After I found out I was approved for health insurance, I finally got the documentation.
My asthma has been excluded. Actually it's a 5-year "waiver" that is removed after 2 years if I have no asthma treatment, if I put in a written request with all my medical records. Great. And it also waives any other respiratory infection or inflammation and "emphysema, bronchitis, pneumonitis, pneumonia, cyst, tumor, sinusitis" and so on... You know, for all my pre-existing pneumonia and cysts.
I would have been denied if I had required more than one waiver. Great.
I consider my asthma very mild. I have a low-dose inhaler I use a couple weeks a year, and I have a billion of them stocked up. But if I were to get, say, swine flu, it would turn into asthma for me. And it looks like if I get pneumonia or a cyst, I'm just screwed.
This is now a much more risky gamble. Over at Goliath Debt, his wife had no health insurance when she had their baby, and now the complications have destroyed their finances. I think it's easy to say (in hindsight) that that level of gambling is stupid. Hospitals are expensive!!! Of course you should have some coverage!
Now, without hindsight, I have to decide whether to gamble. If we take the HDHP, I can't seek any treatment to manage my mild asthma to get the waiver lifted, and the waiver could bankrupt us if I don't manage my asthma, or if I get the swine flu.
I could really use some help here. I feel like I have no idea what I am doing in the wild west of individual health care plans. The fact that I even have to make this choice, $1200/month for COBRA, or $200/month with no asthma coverage, pretty much makes me want to cry.
Monday, July 27, 2009
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27 comments:
People who haven't dealt with bullshit like this have no idea how truly bad U.S. healthcare is. I took the gamble and won, but it was for a prior surgery that, luckily, had no complications.
Dog-
Are you looked into the Texas Health Insurance Risk Pool?
LindaB
my advice, strictly based on what I know now, is this: $1,000/month will pay for a lot. What if you got the $200/month plan, and set aside $1,000/month in an "emergency spending account" or even and HSA? In 2 years, you would have $24,000 in the account, and I'm not sure, but I would think it would take a lot less than that to pay for most of what could happen to you...
Dog, you know your situation better than me. And I've never had asthma and I'm not too close to anyone who has, and I'm not affliliated with any health profession, so I'm not familiar with side effects, treatments, etc.... So please take what I say with that in mind.
I suppose the question is, how often do you get your Astma treated? If its been within the past 2 years, forget what I say below.
But it appears that you can save $24,000 in two years if your Asthma is not covered by your $200/month health insurance?
It may be too simple, but that amount of cash could buy a lot of health care (sans major surgeries)... especially if the provider got paid in cash -- not via insurance. Invest that in an HSA and get the tax advantaged savings.
And, that $24,000 can also provide a lot of preventative care that could stave off sickness--vaccinations, better foods, exercise programs. And perhaps, it could give you a little less stress...
I'd take the gamble and like some other commenters mentioned, try to bank the difference between the lower premium and COBRA. What about senor dog's company, can he set up a small business group plan that includes you? It will certainly be more than $200/mo, but as group coverage it shouldn't have any exclusions.
Well, it's a risk. It sounds like you have a mild case (this is what you say) of asthma but what is disconcerting is that ANY respiratory illness is not covered. Asthma or no asthma, that can affect anyone. I think you have to weigh it with how long you'll be without employer-sponsored healthcare. If you anticipate less than a year, maybe go with the HDHP. You could also have Senor Dog on HDHP as he doesn't have any exclusions, and leave yourself on Cobra. I believe you can do that. You would pay the individual rate which would probably be more like $400-500 per month.
Honestly, I was initially surprised to hear that you were accepted without any rate increase or anything but now that you mention this 5-year waiver business, it sounds exactly like the way our healthcare works. You are only a "good" risk for them if you have never had to go to the dr for anything except regular checkups. Our health is tied to insurance companies' bottom lines.
Take the insurance then wait. One of the features of ObamaCare that has wide bipartisan support is forcing insurere to insure pre-existing conditions. That provision is firmly in the bill (HR-3200). Therefore, it is almost certain that your waiver problem will go away by law in 12-24 months. In the interim, conserve your money to self-insure respiratory issues (ditch the housekeeper?). And stop stressing so much - it will make you ill.
This makes me very glad to live in Canada.
I am so nervous after reading the goliath debt.
This is such BS. I'm sorry you have to go through this. I have no helpful advice, unfortunately.
Hi Dog - I have asthma. (Thank you, 9/11.) If your asthma is well controlled, I think it would be worth figuring out the retail costs of your medication and doctor's visits and weighing that against the cost of the insurance. Most likely, the insurance won't really be worth it.
Conversely, if you have had one or more acute attacks in the past year, I'd view that as asthma that isn't as well under control as you'd like and seriously consider the insurance option. If you are prone to acute attacks, you could end up in the emergency room and I doubt that's a place you want to be without insurance.
In the meantime, my experience has taking good preventative care really helps. That includes eating and sleeping properly, exercising regularly, identifying and avoiding your triggers, and always having a rescue inhaler nearby. I also take a couple of toots on my rescue inhaler before I do any intense exercise, and that makes an enormous difference.
have you checked Texas risk pool?
http://www.tdi.state.tx.us/health/index.html
My problem wouldn't be the asthma itself. That would never land me in the ER, and it's no big deal if it's a doctor visit or two.
My problem would be if I were hospitalized for something like swine flu. That would almost certainly cause asthma complications -- in the hospital. That would sink us.
If you can afford the payments, use COBRA for yourself. The risk that any respiratory infection could trigger asthma complications is too great. Many are emphasizing the money you could save without focusing on the devastating loss to your net worth with only one hospitalization. Your health could also suffer if your medical decisions become impacted by your insurance situation. The importance of financing adequate health insurance should come just after shelter and food.
I admire your attention to details when researching your health insurance situation.
Dog
This is so difficult and a hard road to navigate. I am a RN and the first thing that came to mind is do you get your yearly flu shot? and does your doctor recommend you have a pneumonia shot?
I would not worry about swine flu. Most swine flu cases are treated outpatient with oral meds. The cases that are hospitalized are usually immunocompromised already and it seems your asthma is fairly mild. As for life you can never know what may come your way. My vote is to go with the inscurance plan and save a little money towards expenses. Good luck
I would check with a lawyer who specializes in insurance/medical cases. Unless the laws have changed in the last few years, if you have had continuous coverage, nothing can be excluded. It was put into place while Clinton was in office, but Bush may have changed it. At any rate, it's worth getting a lawyer to look at it and advise you on whether the insurance is operating within the laws. Having fought insurance companies twice, I can tell you they will do/not do whatever they can get away with.
I was going to say what DC said (and others may have -- sorry didn't read the other comments). The insurance contract is not a one-way negotiation. Why don't you ask a lawyer to help you prepare a letter asking them for the basis of those exclusions and to remove the overly broad exclusions. Don't send it on legal letterhead, though -- the point is to get them to deal with you.
Keep copies of everything, and add handwritten notes of the date they were received. If they send you a letter and refer to a conversation that didn't take place or make any other mistake, be sure to correct them.
Hopefully this sorry mess is fixed in the near future.
Good luck dog.
I worked in a doctor's office my 1st job out of HS and there is NO WAY I would pass on the COBRA. I've seen women in the 20s and 30s develope breast cancer, freak accidents, infections, etc. The thing about this gamble is that you are "all in" every single day. I could not personally live with that level of risk. Good luck.
I'm with Anon., "The importance of financing adequate health insurance should come just after shelter and food."
I dealt with health insurance over and over again on behalf of my (adult) stepdaughter as she went through grad school and transitioned to her first job. We always took COBRA (she, too, has a pre-existing condition); here's the thing: with COBRA you have certain legal rights you do not have with individual plans. One is the pre-existing condition thing mentioned by DC (who, no offense, is wrong about that ... if you buy an individual policy -- if you can get one at all -- they can exclude whatever they want, or deny you coverage (my DSD could not get an individual policy in our state and there is no high-risk pool).
If you have access to COBRA and you take it, exhaust it (run the clock out), and then need an individual plan, you have some legal rights. Otherwise, basically nothing; they can exclude what they want, and they can deny coverage if they want. They can also raise your premium if you get sick.
If I had to choose, I'd always take COBRA unless it meant being homeless. Really. The problem with health insurance costs isn't just the one-time whammy, it's that many diseases are chronic ... if you can get good coverage (including COBRA), take it.
And I wouldn't bet on "the Obama plan." If it comes through, great (IMO), and you can make changes then, but if not ...
I'm self-employed and a member of a "union of business owners" or some such thing, whose sole purpose, it would seem, is to insure the self-employed. I live in NY but it's Blue Cross Blue Shield of Illinois. All members have the same premium, so I don't think it counts as an individual plan (so no pre-existing condition concerns).
There are also associations you can join and get access to group insurance plans. For example, you'd join a regional dance/arts association, pay their fairly nominal annual fee, and have access to member benefits. Most don't care if you dance or are even remotely interested in dancing (or whatever) - the bigger the group, the better the bargaining power for premiums, so it's to their benefit.
After reading all the comments and your point about respiratory complications with other illnesses (which I also get every single time I get sick), I think it's important that you keep insurance coverage for asthma. I'd stick with COBRA for the time being.
Have you looked...not are you looked...
I know better than that...LOL
LindaB
Look at how often you get severe respiratory infections that have resulted in you have to get treatment - from what you've said it doesn't really happen you are just worried about it happening.
And yeah it could. But chances are slim. The swine flu thus far is no more dangerous then the regular flu. You can get vaccines for the flu and for pnemonia.
If it were me, I would go with the $200/mo for two years.
As for Mr. Goliat Debt...I don't know his circumstances but from what he said regarding taking a gamble it sounds that he willingly chose to go without insurance on his wife and now child. If that's the case then sorry to say but that wasn't a gamble that was stupid. (not that I don't feel sympathy for him) And utterly different then your circumstances. Pregnancy and delivery even without compications is expensive. Newborn care is expensive. Unavoidable if you plan to have a child.
Mild asthma for which you rarely even use your inhaler...pretty different.
I don't know about this. I am a very-healthy 30 year old with no ongoing issues, never had a hospital stay, and have taken prescription medication (including antibiotics) maybe a dozen times in my adult life. That being said, every single issue I've had to go to the Dr has been for Sinus infection (sinusitis), Bronchitis, and one nasty bout of Influenza. These are just the common afflictions people get and have to go to the Dr for. To exclude them would, for me, exclude nearly every reason I have ever had to go to the Dr in the last 15 years.
R. May-
How is it a gamble for Goliath Debt to not insure his wife because he didn't expect the complications but it would not be a gamble for Dog if she decides not to insure for her asthma? If Dog decides to go with the $200 asthma excluded insurance then she will be taking the gamble that she will have no asthma related problems while covered under this insurance. As she said any thing such as flu or pneumonia can cause her to have asthma complications. While not expected, people do get sick or have complications.
I will say Goliath Debt had the option to get insurance and decided not to so I have no sympathy for him when something bad happens to put him in a financial hardship. I will also have no sympathy for Dog if she decides to go for the $200 insurance that excludes coverage for her asthma and she ends up getting sick and has big medical bills because of her asthma. It's her own choice at this point because she has the option of paying less in premiums but without the proper coverage or paying more in premiums but with the coverage needed.
Henry - it was a not a gamble for Goliath because, as I stated, pregnancy care and child care is a requirement regardless of whether or not there are complications. He was going to have massive costs 100% no matter what.
If Dog has no history of complications from her asthma then while a risk, she will likely be ok for the 2 years necessary.
Individual insurance can decline you or rider you for conditions and this is one big problem with our USA medical insurance that needs to be fixed. Group insurance from your employer cannot do that. I would recommend the COBRA option, as now Obama ARRA 2009 has it so you only should pay 35% of the premium. I think you have 60 days to get on it from the day you leave work, but I am uncertain of your State rules, so I would call the HR dept. If your spouse has coverage you could become a dependent on your spousal policy due to a qualifiying even. Or best yet, get a high deductible plan and self insure by putting $300 a mo into that bank acct with interest and it is tax free. Whichever works for you. I would suggest COBRA at this time.
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