into giving me the manager’s fax line and sent all correspondence there, keeping the confirmation records showing the fax went through. This went on for so long (9 months) that finally, after I had called the hospital on many occasions to pay our part of the bill and to explain to them the insurance situation, the hospital adjusted off $800 so we could just stop dealing with it.

    I cannot imagine having a plan that does not cover prescription drugs. That said, there are ways that it could work. The pharmacies are the ones who set the price of the medications they sell (the markup would leave you furious, so I will not give an example). Most pharmacies have generic drugs available for small co-pays. IF your medication(s) are working for you and unlikely to change, I would research the pharmacies near you and see which ones cover what you need, which ones cover what you might need in the future, whether there is a yearly fee to get the reduced prices, etc. If your meds are pretty much up in the air, this would not be an advisable choice (but sometimes we do not have enough options to make the kind of choice we would like to).

    You mentioned “long-term care.” I may be wrong, but this USUALLY refers to elder care services in a long-term care facility like a retirement home, nursing home, etc. So probably not applicable right now. πŸ™‚

    As far as finding a low-cost health insurance plan here in the United States, I have no advice. But I wish you the best of luck!

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    • Wow. To be honest, I’m kind of impressed that the hospital adjusted off $800 instead of, say, insisting that you pay it. The more cynical side of me wonders if that’s an example of how much they overcharge for their services, but the rest of me sees it as an example of how corrupt insurance companies are. It’s ridiculous what they get away with.

      Unfortunately my meds are currently up in the air, so I’m really a lot better off having prescription coverage. Thanks for the information about pharmacies, though – I didn’t know it was possible to negotiate a lower price with them.

      Thanks also for the clarification regarding what “long-term care” means, and for the well-wishes. Best to you as well!

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  2. Even though I’m 27, I’m still covered by my dad’s family plan (most are booted from family plans at 26). This is because he filed to have me considered disabled. Adult children with disabling conditions that prevent them from doing things that would normally get them their own insurance (ie being a full-time student or working full-time) can be covered under their parents’ family plans indefinitely. Does your mom have health insurance, and would she be able to pay a bit extra to have you covered under it? If she has insurance that covers mental health treatment and prescription medications, this might be an option for you.

    I have a friend who also cannot work due to their mental health conditions. They applied for state-based insurance, which in my state at least is apparently pretty reasonable (on a sliding scale based on your income) and covers a lot. I am not sure what the situation is in your state, but that is something to look into as well.

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  3. I totally understand your frustrations with our healthcare/insurance system. Broken beyond repair in my opinion… insurance companies in particular are pure evil. I don’t even believe they would save you from financial disaster anymore because you know they would do everything in their power not to cover your losses. On a more positive note, they also teach you the power of persistence and to never ever give up! πŸ™‚

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    • I hate it when health insurance companies get confused. They forget that they’re supposed to be helping make/keep healthcare affordable, and instead try to provide customers with an education. No wonder they’re so horrible!

      (To give the $400/mo. company credit, they did call back to see if I had any questions about their plans.)

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  4. Pingback: Third 3-Month Review | a day with depression

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