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