It is a well documented fact that almost 46 million Americans are without health insurance. It is discussed almost daily in the news and is a major political platform. The primary reason cited for people not having any or adequate health insurance is because of affordability. It is just too expensive for the average person who is not covered by a group plan provided by an employer.I agree, to an extend, that comprehensive health insurance is expensive. Furthermore, most Americans only know about COBRA (which IMHO is a bold face lie that it is cheaper than individual health insurance). Truth be known, COBRA is the most expensive coverage known to man. For example, when I was recently laid off from my employer, part of my severance package was I was able to keep my health insurance at the employers group rate - $250 - for a period of time (which included dental, vision, AD&D). After that, I had to elect COBRA or go without. The same plan, under COBRA was $1500/month. I don't know who "they" think can afford that (so that I don't have a lapse in coverage), but I wasn't one of them. So, when people say they have to choose between eating/having a roof over their heads and medical coverage; most people choose daily survival stuff and pray that nothing really bad happens in the interim.
Beside the expense of health insurance, I would like to postulate that there are other issues, just as significant & important, that contribute to why so many Americans don't have health care coverage:
FRUSTRATION, ANGER & NO COVERAGE
The average American does not have enough knowledge & understanding of the health care engine to be able to navigate the system...through no fault of their own. It is a complicated industry with more acronyms than the military and more fine print/clauses than a mortgage contract. I've been in the business of health care (sales side) for almost 20 years and I still find it challenging.
Did you know that there are ways/places to get health insurance besides utilizing COBRA? You can go directly to a Health Insurer. You can utilize a search service such as ehealthinsurance.com that will show you all the plans available to you in your geography. You can work directly with a health insurance broker. If self-employed, you can to to an organization like the National Association of the Self-Employed and look into joining their group plan. If you qualify, you can apply for state plans or managed medicaid plans.
Now that you know where to look, you need to do your due diligence (comparing plans & benefits). Do you even have a rudimentary knowledge & understanding of medical plan terms to make an informed decision? Do you know and understand these terms and what they mean to you and your family?
- The difference between a HMO,PPO, Indemnity Plan, Network Plan, HSA Plan?
- The difference between & meaning of deductible/annual-deductible, co-pay, co-insurance, lifetime maximum, exclusions?
- Where to find (in the fine print) whether you are covered for mental health, chiropractic, ob/gyn, maternity, hospitalizations, surgeries, prescription drugs?
The combination of the above mentioned things and more determine how large or small your premium is going to be. I know what all of that means. I know where to look and what to look for. Yet, it still took me about 3 hours, once I selected/narrowed down it down to about 4 different options, to compare them all and comp up with the best combination of coverage & out of pocket expenses & provider flexibility that best suits our family's needs.
DO YOU HAVE THAT KNOWLEDGE, UNDERSTANDING & TIME REQUIRED TO MAKE AN INFORMED DECISION?
I doubt it, but if you did and you've found a plan...now you have to apply to the insurer and go before underwriting. This is where they get you.
- How many of you actually remember every prescription, lab test, lab value, screening test, etc you ever had done going back 7-10 years?
- How many of you have kept every medical invoice/bill and EOB (Explanation of Benefits) you ever got going back 7-10 years?
I bet hardly anyone.
So, here is what happened to me this week once I got to the application & underwriting part of this business. I did my research and chose a family plan from Any Excuse To Not Accept you unless your are in an employer group plan. I chose them because they had the right combination of benefits at the right price. I chose them because I have been with them under an employer plan since 2007. I was happy with it.
I fill out the application and try, to the best of my ability to answer their questions such as "In the past [7-10] years have you ever had a diagnosis, been prescribed medications for, been treated for ________________?" We are a relatively healthy family. Most of the time, I answered the questions - no. Anything currently going on or major, I put down on the application.
Two days later, a nurse from Any Excuse To Not Accept you calls and asks us follow up questions...taking a total of 2 hours to complete.
Yesterday, I get a notice that our application has been closed. No explanation, no nothing. I had to track down the number to the underwriters and find out what the story was.
We were not denied coverage...they just decided to close our application. I ask why. Now they don't come right out and call you a liar...they same that there were inconsistencies on your application. I apparently did not record on our application some things that were in the National Claims Database. Here is how the conversation went:
Me: But I answered ever question your nurse asked.
Underwriter: Yes, but there were inconsistencies.
Me: Where? Be specific In the answers to her questions or on the application.
UW: You were sent a letter. If you want to dispute what your doctor put down when submitting a claim then you will have to take it up with the provider and have them adjust the claim.
Me: Are you saying I have to review 10 years of records?
UW: Yes
Me: And how do I do that?
UW: You will need to call all of your providers and member services for all the plans that you had and ask them for the details
ME: ARE YOU SERIOUS!!!!
UW: It will be outlined in your letter.
I hung up. HARD. ARE YOU SERIOUS? I am supposed to get a list from every provider of health care for the past 7-10 years and review each ICD9 code they used? Do doctors even keep records that long? Am I supposed to pull my medical charts from every provider and do it myself? Do you know how much it costs to get a copy of your records? How do I, as a consumer, get access to this National Claims Database? YOU CAN'T. YOU DON'T. Since I'm already covered by those idiot, can't they just transfer me to the new plan. NO..that is a group plan - you are applying for an individual plan.
I spent four hours yesterday pulling off 2 years of EOB's off my current plans website (that is as far back as they even go). I also reviewed what records I still had & tried to piece together a COMPREHENSIVE medical history of every time we sneezed or got even a scratch. FOUR HOURS. I am considering just paying for copies of our medical records from our primary care doctors. I have an appointment with a broker. I've applied (took an hour to fill out this application) to another company.
HOW MANY OF YOU HAVE THE TIME, MONEY, DOCUMENTS TO FIND & PURCHASE YOUR OWN INDIVIDUAL HEALTH INSURANCE PLAN?
I am so frustrated & hostile, you could fry an egg on my forehead. We are healthy and are having this much trouble getting coverage. Why not just use COBRA, you ask. Because it is TOO DAMN EXPENSIVE! This plan I applied for cost 1/3rd of the COBRA.
The underwriter made me feel like a liar and that our premiums aren't good enough. It became obvious to me that most plans only want to cover individuals/families that are so healthy that they have NO MEDICAL HISTORY at all - cause they never use the service. You see, that is how many companies make the profit margins that they do. They only insure who they deem super healthy, collect premiums and provide no services. A big win for them. Sucks for the average American. Health Insurers prefer larger employers because they can lump everybody together and mitigate their risk.
Denying health care & coverage is illegal...but they don't do that. They just close your application & send you a letter outlining the appeals process that, unless you have a PhD, you wouldn't have the ability to understand, let alone complete. Even if you did, you would be without coverage for months while appealing. Is it worth it?
I've ranted ad nauseum. Be an informed consumer. Educate yourself. Read the fine print or find someone to help you. Keep good records. Document everything - for life.
Here's to your health(care)...if you can get it.
