Introduction to Health Insurance 101

I may stir up trouble with this topic but I feel like it’s time to talk about it. I lost my oncologist recently when HealthNet changed network providers from Dignity Health to Banner.  HealthNet had previously approved my continuity of care but they are not going to keep doing it.  I’ve been told to “transition to an in-network provider.”  So I have to give up the doctor I’ve had for three years, who has seen me through one of the darkest moments of my life.  I guess it could be worse, this could’ve happened during chemotherapy or radiation.  It’s disappointing but unavoidable.  I need an in-network oncologist.  For those who don’t know, I work part time and am not insured by my employer.  I hold an individual policy through the ACA Marketplace.  My husband is self-employed and has his own policy, as does our daughter.  I could choose to work full time and qualify for employer sponsored benefits where the network is huge and I could likely see any doctor I want, but I do not want to work full time.  I also don’t want my medical insurance dependent upon my job situation.  It’s sticky because you may have a gap in coverage and need Cobra.  Right now I work four days per week and I feel that gives me some balance.  I have time to run errands and schedule appointments on my weekday off, leaving the weekend to spend with my family.  So, if losing my doctor is what happens I’m not happy but it’s the price I pay for my choice to work part time.  What I will be unhappy about, is if the ACA gets fully repealed, something isn’t figured out, and I lose my pre-existing condition protection.  This provision along with the ability for parents to carry their college aged kids under their policy was a beacon of light in an otherwise black hole of regulations and dwindling insurance providers.  What many people do not understand about the ACA is that prior to its inception, anyone not participating in an employer based insurance based plan who had a pre-existing condition could be denied coverage of said condition, or denied coverage completely.

See, until I was a stay at home mom many moons ago, I never knew that people who carried individual health insurance policies were not subject to pre-existing condition protections. My first ever diagnosis of a pre-existing condition was hypothyroidism at the age of 36, which was found during routine bloodwork (and which also revealed I was pregnant!)  I quit my job and became a stay at home mom.  I had a broker who set me up with an individual insurance policy since my husband was self-employed and also had an individual policy.  I began to see an endocrinologist for treatment.  I received the first bill and an EOB stating anything to do with my thyroid issue would not be covered.  Excuse me, huh?  I have insurance!  I called my broker and basically said “what the fuck is this shit!?  It’s always been covered before?”  She explained that because I had an individual policy now, pre-existing conditions could be excluded from coverage and that when I had employer based insurance, they could not.  So paying for thyroid related issues was not a huge deal, a few hundred bucks.  Eventually I went back to work full time and had insurance at work and it was now covered.  After a few years I decided I wanted to reduce my hours, work about 4 days, 30 hours per week.  When the ACA went into effect, the pre-existing mandate was put into place.  No more could insurance companies block you if you had a pre-existing condition.  Not only that, but insurance companies could not dig up every single medical record from the time you were born and drag you through the underwriting process which truly resembled a full body cavity search and Spanish inquisition.  Trust me, I know.  When I quit working to stay at home with my baby, I was the picture of health and I got call after call from the insurance company asking me to explain my medical records.  They even had things that never pertained to me and doctors I never saw.  It was a huge clusterfuck.  This changed with the ACA.  No longer could insurance companies discriminate.  Obviously we all paid a price for this boon with increased premiums, increased deductibles and increased out of pocket maximums.  My premium (just for me) has skyrocketed since the ACA came to be, going from $242/month to $730/month.  I figure okay, what can you do?  It is what it is, and there is ONE choice for health insurance in the individual market in my county (the largest county in Arizona).  Costs were supposed to go down, and I was supposed to be able to keep my doctor. Well in my case, the opposite of both those things happened.  I’m not super pissed about paying $730 per month because prior to the ACA I could’ve been really up shit creek with my breast cancer diagnosis in 2015.  A lot of my conservative friends want to see the ACA completely repealed and let me tell you right now, that would absolutely fuck me up ten ways from Sunday.  Surgeries, chemotherapy and radiation costs for me would’ve been in the high six to seven figures.  And that’s factoring in a possible discounted price to match what would be charged to providers.  My liberal friends want single-payer universal healthcare.  I’m not sure that would shake out very well either.  Socialized medicine has its own set of problems.

I consider myself to me fairly libertarian on most issues. I think I am pretty sensible.  One of my first legal jobs was working for a bankruptcy trustee.  We like to look at people who file bankruptcy as lazy slackers who spend too much, run up their credit cards and/or who are just all around irresponsible jackoffs but that is truly not always the case.  Yes, I saw many people who just couldn’t manage their money and bought houses and cars they could not afford.  But I also saw firsthand, so many people who were bankrupted simply by medical bills.  People who worked hard who understandably could not afford six and yes, even seven figure medical bills.  Many of these people paid their monthly premiums but because they held an individual plan, they had treatment that was denied coverage because it was due to a pre-existing condition.  Here are some of the people who fall into this category:

Self-employed

Part-time

Contract

Stay at home parents whose spouse cannot cover them

And before y’all start yapping about Medicaid and low-income benefits-my husband and I are not low income and do not qualify for any ACA subsidies. But we are not wealthy either.  We are middle-class.  We can’t pay six and seven figure medical bills.  I am not asking for anyone to pay my way but those of us who fall into any of the above categories should, like anyone else who gets their insurance at work, be able to purchase insurance that covers pre-existing conditions.  Nobody should go bankrupt or lose their life’s savings because they have an illness that an insurer refuses to cover.  Yes that’s my opinion and feel free to disagree.  I believe in personal responsibility and accountability.  I am dubious about many things the government wants to “take over”.  Just about everything they do costs more, takes longer to accomplish and is usually screwed up.  It is a swamp.  So maybe it means opening up markets and allowing customers to purchase insurance across state lines.  Maybe it means allowing people to have portability if they change jobs.  Maybe ultimately this gets us towards something resembling single-payer and I am well aware of all the arguments against that and many are valid.  I don’t know, smarter people than me are going to have to come up with the answer.  So far neither political party has shown ANY ability to come up with a solution.  I’m looking at you congress-the same assholes who enjoy the Rolls Royce of health insurance who don’t seem to give a shit about solving anything that truly matters to the constituents.

Nobody wants to see themselves or a hardworking friend or loved one lose everything they’ve worked their whole life for, because they got sick. Does someone who wants to carry insurance and is willing to pay for it deserve to be shut out of the process, just because they work less than 40 hours per week or are an independent contractor?  Or how about the stay at home mom or dad whose spouse does not have the option to cover them?  And remember, I’m not talking about freebies here.  I’m talking about access to an insurance policy that will cover me if God forbid my cancer returns.  So maybe congress, you can get with the program and quit crying about Stormy Daniels and wall-building long enough to fix this shit.

 

 

 

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