Saturday, October 17, 2009

Welcome Back to the Ranks of the Uninsured

Last Saturday, I was alerted that UHC had dropped my insurance coverage due to an "administrative" error. I had been completely uninsured since October 1st.

Now, I have dealt with a lot of “administrative” errors at United Healthcare. Every three months, I spend about 6 hours over three days on the phone screaming at customer service reps, their supervisors, rapid resolution managers, *their* supervisors, customer care coordinators, benefit coordinators, and (when you finally reach somebody with any weight in the hierarchy), the actual medical “advisors” who approve and deny my actual claims.

You learn the buzzwords. “Attorney general.” “Lawyer.” “Sue.” “Medical necessity.” “Death.” And, “Gross negligence.”

And in about three days, you get shipped the medical hardware they approved for you a year before.

Yes, I go through this every time I need my medical hardware. But it does get covered. You know, eventually.

Folks who have yet to experience a major medical issue are often ignorant of how insurance companies actually work. They are also largely ignorant of what happens when you get a major illness like any form of cancer, diabetes (including juvenile, the immune disorder that I’ve got),lupus, CFS, or any of the long list of over 30 “uninsurable” medical conditions that – as my shorthand name implies – means that you are completely uninsurable outside a major employer group plan… for life.

Let me say that again:

If you get a chronic illness and/or cancer, any form of cancer, you are TOTALLY UNINSURABLE for at least 24 months. And in the case of certain cancers like leukemia, you are uninsured FOR LIFE outside of an large employer-sponsored plan (so long as you go less than 60 days without coverage. More about that later).

If your employer drops you for any reason – because you’re laid off, because they don’t pay their bill, because of an “administrative” error – you have just 60 days to find major medical coverage through another company, or you will be totally uninsurable for 12-24 months EVEN UNDER AN EMPLOYER SPONSORED PLAN. That’s right: 60 days without coverage and I will have to wait 12-24 months to get insurance covered for the insulin that keeps me breathing. After 60 days, insulin becomes part of me “pre-existing condition” and will not be covered – EVEN UNDER A MAJOR EMPLOYER SPONSORED PLAN – for 12-24 months.

If I bare bones my medical costs, I’m out about $300-$500 a month. Right now, I’m out about $8,000 a year in medical costs with the pump. If I go back to shots and get a cheaper, crappy testing meter (testing strips alone run me $180-$250 a month), I can winnow that down to that $300-$500 range.


That doesn’t include any preventative care. I’d have to drop my 4x yearly endocrinologist visits, gyno care, urgency care visits for antibiotics, etc. That $300-$500 covers the costs of keeping me breathing.

That’s why I include health insurance benefits in my salary negotiations. If I have a comprehensive plan, I can put up with being paid a little bit less.

But when you drop my insurance… you’ve effectively cut my monthly salary by over $500.

And when you drop my insurance… the clock starts ticking.

I have been uninsured for 17 days.

I have just 43 days to get comprehensive coverage, or I become uninsurable EVEN UNDER AN EMPLOYER SPONSORED GROUP PLAN.

I have been here before. When I was diagnosed three years ago, I had very cheap health insurance with a very high deductible. But I was "insured." And I was about to find out just how incredibly "lucky" that was.

What “insurance” means is that I was out ONLY $6,500 out of pocket for my 3 days in the ICU instead of $30,000.

That’s what being “insured” means. It means you get forcibly fucked, but not gang raped.

Over the next few months (again, as an insured person), I was still spending $300 a month out of pocket for medical expenses. I had a $2500 deductible and 80/20 plan. I was shelling out a lot of hard earned cash to stay alive. But hey, we all need to pay to stay alive, right?

And I was INSURED.

Six months after being diagnosed, I was laid off.

COBRA was nearly $400 a month. Rent was $550. Utilities were $200. Unemployment was $328 a week.

You do the math.

I was forced to either cash out my 401(k) or become uninsured completely.

I cashed out my 401(k).

I started living on expired insulin and reused my needles. I saw my endo half as much as recommended. I did the bare minimum I had to to stay alive.

When money ran out, I moved in with friends in Dayton. I lived in their spare bedroom rent free. I continued to live on expired insulin. I had trouble paying for food. I went almost 30 days without insurance.

I signed up with my temp company’s health insurance plan. It was cheap, and nearly worthless. It covered NO pre-existing conditions for 12 months. It was completely useless to pay for any of my diabetes drugs or appointments or any hospital stays I may incur that had anything to do with my illness.

But by signing up for it, it insured I didn’t go more than 60 days without coverage and become totally uninsurable under a “real” insurance plan.

By the time I got employed at my current job, I had over $17,000 in credit card debt. Over half of that was related to medical expenses. The other half was composed primarily of moving, traveling, and grocery expenses.

At my new job, I got day one health insurance coverage. I paid $20 for insulin and nothing for syringes. Co-pays were minimal. Costs were suddenly manageable. I could start living on non-expired insulin again. I had fewer crazy lows and started seeing an endocrinologist again. Life improved remarkably.

When we switched plans to a no-deductible plan, my health insurance costs went down to basically nothing. I now pay just $50 a month for coverage for J. and I.
It sounds too good to be true…

And, of course, that’s because it sometimes... is.

I spent the first 6 months of the new plan arguing with UHC because my account had some kind of “administrative” error that required me to pay the $1,000 deductible out of pocket instead of through the company HRA. Six months this went on. Six months. After six months, they finally “reimbursed” me for the $1,000 out of pocket.

OK. Fine.

Then came the whole fiasco with trying to get my insulin pump approved. It took a year of Insulet fighting with my insurance company before they got approval. Then once they had approval, the paperwork was filed incorrectly. We fought for weeks over that to get Insulet paid. But every three months, UHC found some reason or another not to send my shipment. The shipment they'd APPROVED a year before.

They couldn’t find my paperwork. Or my paperwork was automatically denied because it wasn’t processed correctly. Or there was now an in-network provider for my pump… but no one had the actual phone number of the in-network provider (it took me three days and six hours of screaming and threats to get… a... phone number. I’m serious).

And now… now I’m 12 days from needing my next shipment, and here we go again.

UHC once again dropped coverage. Not just for me, but for everybody at the company. Just dropped it. “Oops.” Just like that.

And just like that, I’m completely uninsured.

I have $186 worth of testing strips that I need to come up with the cash for next week. I have $90 worth of insulin I need to get the week after that.

And I have 43 days to find insurance again. Or J. and I will be turning off our heat completely and living primarily on rice, hot dogs, and expired insulin.

Welcome to America. We have the best healthcare system in the world.

And this is how it works.

13 comments so far. What are your thoughts?

David J. Williams said...

this bites in the worst way.

A lot of the incompetence of Hc companies is deliberately built into the system, so that they have to pay out less claims that way. All this talk about how inefficient govt run health care would be seems pretty absurd to anyone who has had to deal with "customer service" at United, Aetna, and all the rest of those miserable moneygrubbing fucks.

Roman said...

Kam I knew you'd gone through hell in the past few years but had no idea how much. In light of your experiences and the clear impact it has on you, what is your view on the currents debates, viewpoints, and possible legislation on health care?

Kameron Hurley said...

Dave - yeah, it's built so that people get so frustrated that they give up. Most people do. I've learned how to navigate insurance bureauocrazy very well - but most people don't have the time, patience, or verbal/written skills I do. Most people just don't get the coverage they're actually entitled to. And none of us get it in a timely manner.

Roman - my view on current insurance/health reform is: better something than nothing. I don't mind getting fucked with a "no public option" if it means we can all agree on insurance reform (ie elimination of lifetime caps, imposition of premium caps, and elimination of pre-existing clause that fucks so many of us over). Would I rather an expansion of medicare (AKA "public option") hells yes. But I'm more than willing to compromise. Some reform is far better than no reform.

Baby steps.

Ismone said...

Wow. Just wow. Jesus H. Christ on a cracker.

If you've the time, you should see if you can get this published to a wider audience. People need to know about this shit. It scares me how much fighting I've had to do for minor things I was clearly entitled to, and how much that signals to me that poor people who cannot afford it and don't understand their policies are just getting screwed, screwed, screwed, but this is life or death. Seriously, what the hell.

And thanks for writing about it, take care.


CJ said...

hi Kameron

I agree -- this needs to reach a wider audience

it is well written, clear, concise and factual -- an unarguable case

I live in the UK and would love to forward this to some friends of mine -- so I will give them your blog link so they can read it...


Kameron Hurley said...

Yes, please forward away! The reason I talk about my fight with health insurance companies publicly is so people understand how they work.

What's killing healthcare reform in this country is this bizarre belief that you do actually get the care that you pay for.

Amy Sisson said...

I agree with everything you say, but the part I'm not getting is that if they dropped you and everyone due to administrative error, why do they not reinstate you with retroactive coverage to the date of their error? Why does your employer not demand on its employees' behalf that this get fixed? I think I'm missing some critical point.

(It's not that I'm naive -- I have no trouble believing that a health insurance company would resort to such shady accounting to get out of paying claims -- but if your employer is paying for coverage, surely the employer wants to get what it has paid for?)

Kameron Hurley said...

Demands have been made. See.. I don't know how much experience you have negotiating with insurance companies, but simply calling a support number and saying, "Fix this today," doesn't get it fixed.

I regularly have to threaten legal action and filing complaints with the attorney general. The way insurance companies work is that they make it impossible to find somebody with the actual power to fix your account. It took 6 months to get coverage fixed the last time they made similar errors on about 1/3 of the employees on our account.

People got so frustrated they actually used their spouses' insurance instead because even tho UHC's deal was "better," getting it to actually work was confusing, frustrating, and time consuming.

I go through this dance with UHC every time I'm due to get a medical shipment. It takes 2-3 days and six hours on the phone while folks transfer me to different departments and supervisors. You basically need to tell them someone is dying and you're going to the media to get anything fixed within 48 hours.

I know this sounds crazy. And trust me, if you ever have to deal with it, it IS. Also trust that my 24-48 hours turn around after 6 hours screaming on the phone is something I consider a major victory.

Getting the health benefits you actually pay for is tougher than you think.

Kameron Hurley said...

P.S. And yes, the idea is that once it's fixed, UHC will retroactively cover us starting back on Sep 1st. Trouble is, we could go 2-6 months without coverage until then.

And let me tell you: just because they retroactively "fix" your coverage doesn't mean you're safe if somebody does an audit on your account when you re-up for insurance somewhere else. All they need to do is find a copy of the letter that says we didn't have coverage from, say, Sep 1st to Nov 15th, and they'll make you go through hell on earth to convince them that yes, in fact, you had coverage that was retroactively applied.

Again, I realize this sounds crazy. I really believed a lot of the horror stories were anomolies until I got my own chronic illness. Insurance companies hate me. I'll be going through things like this with them my whole life.

Barring a public option.

Cheney said...

I am really sorry & sad to hear that this happened to you. I don't know who you are, but my heart goes out to you and I hope that something will be done soon to make sure that you never get denied again - take care of yourself!

Kameron Hurley said...

There are lots of other folks getting dropped all the time. It just so happens that this time, it's me. Tomorrow, it could be anybody. Check out just a few recent stories:

And, the ever useful complaints board, which describes several situations a lot line mine:

JacquiBee said...

Kam, come live in "socialist" New Zealand, we might not have the newest of technology for you (pods are rare here) but we will look after you insured or not!!!!! I'd like to say how it amazes me that so many don't understand how socialised medicine works but you do. Also check out Suzanne Gordon, a journalist, patient advocate that I respect. She stands up for nurses so we can stand up for our patients.

Kameron Hurley said...

I would LOOOOOOVE to live in "socialist" NZ. I spent some time there a few years ago, and if it wasn't a 12 hour plane flight from the U.S....

The reason a lot of folks in the US don't understand how socialized medicine works is because it's in the interests of the doctors, hospitals, and insurance companies to maintain the status quo. Any industry (just like the oil industry) that's making huge profits is going to fight hard to try and keep their monopoly. It's just disgusting that we allow things like our health and welfare to be dictated by somebody's pocket book.

Incredibly uncivilized... but so American! Here's to hoping it's not "American" much longer...