Just realized my readers from more humanely run places

might not realize what the whole medical plan kerfluffle entails.
The thing is it is suuuucch a pain.
And scary.

What happened was, we were briefly lapsed from our continuing employer-subsidized health care plan, which is currently being subsidized by both Tom's old employer and the government.
Before Tom was laid off, his insurance was paid partly by him, and partly by his employer, which paid for a group rate medical plan, for which we paid a few hundred dollars a month, and an office visit fee of $10, with no deductible amount to be paid out of pocket before the insurance covered costs.
After Tom was laid off, this insurance was continued through a government program called Cobra.

Cobra is a program where the employer and the government subsidize continuing health insurance after someone gets laid-off or fired.
Only some unemployed people though.
Like, if your job had benefits to begin with, or if your employer was big enough to be required to provide Cobra.
And the program only lasts for a while, I think originally six months, on the assumption you go get hired somewhere else and get coverage again.
The government's been extending it because of the economic melt-down, so I think it's at 15 months now.

You still pay – for the three of us it's $480/month.
When Tom's unemployment is $900/every two weeks.
So that's roughly a quarter of it.
But without Cobra the same low-cost coverage he had from the university would cost us a little over $2000/month.

We started Cobra payments in October, but Cobra kept misplacing the fact we'd paid, and canceling us.
Then they'd uncancel us when they "found" our payment, generating cryptic emails, and paper copies arriving two weeks later.
And in the meanwhile they would not bill or display next payment info, since we were faux canceled.
Which was all pretty annoying and difficult to deal with.
But then, when they raised the rate $20 in January, the check we mailed in – which we mailed in on time even though we were faux-canceled in December- was 25$ short.
And we were real-canceled at the end of January, which was indistinguishable from being faux-canceled – so we kept mailing in payments.
And this is what got undone, because the HR people at the university are real human beings and not insurance company cyborgs.

But being real-canceled would have meant we'd have to go find insurance on our own and pay gigantic amounts for worst coverage.
Bigger deductibles – out of pocket payment for everything until you'd paid $2000 or $3000 for each person in the family, at which point the plan would start paying for that person.
Higher co-payments, $20, $30, or $50 to see a doctor, get a prescription, etc., all this on top paying the $1200-$1700 premiums, depending on your choice of how to arrange the whole deductible/co-payment/monthly payment.

In addition, it took a while before we discovered that January was a real cancellation since they continued to cash our monthly payments, and since the on-line account kept saying we owed nothing.
You see, if you're canceled, you don't owe anything, so the billing section says you are up to date.
Until they closed the account, three months later.
Two days after telling me on the phone everything was fine.
Pretty much exactly at the time we'd passed the magic sixty days when your old insurance company has to accept you, warts and all, if you can pay for continuing coverage.
But if you miss setting up a new insurance plan in that window, all bets are off.
After that, insurance companies get to pick and choose.
They get to apply restrictions on "previously existing conditions," anything for which you have ever seen a doctor,  which are then not covered by all the payments listed above.
Oh, and for which they could legally simply refuse to offer you any insurance at all.
Because charging big bucks to insure healthy people is waaaaaay more profitable than insuring people with medical problems.

So one of the things I spent the last month doing was inventing a business partnership because it appears there is a "previously existing conditions" loophole at my health plan which allows small business owners/employees to slip in without passing a medical.
Luckily I seem not to need this at the moment, but I will keep the paperwork.
Because – hey, who doesn't want more bureaucratic garbage underfoot!

Capitalism at it's finest – profit-based health care.
This is the lovely free enterprise system in health care that the Tea Party and the like are grabbing their guns to protect.
Anyone else baffled?

Edited to add:

How do they mess up the billing, and end up canceling and uncanceling people so often?
My April check is shown in one part of my account as received and accepted April 5th.
My bank has cleared the check and dispersed the funds as of April 7th.
My main account page shows it still due.
This month we paid a month early, so this delay is not happening across their deadline… but my educated guess is that the payment will not clear their system until after the 12th.
Bets anyone?

Why are they so inefficient?
Well, far be it from me to underestimate sheer human fraility, but I think greed comes into it to.
The person receiving insurance is not the customer here, but rather an expense to the real client who is the business that laid off employees.
Every person that trips over one of these payment issues is one fewer monthly payment for that client.
It costs the university over $800/month for our coverage.
The program that runs our Cobra declares they have no responsibility to send any bills or notices to anyone, rather it is entirely our business not only to have3 checks sent in on time, but to be certain that they have been properly credited.
If you google Cobra + complaints you can find some truly mind-boggling stories.

Could we plz haz some moar socialism in our health systemz?

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17 responses to this post.

  1. This is horrific. Stories like this abound EVERYwhere. Yes can we please PLEASE have just a touch more socialism……PLEASE?????


  2. Good god, this is horrible. And exactly why we need reform. Single payer, please? UG. I hope it gets sorted as much as it can. Awful awful. So sorry.


  3. (Crosses fingers wildly)Looks as if things are functional again at the moment.So this is a story with a "good" outcome.Longer-term, eeeeeh.In November the same plan suddenly goes to full-price.Macawber-like I'm depending on something to turn up.


  4. I can't help feeling that every teapartier knows someone with a similar story, and they're out there airing their studipity anyway–I hope something good turns up soon!


  5. It's all too upsetting. It really is. And it's getting worse. I wanted Hillary!No way to run a business. Like a scam. But nooo, it's insurance!My insurance also sucketh. The insurance co. made a huge profit last year and raised rates 30% and cut back benefits, which weren't much anyway. I only have catastophic insurance now. $5000. deductible. Teapartiers are a whole new kind of idiot.


  6. This is why we set up Sair's Irish citizenship, which makes her an EU citizen.You know, where those wild and crazy European socialist types live.Eek.Seriously, I don't know whether, having a choice, she ought to settle here as an adult.The middle class is getting stomped into the ground, and though I try hard to believe in change and all — I also wanted Hillary — Tinkerbell would have been a goner if it had depended on me believing.She should go be productive and happy somewhere more functional, because the corporations ruling this place have run amuck.


  7. Hey, if you get that partnership thingy set up, can you hire us? Our Cobra costs nearly as much as the total unemployment.


  8. It doesn't look as if there is much actual cost benefit, though I didn't finish checking it out.The main thing was that if our coverage lapsed there would be issues with covering pre-existing conditions, which applying through a business would side-step.It was incredibly confusing…nothing seemed to exactly match what we had, and I still can't figure out from the choices offered which made most sense – lower co-pay? higher deductible?For now we're back on Cobra through the fall, and I'm hoping we will get something together by then.Sigh.


  9. Go Irish! That's awesome for Sair! And then you & Mr. Lauo can pick up and move in next door to her! Families are very close over there! The kitties would love it so much they'll forgive you for the whole quarantine thing.I have the UK citizen option. My father here is perfectly healthy, but if I outlive him, I'm heading for the UK.A couple times while in the UK I've had need of a doctor and both times, there were no questions about insurance or ability to PAY! They were so nice.Best of luck on employment and good health!


  10. Yeah, I'm with pyrl. Go Irish!


  11. Hussah for Noraway in these matters, I'm so grateful that there aren't issues I need to worry about! Here's how it works here, or in short:The health service in Norway is funded predominantly through taxes taken
    directly from salaries and there is no specific health contribution
    fund. The National Insurance Administration known as the Trygdeetaten
    is responsible for the National insurance Scheme NIS, a state insurance
    scheme that guarantees everybody a basic level of welfare. The NIS
    provides benefits for illness, accidents, bodily defects, pregnancy,
    birth, disability, death, and loss of the breadwinner as well as for
    unemployment and old age. Emergency care is available free to all citizens regardless of their
    status. Ambulance is free. There are relatively few fees in for healthcare in the state system.
    Inpatient hospital treatment is free to all who qualify, but visits to
    doctors and specialists as well as prescription medicine incur charges.
    Citizens must also pay for radiology and laboratory tests and for
    non-emergency transportation. There are a number of exemptions e.g. for
    people who suffer from chronic disease, pregnant woman and those who
    have just given birth. (Maternity leave is 10 months w/full pay, or 12 months with 80% pay, fathers get a minimum of 6 weeks of this time, the rest the parents decide how to distribute)


  12. oh, and fingers crossed that stuff has been worked out for you now! That was what I really came to say, just got carried away by the copy + paste 😉


  13. I'm so sorry. Even with the new "reforms," I'm making 2k more a year than qualifies me for medicaid. Yay me for working and managing to hold onto my job when 70% were cut. :(I pay just over 25% of my wages for coverage. If I need to SEE the doc or take meds, surgery, etc., that's of course MORE ($40 dr / $25/50/100 3-tier rx). Don't ask me about the $5k deductible.


  14. Yes, was just talking with my still-employed buddy.Who has like a 4k deductible.Which basically means that unless something terrible happens, any health care she'd need is out of pocket.For which she pays.No, the health coverage in America is like being in the first part of a horror movie… you're just wandering around, minding your own business, but one misstep and you're toast.Yes, FatCat, you live in civilized parts!I'm fine with passing the band-aid health care bill, it's a first step.But single payer, plz.


  15. Def more socialism…just less EU thanyou very much..i thnk I shall keep my Sterling…and my work week and no thanks to crazy farming subsidies and the French in general!!!!


  16. Yup welcome to America. Health care insurance shouldn't be for profit. It ends up like this. I can't wait til I have to buy in. Everyone keeps telling me "Oh but they can't ask you if you have pre-existing conditions starting in 2014, they just have to insure you" Um yeah. And everyone IN health care tells me "But once you're in and they find out what your health is, nothing says they cannot jack up your rates so high you can't afford it / not cover this or that, make it such a pain to use your insurance that you'll pay out the ass and then STILL be paying cash for your care like you are now anyway, etc".


  17. That's insane. This is reason #984759836792 of why we need a new system. This one is…let's say it together…broken! I will keep my fingers crossed for you and your family. How about we hope your problems with insurance leave you and go to a senator or someone like that?


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