The Ongoing Saga for Healthcare Coverage

I have been trying to compose a blog post on this topic since November 19. This is currently my 5th draft. I’m hoping to write a composed entry, rather than an unbiased ranting of a raving lunatic, because really, I’m so frustrated I just want to throw things.

I have epilepsy, which left me no choice for insurance but the Federal PCIP program when my COBRA ran out. When I had to wait 6 months without insurance to apply for PCIP, we felt that financial pain on our budget just on my meds alone, which cost an average of $1000/month. I have not calculated or included the cost of my husband’s medications at this point.

Now, we’re facing the same situation again. PCIP is going away at the end of the year. If I’m unable to find affordable coverage by December 15, I will not have insurance at all on January 1, 2014, and I’ll get to pay a penalty for that privilege. Continue reading “The Ongoing Saga for Healthcare Coverage”

These are the people who will handle my healthcare.

Our healthcare has been in dire need of reform for years. Ask anyone who’s paid out-of-pocket. Ask any physician who charges “X” and gets a statement back from the insurance company saying they’ll only pay “Y” for that procedure, and no, the patient isn’t responsible for the difference. (Oh, and by the way, if you don’t have insurance, you can’t negotiate the price like that)

When the healthcare legislation was pushed through, many people were quite happy. However, I don’t think it’s the answer. Having our government handle our healthcare? Seriously? Have you ever tried to get anything pushed through the mounds of red tape at any government office?

I have a pre-existing health condition that prohibits me from getting health insurance coverage. As a result, I waited my 6-month period and applied for the Federal PCIP Healthcare Program. I sent in my denial letter and all my paperwork on February 1. After three weeks, I should have received some communication from their office. I started calling on February 25.

I was told my paperwork was still in process and if I was approved my coverage would be effective as of March 1. Any medical expenses I incurred after March 1 I could submit for reimbursement after I received my card and all their paperwork.

March 1 came and went.

On March 5 I called and was told my account had not been updated since February 11. I was forwarded to a manager.

After further investigation, it seems someone flagged me as not being a U.S. Citizen. Although my application clearly stated I was born in the U.S., they had my social security number and had complete access to my identity, someone somewhere didn’t know how to read.

Clarifying this on the phone with me wasn’t good enough. They had one specific person I had to talk to. This person had to call me back. She wasn’t in the office. I was told she had two business days in which to call. I got a call from her the next day, while I was in class. Luckily, I was expecting her call and left my phone on vibrate.

When the lady spoke with me, she said it wasn’t a question of citizenship and apologized for the misunderstanding. They were just missing documentation. (Documentation I sent on February 1). Three things went through my mind at this time:

  • So I get all wound up about this “question of citizenship” for nothing
  • It would appear their right hand doesn’t know what their left hand is doing
  • They’re already losing paperwork and they haven’t even finished processing my app yet. Why didn’t I get some communication back in February saying this was missing???

I got her fax number so I could send her the information, and expressed my disappointment and dissatisfaction. I asked her how long this would delay my application. She said she would expedite the application. I doubt it.

If this is any example of what to expect, I may consider cancelling my coverage and just socking away the money each month. Somehow I think I’d be better off going without.

The Great King COBRA Rant

I can’t convert my COBRA insurance coverage because Premera BCBS is out of state. I have to apply for individual coverage here in TX. They can’t transfer my existing policy because it’s a group policy. I’m an automatic “deny” on my healthcare app with BCBS because they want you to be seizure-free for 5 years before they’ll touch you. They suggested the High Risk Pool.

On the Federal High Risk Pool, you have to go without any insurance coverage at all (note, COBRA counts as insurance coverage) before they’ll cover you. Texas has a State High Risk Pool but if you’re on COBRA and your plan has a conversion option (which, technically, mine does; I just can’t use it because they’re based up in the northwest part of the country and I’m “out of state”), you have to wait 6 months before they’ll cover you.

This. Is. So. Fucked. Up.

I thought “healthcare reform” was supposed to help people who can’t get insurance. WTF? Am I missing something?