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May
14
Health insurance was a huge factor in our decision to move. By choosing to leave Microsoft, we chose to leave what I can only assume is one of the best health insurance plans offered by any company in the U.S. Everything was covered, with no copays. I know of several Microsoft families who had insanely expensive medical situations—long term hospital stays, babies in the NICU, etc—with bills that hovered close to the million-dollar mark or more, and every dime was paid for.
We knew we couldn’t expect the same situation at a different company, and JB’s new health plan will cost us quite a bit out of pocket each month. It’s not ideal, but the ability to chase down our dreams was worth it.
The problem is, the insurance doesn’t kick in for 90 days after his employment starts. Okay, so there’s COBRA, right? Except COBRA costs $1700 per month for us to continue our same coverage.
But what other option do we have? I have a monthly prescription for a chronic health condition that affects me pretty much not at all in my daily life, except I take a medication to manage it, and without the meds, I up my chances of experiencing certain progressive symptoms. You know, such as, for instance, oh, say, DEATH.
My pills cost over $2,000 per month, so it’s not really something I could pay out of pocket instead of paying COBRA. Plus, there’s the situation of losing coverage for more than 5 seconds which allows every subsequent provider to turn you down because ♫ pre-existing condiiiiiiition!
So it’s COBRA or private insurance, and private plans seem to be a bust so far (how about $900 per month and we’ll pay 50% of your prescription costs? Oh, let’s see, carry the FUCK, I guess not), but the problem is that there’s this period between when employer coverage ends (JB’s last day at Microsoft) and COBRA picks up (hopefully very soon, now that we spent $50 overnighting our $1700 check to them?). And that’s exactly when my goddamned prescription needed a refill and the nice Walgreens lady said, oh, hmmm, it says here you’ve been denied coverage?
I tell you this just so I can rant somewhere, to someone, about the deeply painful fuck-upedness of our healthcare system and how it keeps people from taking chances on new jobs and starting their own businesses and sometimes kills people stone cold fucking dead because they can’t afford what they need. I’m lucky that we can go and put a $2000 prescription on our credit card, if we have to, and hope like hell COBRA reimburses us, but what a ridiculous situation. What a shitty deal it is to be waiting for a phone call from my doctor to advise me on the risk of a short-term treatment interruption. What a broken, stupid system where providers are doing everything they can to get out of paying what they’re supposed to, pharmaceutical companies are charging criminally inflated prices for life-saving drugs, and thousands upon thousands have no healthcare whatsoever.
Also, I feel guilty. You know? Or maybe you don’t, I’m not saying it makes sense. But I feel guilty that I am the one causing our family all this expense and worry and it just doesn’t seem like it should have to be this goddamned hard.
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I’m in the UK and from where I stand your system really is f*ked up. I hear Americans freak out about socialised medicine and how much it costs but the reality is that I cannot believe how much money the ‘average’ American family has to pay out for health care compared to what I pay here in the UK. Sorry – I’m not helping am I?
Good luck with everything – I think it will all be worth it for you in the end. And don’t feel guilty – if it was JB and not you, you wouldn’t think for a second that it was his fault would you?
Amen Sister! I know exactly where you’re coming from. I have MS and it has been a nightmare as far as medical bills go…even with insurance. It’s a very sad situation we have going on with the health care industry and it adds more stress to an already stressful situation
Have you checked out a “bridge policy”? They are meant to cover you in just this sort of situation.
I used to work with software support that required visits to different kinds of medical offices. It bothered me at no end to see pharmaceutical reps bringing pies for the office that day… or breakfast… or gift baskets… And between that and all the television and print advertising for prescription meds that we never used to see, it’s no wonder medication costs have gotten so high. Don’t feel guilty about it – It would be unthinkable if something you’ve dreamed about for so long was derailed due to a medical issue.
In Australia we have Medicare and the Pharmaceutical Benefits scheme (http://en.wikipedia.org/wiki/Medicare_(Australia)#Pharmaceutical_Benefits_Scheme) that entitles everyone to free health care & significantly cheaper medication. Our system isn’t perfect but it sounds a whole lot better than what you just described. I heard you guys in the US have been arguing over whether or not to install something similar. What I don’t get is how anyone could argue against it?
Maybe JB can find a job in Australia? :-)
“CARRY THE FUCK!!!” Thank you for that laugh.
Aw, Linda. I love you and all of my American friends, but your system is effed up.
For all of it’s show, the U.S. of A. fails miserably when it comes to its own people.
(Also. NOT YOUR FAULT.)
When I was looking at a contract in England at a base pay of around 180k@year the recruiter figured my cost for the national health care would be around 7k@yr. At least I’m a Canadian Citizen so when the time comes I can get Health Care that the Republicans don’t seem to want us to have. /Rant
It all sounds like a nightmare, and just what you didn’t need on top of the whole moving stress. My heart goes out to you.
And meanwhile, here in NZ, today’s headline story is shock and horror that prescription costs are going up from $3 to $5. I think I’ll bear that perspective in mind next time I feel inclined to complain that we get less than awesome deals on things like internet bandwidth and video game prices.
You’re going to hate me for this, but you should have just elected the COBRA for you, not for the whole family. Its not a well known fact that you can do that since JB was the employee and normally the spouse can’t get coverage unless the employee is covered, but COBRA is a weird (Federal) law that allows just that. JB and the boys can go onto a private policy (yes, they are crappy – I sell them everyday to folks just like you, but if you’re healthy, they do the job). Call the HR department at MS right away and see if you can change it.
Oh honey, we are right there with you! Hubs started his own business and we did Cobra then paid almost $2000 a month in premiums. PREMIUMS. Then 5k deductible per person. 30K in medical bills later we shut down our own business dreams and headed for covered insurance. Bleh. It is messed up. But (Pete) blaming Republicans is a bit simplistic me thinks. I’ve lived in countries with socialized medicine and HOOBOY have my own nightmare experiences to share from that bucket of fun. NIGHTMARES. So yes, it needs fixing and yesterday please! I just don’t think anyone has come up with an acceptable solution yet. Maybe they should get on that. (Also: NOT YOUR FAULT luvee!)
UGH.
I have a friend who went to the doc during flu season last year for a cough. This year went in for a similar cold, that wouldn’t go away and it WASN’T covered because it was a “pre-existing condition” Seasonal colds? You must be shitting me.
will text you with the number of a pharmacy in Juarez, they will ship to you, and depending on what you need, they are hella cheaper! And they speak english, I get stuff like antibiotics from them, retin A, you know, stuff you could get a prescription for but why pay a copay if you don’t have to….it’s worth a call, they may tell you they don’t have it, or can’t ship it, or you need a scrip, in which case nevermind, but it might be worth a shot….
Don’t get me started. This health care shit strips you of your dignity. I hate that we can’t agree that all people DESERVE health care, I get that we as a people will disagree how to pay for it. Saying things are just fine how they are? Indefensible.
When my husband was unemployed I had to buy individual policies and they were over 975 a month for him and our daughter (i was covered under my employer). We however don’t have a costly prescription. As angry as I am about it, I can only feel grateful that paying 975 a month was even an option.
Sorry to hear your about your Catch 22. I hear you Linda, the whole situation is fucked up. But, I lived in the UK for four years, husband was flying for the Air Force at the time and I watched several of my English neighbors die waiting for procedures. Many of which could have been preventable. You don’t want socialized medicine.
I think of that all the time, how health insurance coverage (the need for it) prevents people from taking risks with their careers or with starting new businesses. I think it also keeps people from performing well in dead-end jobs that they keep just to have healthcare.
Been there, done exactly that – except it’s husband & son’s meds that are crazy expensive. I was able to get them filled a week at a time while we sorted out the COBRA/old job hell – forking out the $750/week was painful, but when Cobra finally kicked in – it was only $1500 to reclaim instead of $3,000.
I also discovered that many plans will let you refill somewhere between day 21 & 25… With CIGNA its 22, So by refilling on that schedule i get 16 refills of 30 days, instead of 12, and we slowly build up an extra stockpile for the next insurance interruption (cause there’s bound to be one). So I now
I wish I could leave a comment like, “Oh man that sucks, feel for you,” instead of the real comment that sounds a little like, “Gee. I know exactly what you’re talking about. Like that one time I got a $5,000 ER bill because when I needed lifesaving treatment my ambulance took me to the closet ER not the ER apparently my insurance will only cover. Because apparently I needed to convey this to the paramedics while I was unconscious?” Or how I stopped taking my antidepressants for about 5 months because I was trying to convince myself that I didn’t need them, not because I believed that, but because I was hoping it was true because I just couldn’t afford them any longer. Or how my therapy is only sort of covered, when you squint your eyes and put your head between your legs. GOD FORBID WE GIVE PEOPLE WHAT THEY NEED!
Sorry, I just ranted in your comments. But sometimes it feels good to stand up with someone else and say, “THIS IS ALL FUCKED.” Hoping if enough of us say it together maybe we’ll finally, someday be heard. Someday.
I have always bought my own insurance because I don’t want to be tied to a job I dislike because of benefits. Luckily it’s worked out so far. It’s weird to think about how the U.S. is this place where being an entrepreneur is so important yet our freedoms are obviously so limited by this stupid, stupid health care system.
My husband takes life saving medicine as well totally over $1000 a month. I worry about if he lost his job, what if when we retire will Medicare cover it? Like you his condition does not affect his day to day life but the medicine is a daily necessity. There is no generic and I have no clue why a month supply of pills is this expensive!
Happened to us when my husband left his job with benefits to be self-employed and THAT WEEK we found out he had cancer. We relied on Cobra and then my small mom and pop business agreed to put him on their insurance while we waited for his new benefits to kick in. There was one week where they didn’t overlap and he was doing chemo for a year. He said he wasn’t going to pay $1800 for a week of chemo. I said “The hell we’re not!” Called his mom who sent us the check. But if we hadn’t had his mom, or if my employers hadn’t put us on their insurance… I can’t even go there.
(10 years later he’s still cancer-free!!)
For YEARS we have been paying $700 a month for health insurance through my husband’s employer and it covered NOTHING. Prescription copay $75 on anything I coudn’t get at Target for $4 or $6 generic (which was nothing I needed 90% of the time). Example, my birth control was $75 a month, it was covered by the insurance. The pharmicutical company set the price at $76. My daughter had to have her adenoids out so she could BREATHE, they paid $600 of the $4000. There is something terribly wrong with all of it. It makes me crazy. My husband recently got a new job. They pay for his coverage, we pay MORE than our MORTAGE to cover me and the kids every month on the company plan. BUT!! It covers EVERYTHING with very little copays and very little dedtuctibles. It makes me feel a little better that if something happens and we have to go to the emergency room I won’t be having an anxiety attack about the cost.
Also, someone mentioned above that you can cover just you on COBRA. It’s true. Do it. There is NO NEED to put the guys on COBRA if they don’t really need it.
So. I read Amber Leah’s comment, she sounds like she knows what she’s talking about. And Costco now offers medical insurance at not unreasonable prices, which you can check out on their website, although you do have to cough up the membership fee, which, compared to COBRA and co-pays, are no biggie.
It makes me SO mad. We have kickass healthcare laws in Massachusetts, but it’s far from perfect. I want single-payer, personally, as do most of the physicians who study this kind of thing. It would help a LOT.
(Single payer does not mean socialized medicine, GAH)
Also, it’s illegal to charge higher premiums for pre-existing conditions and/or deny coverage.
But. If you go a month without coverage here, your tax burden for doing so is about $700 per person, and rises exponentially if you go longer. People get pissy about that. I say tough.
That being said, I know at least one person whose life was literally saved by our healthcare availability — she’d never had insurance before, and wouldn’t have gone to the hospital when she was having symptoms of a heart attack, because the cost would literally break her. She had FINALLY gotten coverage because she could. She was having an actual heart attack and, um, she’s alive. So you know.
It’s STILL so far from perfect. But I like that if Adam ever wants to start his own business or go out on his own, he can, and we don’t have to sit around worrying about private insurance for ourselves and our kids, and I like that entrepreneurs have the freedom to make that decision without being tied to a large employer for decent coverage. I like too, that our laws mandate infertility coverage and people who work for out of state employers can change to our state plan to get expensive procedures covered.
The health connector isn’t great. Plans are still not as inexpensive as they should be. But it’s there, and it’s not fair that it isn’t like that for everyone.
That SUCKS about your medications – yeah, that could be a deal breaker.
I left a fulltime job with benefits on a wing and a prayer because my husband went self-employed business owner and we got individual insurance with a rider on his diverticulitis which was “never going to come back!” – guess what! a year later it did!!
Luckily that fulltime job I left was as a individual and group health insurance CSR so I knew the ins and outs and one of the ins was — One Person Group Insurance with NO exclusions or declines through our local Chamber of Commerce. Signed him up and one month later he’s having his $25,000 surgery to have more large intestine removed.
Hell, do they have that through your local Chamber of Commerce out there?
This scares the shit out of me.
the company we work for has pretty sucky insurance… we only pay $580/month for a family, which sounds ideal except we also pay the first 4,000 a year and we are relatively healthy so for example the last time my daughter had strep throat at 7pm on Sat night, I took her to urgent care, got a $750 doc bill and because I couldn’t use the preferred employee pharmacy (which is only open Mon-Friday 8-5) generic antibiotics cost $125….. every time my kid gets sick I have to think, is he or she REALLY sick, like $900 sick or is this something that can wait until Monday? It bites that I have to make those kinds of choices… but at least we HAVE insurance for the years someone needs surgery (though my daughters laser treatments for a hemangioma at $600 were spread out over a couple of years so all those got to be out of pocket as well) *sigh*
I think we have to attack this problem not just from the vantage of the payor (insurance companies) but the providers (why do doctors, especially specialists, have to make so much $$ and what is the incentive to give higher quality, lower cost care – answer: there is none) and pharmaceutical companies (why do drugs cost so much less in other countries and why do drug companies spend more $$ researching a better erectile dysfunction drug than better drugs for rare, life threatening conditions – answer: $$ baby).
Don’t even get me started. The entire world has “socialized medicine”, it’s only here in the US that we are ruled by insurance and pharmaceutical companies. I had to leave work because my COPD was so bad…but now I can’t afford the medicine that helps it because those 30 little pills cost nearly $1000 a month, and I’m living on Social Security. And I’m better off than most people because I do have Medicare and ONLY have to shell out $155 a month for Parts B and D (which is ONLY about 12% of my total income). But I can’t afford not to have it. I’m just doing without the Spiriva and trying not to breathe when I go outside where the smoky air (from brush fires) and humidity give me fits.
We shouldn’t have to put up with this shit.
I feel your pain, sister. My husband and I are school teachers, and several years ago, our district negotiated away our health care plan and replaced it with what I call a Christmas Club account .. aka health savings plan with a $2400 deductible before it pays anything at all. Two weeks ago my eight year old daughter had a raging fever of 103 for 8 days and when the pediatrician recommended she have a chest x-ray to rule out pneumonia, I begged him for a $20 generic antibiotic instead because we couldn’t afford the Children’s Hospital bill for the x-ray. He refused, despite my pointing out it made more sense financially to go the cheaper route first. I’m sure I qualify for the parent of the year award for being so concerned about the cost, right? The system is so fucked up and we little people in it are caught between a rock and a hard place. Anybody who says we don’t need a better system must be crazy or independently wealthy.
I couldn’t agree more…this is why there needs to be some kind of reasonable alternative in place for people. Even though I didn’t completely love the Obama care plan I get that there needs to be SOMETHING out there.
I take migraine meds that, without a copay, were costing me $230 for 9 pills on my old job’s insurance plan. And the job I was working at the time (the insurance had a $2500 ded for just me) was making me SO stressed out I was having these migraines a few times a month, generally blowing thru at least 3 pills at a time. And it totally incapacitates you so you can’t not take it. So here I am paying out a huge % of my measley pay in premium and still having to cough up the $2500. I also had cervical dysplasia that year which meant I had to have day surgery and even between those two things do you know I BARELY hit that deductible? I mean, thankfully I had ANY insurance but shit, I don’t make THAT MUCH money!
I also had a friend who got denied insurance when she applied for some after she couldn’t be on her parents plan anymore–she was denied because the therapist she had gone to (of her own free will do help her deal w/ some bad feelings from a really crappy relationship) had put down that she “discontinued treatment against advice” (she quit going to the appts when it seemed more about the therapist getting a copay & she felt she had gotten all she was going to out of it) so the insurance co said “Sorry…pre-existing condition”–you’re clearly a nutjob because you quit going to the therapy that you elected to go to in the first place. ??? WHAT?
And also….I worked for a health insurance company once. I made terrible pay and ironically had mediocre insurance, but meanwhile you hear that the CEO is getting a million $ bonus and NO WONDER health insurance is expensive, those guys at the top are lining their pockets with our money. By the way….my job there was sent to the Phillipines sortly after I moved on to new horizons. My friend went to train those people & he said they’re paying them about $3/hr. Can you say CORPORATE GREED?
oh god, that was really long. SORRY!
Oh, mama. Don’t worry, even if they get your check on day 29 of the month, they’ll retro your coverage back to the beginning of the month. So while that’s an awfully big check to write, you can breathe a bit easier about them receiving the check!
Hey there, long time reader here. Rarely comment. I am so sorry you have to deal with this! It SUCKS! My husband works for a company with similarly amazing insurance coverage and we feel like he can never switch jobs.
One quick thing to give you one less thing to worry about. I am a medical Social Worker so I deal with this stuff all the time: If your insurance will be through JB’s work then you CANNOT be turned down for a pre-existing condition, even with a lapse in coverage. Plans through employers have to cover every employee and every family member. This will still be true ever if The Affordable Care Act gets overturned (fingers crossed it won’t). Hope that gives you one less worry.
GOOD LUCK!
Amen. AMEN!
Now, go forth and write to/call your legislators and tell them to fix this shit, because that is the absolute only way to effect positive change at the federal level. Speaking as one who works in education, I feel I have the experience to recommend this course of action. Copy. Paste. Edit curse words, or not, send, set to repeat weekly, done.
I didn’t realize how bad it was until I got my first job after school and actually enrolled in coverage. Until that point, I had never had coverage- even as a child under 18. It was just, fingers crossed we don’t get sick.
I was so excited to get insurance, like I was almost winning the lottery or something. Then it was all wait… wait. I’m paying… so that I can pay this deductible… to be able to pay this copay. What? There’s nothing wrong with me!
I guess I’m just commiserating, because I don’t have any solutions. But jesus, it’s effed.
Sometimes the pharmaceutical company that makes the medication has programs to help people, maybe that is a possbility to bridge your medication until you are insured again? I’d be a bit concerned about on-line companies. I recently heard about realy awful scams with some of those companies and they are offshore – Dominican Republic-and so out of reach of the law. I’m so sorry this is adding to the stress of relocating. Good luck. Hope the suggestion to get COBRA for you only works out.
You aren’t the only one. My mom pays $800 dollars a month for her insurance to deny her the cancer-fighting drugs her doctor wants her on. Lovely system we have here.
I hope you don’t find this disrespectful, because I’m genuinely curious – you’ve referenced your prescription and condition several times but have never gone into detail, I don’t think. Will you ever write about it? You’re SO open with so many sensitive topics, which I love, but this one seems to be off limits and I wondered why.
I know exactly how you feel. I had to stockpile rx’s by alternately lowering my dose every other day for months before I changed jobs. Chronic health management costs me $600 a month without insurance and I have to take jobs based on rx drug coverage. Preexisting condition will haunt me too. And yes it’s sooooooo fucked.
I can’t find the stat right now, but I remember reading that one of the reasons so many entrepreneurs/small business starters/i.e. “job creators” in the U.S. are in their 60s is because then they have GOVERNMENT PROVIDED HEALTHCARE BENEFITS and thus can comfortably spring off into the great unknown of starting a business, because getting sick isn’t the end of the world.
I say fix the damm system for people in their 20s and 30s and 40s — you know, the folks with lots of ideas and energy and kids who go to the doctor for shots — can begin starting businesses and creating more jobs too. If we decouple health insurance benefits from the job market, both would probably do a lot better for us in the long run.
I’m sorry you are facing this frustrating and expensive situation. I often wonder how in the world Americans can afford to live, let alone save anything, given your outrageous healthcare costs and nonsensical system. I am a Canadian, and while our universal healthcare system is not perfect, I have never known anyone personally who did not get top notch treatment in an emergent situation. I can get in to see my doctor anytime and all the doctors I have ever dealt with have been very good. (Specialists are bit of a different story: longer wait times.) My daughter was born weighing 810 g (1 lb, 12 oz) and was in the hospital for five months where she received exceptional care. We paid nothing for it. Our taxes are higher than yours, but I will gladly pay them without complaint to avoid a similar mess to the one you have down there.
You’ve just outlined nearly exactly one of the major reasons we left South Africa. The cost of healthcare. In SA you *have to* have private healthcare or risk death at a state institution, so you know, not really an option. I also have hugely expensive monthly prescriptions, and here in the UK, it’s all covered for free, by THE GOVERNMENT. No. Shit. I thought that because it was ‘pre-existing/chronic/lifelong’ etc I would at least have to pay for the ‘prescription charge’ but no, lifelong and chronic = free. Obviously it’s not the only reason we left, there was also a)wanting to return to my husbands country of citizenship/upbringing b)not wanting to experience the same level of fear around crime anymore c) relatively stable political situation etc – and well the list goes on…
Hooboy. Chronic illness girl over here, and insurance issues have regularly caused me rage and tears. Right now I’m working part time, and my husband is a fulltime student, I pay for private insurance without much coverage and a pretty high deductible. I take a medication that costs–wait for it–$20,000 a dose. Fortunately I only get the treatment twice a year, but…um. UM. Our saving grace has oddly enough been the drug company itself…they have a pretty generous assistance program, and without them we would be swimming in debt over here. As it is we had to pay a little less than 20% of that. Something maybe to look into with your own drug company?
Aside from another “dear God what a nightmare” comment, I have to tell you that the way you wrote “preexisting condition” I sang it to the same tune as “let’s got out to the lobby!”
I hope you guys get a quick fix, and that this becomes one less stressor on your plate.
It’s so much easier and more common to take chances here in Sweden–change jobs, start your own company–because of the universal insurance and the social safety net. People fail sometimes but also they succeed and you see how many great things come out of Sweden for such a small country because people are more likely to take risks.
I can’t figure out why some in the US can’t see that. It ends up being better for the economy, not worse, to take care of your citizenry.
I’m in the UK too and I thought for a second, ‘Thank goodness for socialised medicine.’ Then I remembered we are paying 40% of our income to the government and my husband is self-employed as he’s following his dreams (and he’s amazing at what what he does) but the taxes are KILLING us financially. So. In a weird way, I feel your pain.
In 1999, my mother had a disease that could have been treated with a new-to-market medicine. Her insurance company said the medicine was too expensive and would not cover the cost. After our Senator intervened the company finally agreed but it was too late. She passed away.
The medicine was meant to treat pulminary hypertension but years later, they started marketing it for the side effect – erections. The medicine is now called Viagra.
I am an American living in Germany with my German husband and son…been here for 3 years. I was uninsured in the US for 10 years and than insured in the US for 3. We decided to move here after the 2008 crash partly because of medical benifits. After being in Germany for 3 yrs, I can say the benefits are not the best. Commen cold? No problem. Cancer? You may die before you are able to see a specialist. 30 percent of our salery is for taxes, and the payscale for jobs is much lower. After paying for the basics, rent, car, insurance, we have no more money after the 15th of the month. So we have heathcare but do not know where our next meal will come from. It is all a crapshoot. I do not believe the US is worse or better than socialized Europe. My prayers are out there for you Linda, and for all of us that struggle to just have good health at a reasonable cost!
My husband shares your guilt. He’s the one with the medical issues in our house. Right now he’s an internal consultant at a large company with relatively good benefits. In the past, his health issues have stopped him from starting his own consulting company and prevented him from going to work for smaller companies. It’s not fair, but at least he likes his job.
This doesn’t apply to your current problems, but a future fyi. I’ve saved our family a lot of money simply by being annoying. Whenever we get a large medical bill, I resubmit the claim to our insurance company. Then I continue to call them and puruse the issue up the chain of command. Nearly every single time, the insurance company ends up paying more of the bill. It takes time, but it has helped lower our out-of-pocket costs.
We are looking at switching jobs too, and for us that means giving up our military insurance which, while run by morons who couldn’t administrate their way out of a wet paper bag, is AMAZING! It is the system that would be in place for all should we switch to a “socialized” model in this country. It is no less annoying, but it sure is cheaper.
I am so sorry this happened to you, so stressful and stupid. You embody the dirty little secret of all the anti-Obamacare people: the ones hurting most are not the much hated women, people of color and the poor, but those of us who have clawed our way into the middle class. If you really want to get your blood pressure up check out Deadly Spin by Wendell Potter. You are not the only person experiencing this and as long as Americans believe that insurance is a privilege for those deemed “worthy” and not a right for all human beings, you wont be the last.
This job will be worth it. This job will be worth it…
Hi, I thought I was the only one trying to get my mind wrapped around the US health care system.
As a Canadian who recently moved to the US to get married I find it really scary that you could get a bill in the mail if your insurer, for whatever reason decides to not pay the doctor and you could lose your house/savings or even both.
I didn’t move here for the health care that’s for sure, and in the meantime I’m extra careful with knives in the kitchen.
Yep – big hug and empathy from me.
Choosing for me to be a stay home mom makes me feel the same way. Ohhh, umm, I’ll skip getting new glasses and let me cancel my teeth cleaning and maybe that will save enough of the flex money to cover the unexpected expense of one of the kiddos needing stitches.
I stopped taking a medication (not life-saving) because it was too expensive. I find I am doing fine without it (which is scary in a different way); however, it seems rather ridiculous that anyone would stop a med due to cost.
I think some of the other comments don’t quite have the pre-existing condition thing down. It’s not that you could be denied coverage but they can put a waiting period for coverage to begin for pre-existing conditions. I know this because twice in our last two job changes I’ve had to fax in certification of prior coverage. Otherwise, it was going to be up to 12 months of NO COVERAGE for anything deemed pre-existing.
*head hits desk*
God bless Canada, and Tommy Douglas for starting our universal health care system.
My husband switched jobs in the past year and we had the 90 waiting period to deal with. I can’t even bring myself to think about the problems with our whole system right now, but I did get very annoyed by the 90 waiting period. It just seems ridiculous to me that this period exists in so many companies. Does it really save the companies so much money that it is worth the hassle that it causes employees?? And, I would imagine that it is a hinderance on recruting when families have to make decisions about it. Luckily we were able to buy a very inexpensive private policy for my husband and kids (I’m covered at work) because the price of his maintenence drugs weren’t expensive enough to make COBRA make sense. But, we spent hours going over the numbers and weighing the cost/benefits of our different options. I just don’t believe that the 3 months of savings that the employer has by having the waiting period is worth the hastle that is causes everyone face with the situation.
God, I am right there with you. I’ve had steady work with company benefits for 14 years. Three months ago my company went out of business and I was lucky to find another job quickly. A week later, I found out I was pregnant. We all went on my husband’s company benefits since mine didn’t kick in for three months.
Fast forward to a week before my company benefits kick in and my husband switches to a promising start up company with NO employee-offered benefits, a small salary with long-term incentives, and I fill out the paperwork at my new company to put our family of three (soon to be 4) on my benefits.
And then I was fired.
We are now looking at a $2000 cobra bill that’s coming sometime between now and June 1st and I have no job, am 7 months pregnant and will not be hired anywhere, am on unemployment and am looking at a discrimination case that costs $$ to pursue. Money that I can’t spend on an attorney because I have to spend it on frivalous things like healthcare and the mortgage.
We are so screwed.
Does Cobra even take credit cards?
I’m not reading the previous comments, so apologies if this is a repeat, but can you get a 3 month prescription for your medication before you lose insurance? Sometimes providers will work with you if they know you’re facing financial difficulties…
I 100% relate to this post. Only instead of going to work for a company with a less good insurance plan, my husband went to work for himself. No insurance plan. And it’s my chronic health problem that keeps us from getting good insurance. So it’s me that feels guilty because I can’t not have the condition.
We currently have the preexisting condition insurance for the whole family, because that’s all we can get. It’s expensive and it isn’t very good coverage. But it’s better than nothing. And that sucks.
Amen to all that.
And it IS a tragedy that all this squelches anyone’s dreams to pursue a non-traditional work situation.
I’d wanted to start a business forever, and I would have happily pulled together a few part time jobs until I could grow freelancing into a full-time thing, whatever it took. But no, no, thanks to healthcare costs I needed to stay at my shitty full-time going-nowhere office job and stew in my own misery until I could figure out a way to afford the healthcare I needed to go a non-traditional route with work. For me, it could only happen because I got married, which is fucked up. Now, I love what I’m doing, it contributes to the economy, and it never should’ve been delayed because I was cornered by healthcare into a certain type of job for year after year.
An overhaul to the system is beyond overdue. Good luck with everything.
Ok. but the point you’re missing is that it was YOU that didn’t make up your mind and get the check there in time, so NOW there is a lapse in your coverage. It’s not ALWAYS someone elses fault. Quit complaining about something that YOUR irresponsibility cost you. If you don’t pay in time, no one can save you from that….nor should they.
Yes,insurance costs are through the roof, but socialized medicine will work equally as well as all other government run programs. Right now here are very few Medical Centers that turn people away who can’t pay…once again the taxpayers, the 48% who pay ALL the tax, will pick that bill up and no one will be motivated to get a job and pay their own way.
THAT”s the real problem. Following your dreams should not = being irresponsible and expecting someone else to pay your bills.
Jen: what? We did everything as soon as it became available to us, including overnighting the check before the payment coupons had even arrived in the mail.
My husband has Crohn’s disease and takes lifesaving meds that are close to $5000/month. He’d like to retire early from a job he hates. Think he’ll be able to? Think again. Not unless we fix this broken system of ours.
But I have faith that we will. We can’t be the only country that wants to live with this shit.
I wish you wouldn’t feel guilty about it – I think of it like this: my son has autism and we live in a state that has an autism mandate, where he can’t be denied insurance for a pre existing condition, and because we have it, our lives are changed for the better in ways I can’t even begin to articulate. My life and my husbands and our other three kids, too. But I don’t really want to live in this state, it’s not where I’m from, I prefer my home state, etc. But I never look at him and think, damn it, it’s your fault that I have to live here! Medical issues are medical issues, there’s no fault involved, or there shouldn’t be.
Also, I just had to have my six month old get tubes in her ears and I got the bill, 90 percent of which was covered by insurance, and it had a $250 charge for a Tylenol suppository. I made a joke about it on FB and a friend of mine’s husband, who is a doctor in an inner city hospital, said that it costs ONE dollar for the Tylenol, but that when you have insurance, they charge 250 times that so that you can cover 250 people who don’t have insurance. Can you imagine anything more effed up than that? It’s insanity. And that was a charge for something pretty straightforward, tubes in her ears. When we get coverage for my son, we have to see a billion doctors to get diagnosis. It’s crazy town.
Out of pocket my MS meds are $3500/month. There is no world that exists for me in which this is possible, so I’m thankful everyday for the coverage that we have. I understand the guilt, though, staying home with our son, generating no income, yet costing SO much. My job is important, of course, but there are no health benefits.
I hope you find some loopholes that can get you through the waiting period.
Methinks Jen is not taking *her* meds.
AMEN! I had hyperemesis in my last pregnancy, which as you may know, can be very serious and life-threatening to the fetus (and even the mother). In any event, I was prescribed Zofran which is crazy expensive, and because it’s primarily used as a treatment for nausea associated with chemo, my health insurance decided I was only allowed to have 10 days’ supply per 30 days. So the rest of the month was out of pocket – at which point I have to say thank GOD for Walmart, because they charged me $65 for a week’s supply which at CVS et al. was going for $250. (And I’ve always had really good health insurance – so while the underinsured and uninsured face HUGE obstacles, these problems also strike the perfectly insured, and let me assure @Jen a that I pay a sh*t-ton for my insurance, premiums + co-pays an have my entire adult life. We are all vulnerable to the system.)
I wish I could bottle your column and sell it on Capitol Hill. The debate about universal health care in our country took my BREATH away with its fervor and lunacy: more than at any other time, it made me feel alien and alone within my own country that so many of us are so virulently opposed to this basic concept. I’m so sorry you guys have this great worry to deal with; we have been there too, paying out of pocket for private coverage, and only people who have been trapped in that situation really now how isolating and terrifying it is. Good luck, and I also suggest Cobra for sure (don’t take any chances!).
In WA State, there is an exemption to filling out the health questionnaire; so long as you have had a continous 24 months of group coverage and you decline to take COBRA and are applying within 90 days of the qualifying event. It’s question #7 on the WSHIP Health Questionnaire. You’ll need to provide your COBRA notice from JB’s employer and the HIPAA certificate showing coverage start and end date.
https://www.wship.org/Docs/SHQ%20Insert%20Revised%2004%203%202012%20Final%20Post.pdf
Reading these comments has me seething. I know this is minor compared to many of the experiences above. But when I got my first job out of college and had to go to the gyno so I could get my birth control filled. The company refused to pay for the visit because evidently a uterus is a preexisting condition.
Sorry one more note to add: so long as the group coverage through JB was considered “creditable”, they should be able to credit the months of prior coverage towards the 9-month pre-ex that most individual policies have.
The way I understand it, your insurance company is REQUIRED to reimburse you for that medicine. It is a HELL of an outlay for you – that would freak me out. But, COBRA is a government act that allows you to continue your healthcare insurance for up to 18 months after separating from your employer.
COBRA requires insurance companies to provide you with the same insurance policy that you had while with the employer. There is a 60-day window in which you can opt in to the policy and coverage during that period is retroactive. (So, I’m sure it will be a headache, but that is why you were “denied coverage.” And COBRA is not the one reimbursing you, it is your same insurance company and everything you had before, you should have now.)
Honestly, I’m surprised you got the paperwork so quickly. Sorry that it sucks though and does make your life that much more stressful.
Ditto what Meaghan said above. And I’ve been in the “time period switching from company plan to COBRA and dealing with monthly medication” thing too. As soon as I gave notice to the company, my insurance started denying my prescriptions (even though it was still 6 weeks before my company benefits were to end). They wanted some guarantee that I was going to be extending the coverage through COBRA even though I had the aforementioned 60-day window. I ended up doing the same thing you did: I sent in the COBRA check before I had the coupons and before I had even left my company! And even when I saw that the check had cleared, it took another 2 weeks for my insurance company to give its blessing to continued coverage.
You are SO within your continued-coverage rights/requirements, if your insurance company even balks about reimbursing you, just get on the phone and raise hell. I’d think that the MS benefits people could help you push on them as well.
I was faced with a similar situation with my last job change. My university alumni association offered a variety of group policies with different options for each. I was able to tailor a plan that we could afford for those 90 days. Sure it did not cover everything but it covered the medications we also had to have and it prevented the lapse in coverage.
The situation is just awful. Both my parents are self-employed, so I was on my dad’s private insurance through college. I had to have an MRI done of my knee my junior year and even though I followed the referral/preauthorization/etc protocol to the letter, the insurance company denied the claim and refused to pay the bill for months. It pretty much ruined my life, repeatedly getting bills for a $2000 MRI and having to call the insurance company and argue with them about how they should pay for a covered procedure. And all the time when they were denying the claim (which was absolutely covered by our policy), my dad had to continue paying the $1000/month premium. Awful.
WOW Jen, you make me ashamed of my own name… remember you don’t have to read or like others opinions but to be so nasty… WOW.
I will not go in to my beliefs of the system, yups it’s pretty mucked up, and as a canadian – I know, and have experienced the benefits of socialized medicine.
But I do want to say this – Linda, not your fault. You are what you are, and we are given challenges in life to help us grow. Sometimes you wonder who invented that mucked up system too, but thats life. If JB was in this situation would you begrudge him? No. So don’t do that to yourself.
I didn’t read all the comments, so I don’t know if someone else mentioned this, but you should be able to pay PER PILL, not for the whole month. So maybe you could pay for 10 pills out of pocket or whatever while you wait for coverage.
Sorry to hear it, Linda! I have been without insurance andworking at a barely above minimum wage job. Its scary to face medical bills that you can’t affort. It does not make sense to have health insurance tied to employment.
Oops! Affort = afford
Dude. “Carry the Fuck…” So going to work that into a conversation at some point.
Shitty situation, for sure. I have no advice for you, other than to chime in that my mother-in-law has leukemia; *but!* there is a life-saving drug she can take daily to keep it in check. The prescription, patented through 2031, is $3800/ month. She’s 58 and would love to retire early, with her husband who is 10 years older than her. But she can’t because she can’t lose/ switch her health insurance due to the preexisting condition.
Another one: my grandmother is 82 and FEISTY. Lady smokes 2 packs a day, drinks whiskey in her coffee, walks 3 miles a day and has no health issues (apparently she’s the “smoking will kill you exception). She is, however, losing her hearing. She’s a wonderfully social person, and not being able to hear people speaking to her is so isolating. But Medicare doesn’t pay for hearing aids… They’re $5,000 a pop. Huh? I think we’re all chipping in and getting her hearing aids for her 83rd birthday next month.
Sorry Linda; that is an absolutely shittastick situation.
So messed up. A consultant I work with (and friend) just lost her husband–essentially because insurance didn’t approve a medication he needed for a rare form of liver cancer in time (a $1200 medication. We lost an amazing man over $1200.). Instead, the insurance company is now going to be paying a sh*t-ton more money for all the hospital bills, along with, I HOPE, a lawsuit from the family. It’s really heartbreaking, and I get so enraged when I hear all these horrible insurance stories. It’s just not right.
I’m an EB attorney that specializes in stuff like this. COBRA is generally retroactive to the date of the “qualifying event” (e.g., the reason JB and the rest of the family lost COBRA coverage due to his termination of employment). Although you have 60 days to elect it, the premiums you sent in should have been retroactive to that date. If you have any questions about your particular situation feel free to e-mail me. I can’t make the situation suck any less, but I can try to help you make sense of it.
Just to clarify – they will reimburse you (at the same rate they would’ve under the plan while JB was actively employed), provided you elected COBRA & provided the premiums within the initial 60-day window. Assuming that happened, there won’t be a gap in coverage at all. You’ll have COBRA coverage retroactive to the date the Microsoft coverage ended.
I have no advice, just choose to add to the many rants. I hate the healthcare situation in this country and I’m so disappointed because I believe deeply that we can do better. For reasons that totally elude me, we choose not to. Unacceptable America. Don’t make me pull this country over.
Coming back to mention the other thing: having to get on the phone with pharmacies/ doctors/ insurance companies/ HR/ COBRA/ everyone in the world to “raise hell,” often when you’re dealing with chronic illness or cancer or hyperemesis or some damn thing. (Or moving!) Like we have time for this. I think they make a lot of money off people who don’t have the time or energy or education or English to do it.
I would look at all the money you saved over the course of your husband working at Microsoft, and divide that by the $5,100 and I bet you feel better. I’m not saying we have a great system, but when you have the gift of no insurance expense for years, you should probably save that money for a rainy day such as this.
TOTALLY here you. I left Microsoft to work for a startup about 6 months ago and it was a huge decision given my type 1 diabetes. Luckily my husband works at Boeing and they have decent health benefits for non-union workers. And I definitely feel like a burden to my family with all my health care costs and other chronic illness crap. This is very common. Which doesn’t help, but you know. Youuuuu are not alooooone.
*hear (sheesh)
Every time I read about the health care system in the US I just don’t get it. I’m Canadian. And for all those people commenting about our “socialized” health care system we prefer to call it universal health care. Meaning we’re all covered regardless of income, etc. I can go to whatever doctor or hospital I want and don’t have to worry about how I’m going to pay for it. Is it perfect? No, but it seems a lot fairer to me. (And I guess I’ll stop complaining about the $50/month I pay for prescription & dental coverage through my job…)
I hear ya. I’m 27 and I haven’t so much as had my wisdom teeth out. I’ve worked my ass off my whole adult life and have never had health insurance. Every time I talk to my folks, I hear about their knee surgerys, their Prilosec prescriptions, their back pain pills, their sleep apnea tests… Neither of them will ever get out from under their medical debt, neither of them will ever retire. And they’re not slackers, stupid, or white trash, they’re just normal people in their 40s/60s, trying to get by. And that’s what I have to look forward to when my body stops being all indestructibly in-my-20s… It’s a sad state of affairs
I live in Massachusetts, with Obama/Romneycare and it is AWESOME. It makes things possible- like my husband being able to be self-employed.
No worries about being denied coverage, about being forced into crappy plans, or about lifetime caps.
You have to pay, yes, but still- AWESOME.
About that Australia idea that Cords had – yeah, as a US citizen, you can’t get coverage under Medicare (and the PBS) in Australia until you’re a permanent resident. As a temporary resident, I pay out of pocket and then seek reimbursement from my insurance. Some things are cheaper than in the US, some more expensive. My IUD cost $530 and I don’t know how much of that I’ll get back. It costs $33 for people under the MBS.
I’m confronting this nightmare of American Health Care as we speak, as I try to switch from my ex’s plan to private health insurance. It is, in a word, horrifying. Horrifying and financially insane. Here’s hoping we both get through the transition relatively unscathed(ish). xo
This is why it’s such a farce to have legislators who are guaranteed health coverage for free for life deciding this nation’s healthcare decisions.
I wholeheartedly agree that the health/medical/insurance system is broken as all getout, but as a person without insurance who can’t even afford to go to a doctor for regular checkups, I have zero sympathy for the idea that someone risks not having health insurance for a temporary time frame. *End Rant*
I completely agree. I’ve never understood why people are opposed to universal healthcare as being too socialist. As you said, if we covered health care for everyone, it would free people up to move jobs and start businesses. You can’t get any more capitalistic than that.
I haven’t read all the comments so I’m sorry if this is a repeat… but how rediculous is it that a pharmaceutical company or pharmacy has to charge $2000 per month for a prescription? Yes, I’m sure a lot of research went into developing and manufacturing the medicine. But that price seems way past the point of reasonable for a medication.
I have a couple of shitty health care system stories. The first being my issue with chronic UTIs (NOT sexually related, oh judgy ones, it stemmed from childhood). I had no insurance in college, and nearly went broke over it. It cost $300 for me to just go pee in the cup, which they make you do every damn time, even though you know what’s wrong with you. Then comes the super expensive powerful antibiotic, b/c you’ve been on too many antibiotics in the past. It was around $2000 a year, which may as well be $1 million to a college student.
My second example is from when I was 28. My husband worked at Yahoo! and had similarly awesome insurance (this was during their now-extinct glory days). I contracted salmonella and had a myriad of complications as a result. In the end, I paid about $3000 out of pocket between co-pays, which makes me really really wonder how much the grand total would have been had I not been insured. How awful it must be to get so ill, at no fault of your own, and have no way to get yourself the proper care.
Have you tried calling the pharmaceutical company that makes the meds? A lot of them have programs that help pay for prescriptions (especially if they are life-saving)and will give you free meds or greatly discounted meds. It’s worth giving them a call and at least explaining the situation. At least it’s temporary, I can’t see any reason why they wouldn’t help you (unless they are COMPLETE douche-bags, but lets hope they aren’t)
Don’t even get me started on how screwed up our system is. It became crystal clear to me when my Dad was in a hospital dying and my Mom had to tell the Dr. that we couldn’t try one last medicine that could prolong his life because SHE COULD NOT AFFORD IT. He died two days later. It’s sickening.
We honestly can’t afford private insurance or COBRA, my fiance’s insurance starts in July but obviously I can’t be on it since we’re not married. He has a knee issue which he’s just hoping he can live with until July (his job is physically demanding) and lately I’ve been showing all the symptoms of CHF (shortness of breath, severe edema, which I recognize since I have a history of it-although this time it’s unusual since I’m not pregnant which is the only time I’ve had it) and have been reluctant to go to the ER since I am uninsured. I’m sure that people will be all Judgy McJudgement pants about this but whatever.
*I meant to say can’t afford private and do not qualify for COBRA..oops*
Lots of good suggestions here. I wanted to add that the 4 of you in your family each have his/her own individual right to elect. So if you are the only one who needs to be covered right away, just elect the COBRA for you and it is less than the $1,700–perhaps. That is if your Hubs’ ex-employer has the plan set up that way. If this is the case and you have already elected for the whole family, you can write and state that you are rescinding electing COBRA for the other 3 in your family. You can do this during that 60 day decision time. Then, find something individual and inexpensive for the other 3.
This is one of the many reasons we’ve got to re-elect President Obama in September, people! Don’t expect the Republicans to give a damn (or a dime) for a decent health-care system in this country!
HAD to comment when I read the comment of the chick that lived in England and some of her neighbors died waiting for procedures.
1) Where the heck did she live that her neighbors were dropping like flies?
2) I call BULLPUCKY! I lived in the UK for 30 years I have family there now. Yes there are waiting lists for some ELECTIVE procedures (i.e knee replacement, hip replacement etc). Anything life threatening is dealt with straight away. In fact they have recently passed a mandate that if you find a suspicious lump, it has to be seen and assessed within two weeks.
Makes me mad when people spout off these fake horror stories. This is the reason people believe republican ‘death panel’ bullcrap and why they vote for said idiots…and the reason we don’t have a single payer or double payer system…and the reason millions of people have no health coverage at all.
Rant over.
What would you do if your meds didn’t exist, my dear? What would any of your f’d-up friends do without their meds? And you want everyone else to pay for your problems? No thanks. We’re not your nanny. Microsoft and other companies of that ilk have perpetuated the entitlement state that Obampster and his cronies want all of us to pay for. Your foreign friends think their healthcare system is great until they need something major done and then they come here. What a crock.
Apologies. Your post caught me in a bad mood. I just don’t like the government anymore in my life than it must be and I grow tired of the welfare state we’re in. I sympathize with you as my partner is on meds that cost him as much as yours without the insurance.