Last week I received a 400.00 bill from my children’s pediatrician. Confused, I called the Doctor’s office and was informed that our insurance provider had denied the claim.
Now, before I continue, let me say that we are extremely fortunate to have – what most people would consider – excellent insurance. This wasn’t always the case, for there was a time when Mr. Pandora and I suffered through the hell known as individual health insurance. And for those of you who have never experienced buying your own insurance allow me to educate you on the scam it is and how you could find yourself in this predicament overnight.
First, for all the praise lavished on small business as the backbone of our economy most people do not realize that a lot of small businesses are one employee illness away from losing their group insurance. And that’s exactly what happened to me, and up until I found myself in this situation I had barely given health insurance a second thought.
In the early 1990s I worked for a thriving small, Delaware business that employed approximately 200 people. It was a young industry, with a workforce whose average age was 30. In other words, we were an insurance company’s ideal demographic. Things were going great until one employee, a young woman, developed a life threatening condition and actually used her health insurance. This is where the nightmare begins.
For several months everything remained normal, then the time rolled around to renew our plan with our provider. For those of you not aware, this procedure occurs every year. Imagine our surprise to discover a 30% increase (maximum increase allowed by law) in our rates – an increase not everyone could afford. One by one employees dropped out of a plan they could no longer afford, until the insurance company informed us that we had fallen below our participatory number, no longer constituted a group, and that they were dropping all of our coverage.
Let’s recap. Small business group Insurance = one illness = 30% rate increase = loss of participants = no longer considered a group = No health insurance.
In all fairness, the insurance company did offer us another option: Fire the sick employee. If we got rid of the sick employee then they wouldn’t get rid of us. We kept the employee – an act I’m very proud of – and lost our health insurance. And don’t kid yourselves by thinking we could simply choose another provider. Pre-existing conditions are what leads to cherry picking. Overnight it was every man for himself. Overnight I went from insured to uninsured, and since Mr. Pandora was self-employed at the time I was the one who carried our benefits.
Now being young (28 at the time) and healthy meant that finding affordable, individual health insurance was easy – at least for the first year, until renewal rolled around and we were once again faced with a 30% increase. When this happened we would shop around, find a new provider with a better rate, and wait until the renewal period returned and forced us to complete the process again.
Thankfully we both stayed healthy, so insurance hopping wasn’t too difficult. But then we did the unthinkable. We decided to start a family and quickly learned that we were now prisoners to our health insurance. Most individual health insurances (if not all) require a waiting period before covering pregnancy – anywhere between 12 and 18 months in the 1990s – so we understood our days of insurance surfing were over. Our rates would increase 30% before I was even pregnant, and if we wanted coverage we would consign ourselves to the role of hostages and pay the bill. Which we did.
Luck was on our side again when, after the mandatory waiting period, I easily became pregnant. However, during my pregnancy another renewal cycle passed complete with another 30% increase. We were well and truly stuck. (Pregnancy is the ultimate pre-existing condition.) So we continued to pay a health insurance bill that rivaled our mortgage payment and found creative ways to lower our monthly premium. Did you know you can lower your rate by increasing your deductible? Pretty nifty. In the three years between the birth of my son and the birth of my daughter our deductible went from 200.00 to 2,500.00. In essence, we ended up with very expensive catastrophic health insurance – that fortunately we never had to use – while paying for every doctor’s visit out of pocket.
Why not drop the expensive insurance after the birth of your son? Not so easy since we wanted another child. And not that it’s really anyone’s business, but the three years between my children was supposed to be two, only nature wasn’t as accommodating this time around.
Another recap: Son born in April 1994 + Advised by insurance provider and pediatrician to wait until child is 6 months before switching insurance due to any illness/condition that may be contributed to birth and thus risk being classified as a pre-condition and therefore might not be covered by new insurer + 12-18 month waiting period for pregnancy for new insurer.
So by switching to a new health insurance provider I wouldn’t have been able to try for baby #2 for at least two years. Given the unintended three year spread this might have been our best option, and I shudder to think of all the money I could have saved during this time had I been psychic.
But we didn’t switch and when my daughter was born we faced our first crisis as new parents. Pediatric Cardiologist are really scary words. They also meant that we weren’t switching insurances any time soon. And so we payed our monthly premiums which were now more than our mortgage payment, held a 2,500.00 deductible for each member of our family, and payed for every well baby visit and immunization out of our own pockets. Until…
Until, Mr. Pandora finished graduate school and landed a great job with a great, big company. Talk about celebrating.
And then last week I received the 400.00 bill from my pediatrician. Seems my great insurance ain’t so great anymore. You see, they’ve changed their policy. Children over the age of six may now only have a check-up every two years. Are you kidding me? Children can’t even enter school or play sports without a current physical. And what responsible parent wouldn’t want their child to undergo a check-up every year? Yet again, we are fortunate. We can pay the bill. I wonder how many others can’t.
Starting to see the difference between healthcare and health insurance? They aren’t remotely the same thing.