Sunday, November 11, 2012

Bottom Line: Don't Get Sick.

Everyone has a horror health insurance story. And everyone has a political view on health insurance. I am just going to tell you our experience of getting individual health insurance and you can make your own judgement. My opinion is that it's neither a horror story, nor political, just kind of comical.

Deal and I had employer-provided health insurance through my terrible, no good, very bad company up until August 31. Deal's employer is a tiny non-profit. So our choices were expensive COBRA, even more expensive plan through nonprofit or venture into the individual insurance arena.

Let me preface by saying I tried to get individual insurance before we did the AT, Deal was flat-out denied (pre-existing condition from 10+ years ago—you guessed it. Severe mental illness) and I scored a decent plan. He ended up with expensive COBRA for that time period.

I thought maybe the health insurance landscape changed a bit in the past 2 years, so this time around could be a little easier for Deal.

Well, he wasn't denied. That was good news. But, we did have to jump through fire-laden hoops and fill out an application that asked how many cuts and bruises we ever had. I'm not sure if it's Deal's pre-existing—which is non-existing by the way—condition, but it took us a about 45 days for them to process our application and we ended up with a plan that is very affordable, but has the most asinine restrictions.

1) I cannot get pregnant because the plan does not cover maternity care. If I do, that baby is going to cost a BUNDLE. (They gave me a pee test to prove I wasn't pregnant before approving us. Either that, or they were testing me for drug use).

2) Our copayments for office visits are on a sliding scale for the first four visits, then we pay out of pocket for visits 5+ until we hit our $750 deductible.

3) Our copayments for prescriptions are also on a different sliding scale. Just to mix things up. (Except my birth control was FREE versus $250 thanks to Obamacare. Need the birth control. See #1.)

4) No chiropractic care. The nerve. We've gotten really good at cracking backs though.

5) Does not cover frost bite. Does cover broken arms, but not broken legs. Does cover impalement by tree branch, but not ice axe.

6) We can only go to the doctor's office on Tuesdays and Thursdays between 4pm and 6pm. 

7) It does cover medical marijuana, but not generic drugs.

Okay, so maybe #5-7 are not true, but still. The health insurance market is brutal, confusing and laughable. But, I suppose we are happy to have insurance and hopefully we won't need it too much because I believe what it all boils down to is that nothing is really covered in our plan??

1 comment:

Misti said...

You know, I keep wondering when my birth control is going to be free...'cause it still isn't. I don't know if insurance companies are allowed to hold out as long as possible or what.

Welcome to the land of the insured...don't worry my plan isn't all that great either.