Diary of an Ex-Employee - Day 97.0

An explanation for my friends who don't live in the US, and don't follow US politics: Healthcare reform is a hot-button here right now. President Obama wants to reform the system, and everyone is talking about it.

I don't know the statistics regarding private health insurance - which many cannot afford - vs. what those who are against reform, here, call "socialized healthcare." (Note the clever insertion of the concept of the dreaded socialism in that phrase.)

I don't know what having people who are uninsured going to the A&E (ER) costs vs. them having access to GPs (family doctors).

I don't know how healthcare reform will change the once-mighty US of A.

What I do know is two things:

1. Having "insurance" for something that has a one in one chance of happening (people getting sick) is a flawed concept
2. My personal experience with the healthcare system.

So let's talk No. 2 - my experience.

Stage 1 - Reasonable health coverage

When I first got to the US, I was covered under Fluffy Bear's policy. Different companies offer different levels of cover which means that, if you go to work for a very small company, healthcare coverage may be more expensive for you.

One could argue that small business is therefore not generally attracting the best talent, because people may choose to work for the larger companies which, getting bulk rate, can afford to give employees better cover.

But that's a generalization.

Back to stage one of my healthcare coverage. We had to pay what they call a "co-pay" when we went to the doctor. Sometimes it is a fixed amount, sometimes a percentage, I think. I'm not sure. I just know it was strange to hand over my credit card in a doctor's reception.

Some plans also have what they call a "deductible," just like when you insure your car. So the initial cost of any repairs you undergo, as a sick person, need to be covered by you. It may be $500, or $750, or whatever. I don't remember what ours was.

Stage 2 - Excellent health coverage

At my previous employer I got excellent health coverage. I could go to the doctor when I needed to, I didn't have to pay for medicine (drugs), I could be referred to a specialist without the axiety of cost.

I didn't realize how lucky I was compared to others.

Stage 3 - Limbo

Now, see, here's where I start to get pissed off.

The way the system works - from what I can tell - is that they have this thing called COBRA.

Here is the best online definition I found for it.

COBRA stands for the Consolidated Omnibus Budget Reconciliation Act, which became law in 1986. COBRA gives you the right to choose to temporarily keep the group health insurance benefits that you would otherwise lose after you reduce your working hours, quit your job, or lose your job. It also lets family members choose to keep health insurance after your job loss or other qualifying event that would normally cause them to lose the coverage they have through your employer.

Before this law went into effect, when employees left their companies, they and any covered family members lost their health insurance immediately. If the employee or a family member were ill, they were often not able to get new health insurance because they were already sick. COBRA allows an employee to buy health insurance through the employer even though the person no longer works there or no longer works full time.

I don't know who sets the rules for how transition to COBRA coverage works. i don't know if the healthcare insurers, or the government, or my previous company set up this process.  All I know is what I experienced.

First, even though I called my previous employer twice prior to my final pay day to see if I could set things up early, I was told that details of COBRA coverage are only sent out on the final day of your employment. Cover, I was assured, will be retroactive to the day that you left your prior employer.

I waited almost a week to receive the pack of information.

Second, once I got the information, I had to go online and say that, yes, I did want COBRA coverage, and what level I wanted it at. Prices vary according to coverage levels. I chose to stay at the level of coverage - for Fluffy Bear and myself - that we had previously had. Normally, this would cost us $960 dollars a month. Thanks to a temporary government grant, 65% of this is now covered.

Third, my information chewed it's way through the system. This lasted over a week. Then I was sent a pack of "coupons" which I had to put together with my check and send to my previous employer so they could reactivate my coverage from the date that I had left their employ.

I waited for coverage to restart.

I called my health insurance provider and explained that I was out of medicine. The woman on the phone was sympathetic, but unmoving. She asked me if she could put me through to a doctor who could talk to me about what to do. God forbid they should open themselves up to lawsuits, after all. I can just hear it: "We did try. We asked her if she wanted to talk to one of our doctors, for free.  It's not our fault she can't afford health insurance."

I kept going to the pharmacy, only to be told that I had no coverage and, if I wanted to pick up the two prescriptions I had pending, I would have to pay $350. Eventually I had to call my health insurance provider and had the good fortune to have my call answered by one of those gems - a proactive, customer service oriented person - who, even though it was not their job to do so, had to chase up my previous employer for their payment so I could get coverage again.

Bear in mind that health insurance was, throughout this entire process, the SAME coverage through the SAME health insurance provider, paid for by the SAME company, my previous employer.

And yet, I spent a month uninsured, in a heatwave of summer, with no asthma medication.

Does anyone get that, during that period of uninsurance, even if you can claim back money spent on medicine, you just may not be able to afford to pay for it in the first place?

Does anyone get that going off medication suddenly can be incredibly dangerous?

Does anyone get that, if you are in the middle of treating something, stopping treatment could delay overall cure? One of the medicines I needed was my poopershoot cream. The last time I went to see the nice man who sticks things up my anus, he said I was almost cured and that one more treatment should do it. Try not medicating for a month. When I say "it burns my ass", I bloody well mean it.

Does anyone get that it takes more money and administration to turn off my coverage and then turn it back on rather than just allow me to make my elections one month before going off payroll?

Anyway, it's all fixed now, and we are onto...

Stage 4 - Paying for health coverage at a time when we can last afford it.

Goddamn annoying, that's what it is.

Comments

[Kati]

Amen sister!