Wednesday, January 21, 2009

Health Insurance Woes & Confusion

image So I was tearing up while I was searching for health insurance, (everything to do with the baby who I haven’t even conceived yet is making me thrilled and emotional) and OH MY GOD where can you get health insurance that includes maternity care?

My music professional organization doesn’t have it included. Isn’t there a writing org that advertises health insurance? Which one is that? I don’t think RWA offered it.

What is really annoying to me, is that for $700 a month, I can get a plan with a $5,000 deductible. And, hello, if I’m paying $700 a month, how the heck am I supposed to afford $5,000 on top of it if I actually need health care?!

That’s a total of $700x12 months=$8,400 a year. Plus the $5,000 deductible is an annual total of $13,400. (CRAP! HOLY FREAKING CRAP!)

Okay, now add to that the UNCOVERED maternity costs of $5,000 (roundabout), and we’ve got $18,400 for the year.

All that, just in case something happens to the baby during birth.

But if I don’t get health insurance, that’s $5,000 for the birth, and I’ve got $13,400 in case something happens. And if nothing happens, I get to keep my $13,400.

The numbers on health insurance never add up for me. I truly don’t get it.

How long do you think it will take Obama to solve this health care problem?

What irritates me to NO end about health insurance, is that the “regular” health care can never fix my issues. Not to mention, I don’t spend $5,000 a year, so I’m just throwing the health insurance money away.

It’s such a waste. Such a scam! I truly don’t get it. Yeah, yeah, there’s the “if you get cancer” argument, but I won’t be using that kind of health care if I get cancer.

imageI think I’m going to look into the medical savings account thing. This just doesn’t make financial sense to me. It doesn’t compute for me.

Am I missing something?

But I refuse to let this deter me. I’m going to find a way. My eggs are all ready to conceive, they told me so. And my heart’s already in love with my not-yet-conceived babies.

I have even begun to visualize childbirth, which is a huge step, because I was avoiding thinking about that little tidbit for awhile. But now I’m vividly giving birth to babies every time I drive down the street, LOL.

There are plenty of people who make less than me who have children. Aside from making more money, I just need to figure out how to do it.

Um, so do you know how they do it? Any tips? There has to be a way. I mean, I’m not saying the world owes it to me to make it possible for me to have a baby, but people working minimum wage jobs have babies all the time. I make more than that. There has to be a way.

I’m confused!

63 bonus scribbles:

Robin 1/21/2009 10:38:00 PM  

Yikes! A 5,000 deductible is INSANE. I feel compelled to look into this. A friend of mine, a 62 yr old lady from Russia, never had health insurance, and then called me upset because she noticed a mass in her abdomen. We looked into it, and Highmark BCBS had the lowest copay and deductible. (It turned out she was fine. Phew.)

I'll be back...

Edie 1/21/2009 11:23:00 PM  

Spy, I hate insurance. Robin, big deductibles are getting to be the norm. This is why our health care system is breaking down.

I hope someone gives you good advice, Spy.

spyscribbler 1/21/2009 11:43:00 PM  

Wow, Robin! Okay, you're making me cry. You're an amazing person. Thank you!

(Gosh, I am SO emotional lately! Sheesh!)

spyscribbler 1/21/2009 11:45:00 PM  

Oh, Edie, the thought of paying all this money makes me sick. I don't know. I need to look into how much it would cost if my baby is born a preemie. Can it be more than $13,000??

Sheesh. It's really terrible. People say socialized health care sucks, but not from where I'm sitting.

Charles Gramlich 1/21/2009 11:49:00 PM  

It's scary. My son's health care just went up 50 bucks a month.

spyscribbler 1/21/2009 11:52:00 PM  

Sheesh, Charles. These prices are insane. And in the last ten years, I've spent $5000 total for health care. And that $5000 was WASTED, because it didn't do a thing for my foot.

So now I'm supposed to pay $13000 a year? Instead of $500 a year? I just don't get that.

mom2brie,  1/21/2009 11:57:00 PM  

Spy - don't kill the messenger - but here are some other numbers for you to consider.

1) My hospital bill for giving birth in 2006 - $15,980.11 - of course I had a c-section so that has to be factored in.

This does NOT include Brie's hospital bill. I really, really wish I could find that, but if memory serves it was about $8000.

Then there was the $3000 for the one day that I was admitted to the hospital 6 weeks before Brie was born because of my blood pressure - which lead to tests and ultra sounds every WEEK until she was born.

So that's $27,000 just for Brie and my hospital stays - not including all of the prenatal care.
:( :( :( :( :( :( :(

Oh, and you ask about how people with low incomes can afford it - Medicaid is the answer - remember teen Tuesday at my OB/GYN office? Is there any chance that you could qualify for that? Have you looked into the "Medically Needy" section. Here's a brief quote from that page "However, States which elect to include the medically needy under their plans are required to include certain children under age 18 and pregnant women who, except for income and resources, would be eligible as categorically needy." I have a feeling you make too much, but just a thought...

:( :( :( :( :(

spyscribbler 1/22/2009 12:02:00 AM  

Okay, now I'm totally crying and not in a happy way. Mom2Brie, that SUCKS! Crap!

This is so not fair. I refuse this to be the way it is. There has to be a way. I can up my income, but by $13,000 a year? I'm not sure. Oh man.

Damnit.

The universe and I need to have a conversation about this. I am having a baby, and not just one, either. The universe had better step up to the plate on this one, because this is not up for negotiation.

mom2brie,  1/22/2009 12:06:00 AM  

You said "I need to look into how much it would cost if my baby is born a preemie. Can it be more than $13,000??"

Aw, honey, yes, yes, yes, it would be TONS more than $13,000. NICU bills are horrible. See this link from Preemie support group https://www.inspire.com/groups/preemie/discussion/giant-insurance-bill/
(It included things like "For a 3 week NICU stay, my 3 week before birth stay and a 1 week re-hospitalization 2 weeks after coming home was a little over 500K." and even one that had a $2,000,000 bill).

Of course a BIG point to make is that what the hospital bill says is not REALLY what people actually pay.

Sorry to make you so upset!!!!!

spyscribbler 1/22/2009 12:07:00 AM  

It's okay, mom2brie. And if you're uninsured, hospitals automatically charge you 30% more. (So unfair, btw, don't get me started!)

mom2brie,  1/22/2009 12:10:00 AM  

Oh, and a positive note!!! You are right by Rainbow babies hospital which is the #2 NICU hospital in the nation!! You might want to consider talking to someone there about prices and uninsured situations etc.

spyscribbler 1/22/2009 12:13:00 AM  

And I definitely want insurance that covers University Hospitals. (I hate Cleveland Clinic, passionately. I even have students who are doctors who dislike it.)

Okay, now I want to go back and work at 121 Fitness Center. When I was just out of college, I was paying $60 a month for EVERYTHING COVERED AWESOME health insurance! I never paid a dime for medicine or anything!

Bevie 1/22/2009 04:51:00 AM  

"people working minimum wage jobs have babies all the time"

Yes, we do. It's one of many reasons we're losing our homes. We also get sick, break bones and suffer from other maladies for which we are either uninsured, or insurance will refuse to cover.

Edie is only partially correct: our health care system isn't breaking - it's broken.

(Hello. I got here through LaughingWolf, who visits my blogs.)

Hopefully, Robin, or someone, can direct you to a good insurance carrier with something reasonable.

You have my prayers.

McKoala 1/22/2009 06:08:00 AM  

Half serious here, consider moving to a country with a nationalised health service for the childbearing years. The costs in the US are mind boggling. Costs a chunk here in Oz too. I was lucky enough to have both of my kids in the UK. Perhaps the surroundings are a bit shabbier and nurses come and go, but the procedures went well (one vaginal, one c) and no charge for anything.

Heather Harper 1/22/2009 07:16:00 AM  

Insurance and the medical industry PERIOD is a racket. I understand it takes money to operate, but I don't get it, either.

And we may face a run of COBRA payments again in the next month or so and the last time we did that (3 years ago) it was 1400 a month for the five of us. I was afraid to go a cheaper monthly route with higher deductibles.

On the other hand, our insurance costs more now, pays less, and has a higher deductible, so maybe COBRA is not the best option. I'm sure it will be way more than before. Hmmmm.

Have you looked in to midwifery? Hospitals are used as a back-up for emergencies and high-risk moms. Might be more cost effective.

StarvingWriteNow 1/22/2009 07:57:00 AM  

First off, don't panic. Second, do more shopping around, or go and talk to an actual person at Anthem or wherever. They can look up quotes and do comparisons between companies to get you the best deal/coverage.

One thing to consider is that you want to have coverage in place before pregnancy, because I believe that if you apply for insurance with a "pre-existing" condition (like cancer, pregnancy, etc.) you could be denied OR your rates could be sky-high.

Get more information. And again, don't panic. Breathe in, breathe out.

Susan Helene Gottfried 1/22/2009 07:58:00 AM  

Holy smoke. I know nothing about any of this and man, am I glad the Tour Manager's got us covered.

spyscribbler 1/22/2009 09:01:00 AM  

Bevie, I agree completely. It is totally broken! I was kidding myself that I've chosen not to have health care all these years. This is nearly impossible!

Must make more money. Must write faster. CRAP!

spyscribbler 1/22/2009 09:02:00 AM  

McKoala, I was totally considering that. Seriously. No joking. Moving to Canada suddenly sounds like an awesome idea. (Except the cold!) I don't think Glenn would go for it, though.

But this? This is insane.

spyscribbler 1/22/2009 09:05:00 AM  

Heather, yes, definitely. I will definitely be going the alternative birth route, but I'm just preparing for the worst case scenario.

That is appalling. That is impossible! I don't have an extra $1,000 a month laying around! I still haven't started a retirement account! Between retirement and health insurance, doubled self-employment taxes, we need to be pulling in 72K just to squeak by. I do NOT make that much money.

Crap. This is incredible. I don't understand how people do it.

spyscribbler 1/22/2009 09:07:00 AM  

Yeah, WriteNow, that's why I'm looking into this now. But I just can't wrap my head around all this. I don't understand it! This seems impossible!

Okay, breathing. But man. Okay, breathing.

spyscribbler 1/22/2009 09:08:00 AM  

Susan, the more I investigate and think, the more I'm panicking. I don't understand!

Eric Mayer,  1/22/2009 09:25:00 AM  

Confused?

What part of "stick 'em up!" don't you understand?

Every time I pay for my own useless health "insurance" I feel like I'm being mugged. We're all forced to turn over billions of dollars to these crooks who provide nothing of value. Zero. No health service. As far as I'm concerned the insurance industry is mostly a huge crime.

I have no useful advice except let's all hope for some health care reform soon.

Note though...it'll probably take more than 9 months so...

spyscribbler 1/22/2009 09:32:00 AM  

Eric, ROFLMAO! Yes, that should be easy to understand!

There was a great quote by Joseph Kennedy, the father, who declared insurance to be the most profitable legal scam around. I wish I could find his exact words!

Janna Qualman 1/22/2009 09:40:00 AM  

It IS ridiculous! What we've found is that maternity coverage (at any sort of "reasonable" price, if at all) usually only comes with group plans through large employers. It's ridiculous! (Did I say that already?)

We've had coverage for both our girls, but I have heard if you get pregnant with no insurance, you can "contract" with the hospital for a certain amount. Then, you'll have no surprise fees at the end (unless something goes wrong, of course).

Janna Qualman 1/22/2009 09:41:00 AM  

Psst! Are you sure you didn't get pregnant BEFORE Glenn left?

Edie 1/22/2009 09:45:00 AM  

I agree that it's broken. All federal government employees, especially members of Congress, should have the same benefits as the average person. Then they would find a better way.

Moving to the UK sounds like a great solution. If I didn't have ties here, I'd go.

Aimless Writer 1/22/2009 09:59:00 AM  

The cost is insane. My one dd is 25 and no longer covered under our health ins and still has not found a job with benefits. She has a college degree, did great in school, very smart....but the job market...well, you know!
I worry about this all the time. I've looked into buying private insurance for her but the costs are unbelievable. Now she's going back to school so the school will cover her for accidents and such.
One of her friends just had a baby and she went on medicaide? medicare? Whichever handles those who cannot afford it. Go to your state website and see what they offer.
Not sure that would work, but hey, give it a lookie.

Melanie Avila 1/22/2009 10:09:00 AM  

Spy, this is a big reason we like the idea of Canada. Of course I'd rather live in the US, but how the F are we supposed to afford this? England also looks nice...

I hope you get this figured out.

Sarah Laurenson 1/22/2009 11:10:00 AM  

I have had student insurance which cost me $500/yr but I'm sure it covered next to nothing.

I have had short term insurance that was $127/mo and I could get that for 1 year before I had to get something else. That was when the insurance company quoted me one price, then upped it to a ridiculous amount per month (more so than your quote) with a high deductible (less than your quote). So even if you apply for insurance at a certain rate, they can turn around and screw you by charging what they please. I don't know how much the short term insurance covered.

I have friends who own their own business and they have insurance through Kaiser. Do you have Kaiser there? It's sort of like beign in an HMO and the level of care really depends on which Kaiser hospital you go to.

SCBWI had group insurance for it's members. I don't know if they still do or what the details are. I do know there was a lot of talk not that long ago about the rates being jacked up.

We have women's health centers here that are supposed to be cheaper. I know my doctor (who retired) charged less if you had no insurance and were paying in cash.

You can try esurance.com, but I think that's where I got the one quote that became the 'screw you' real price.

Mary Moore 1/22/2009 11:24:00 AM  

Yikes! That really sucks. Here in Canada, it's all covered. Not that our healthcare is perfect by any stretch of the imagination, but we sure don't have to worry about things like that! Good luck.

Robin 1/22/2009 12:42:00 PM  

Oh, Spy, I'm sorry you're confused and stressed. Healthcare is something that definitely needs to be addressed in this country. I wish you the best of luck sorting it out. I'll be thinking positive thoughts for you. (Sorry I'm not an insurance agent so I could help you out!)

Leon Basin 1/22/2009 02:09:00 PM  

Wow, what an awesome blog. I really liked your banner. Thank you!!!

Christina 1/22/2009 02:46:00 PM  

Health insurance is such a scary topic, isn't it? Since I've suffered from a life long illness, I'm so afraid of losing Emory's insurance policy. Since he works for the government, it's really great for me having to visit so many specialists. On the pregnancy front, I completely understand what you're going through. I've been told if I got pregnant, I'd be a high risk. How scary to lose insurance when you're a high risk and need the specialists? Ug. It's a fear that plagues me since jobs right now don't seem so stable.

Lauren 1/22/2009 02:54:00 PM  

First off, I love your little icon for this post! So true.


My dad used to always say that insurance was a lottery that you hope you don't win and, like in all gambling situations, the house always wins. But you got to have it.

I hope that you can find something. You are in Ohio? Do you have Blue Cross Blue Shield? In some states they have a decent independent insurance program, but I'm not sure which ones nor how much it is. Might be worth looking into...

Sarah Laurenson 1/22/2009 03:02:00 PM  

This looks like an interesting site. Not sure who sponsors it though. Looks like Ohio does have Kaiser.

From the stories I've heard from friends, I don't know that I would choose Kaiser myself, but it does seem to be an option that doesn't kill your wallet, just your time and patience. My cousin works for them and her hospital is one of the better ones.

Kath Calarco 1/22/2009 04:53:00 PM  

The only people benefiting from health care benefits are those fat cats sitting on the health care boards.

I feel your pain Spy, yet I'm hopeful that health care will be the first "Change" Mr. Prez makes.

Here in New York State there's what's called "Healthy New York", which are affordable health insurance plans. BUT, still, you have to pay a premium, or course, but there isn't the incredible deductibles.

Georgie B 1/22/2009 05:59:00 PM  

Wow.

Not sure what else to say, other than "wow".

I think I picked the wrong post to leave my first comment on. If people here knew what I pay for health insurance, I think I would be hoisted up by my own petard.

So with that said, I wish Ms. Spyscribbler the best of luck in trying to find the most reasonable health isurance you can get.

BTW: found yours through Razored Zen.

Rick 1/22/2009 07:32:00 PM  

Hello, Spy. Have you thought of going back to school? Wait, don't hit me- students generally get group coverage with great packages. I believe maternity is covered.

What I do as a writer is to take one class at a university per semester, then get the health coverage for the whole year. It's worked well for me. I can go to school forever at those rates.

It used to be the National Writers Union (www.nwu.org) had a great plan, but that got axed when they decided we weren't really a group, but a loose affiliation or something like that, but they're always worth checking for updates.

Anyway, take a look at getting on the student group policy by taking a class.

I wish you the best.

colbymarshall 1/22/2009 08:46:00 PM  

*shrug* afraid I can't help with this one. My insurance plan would cost me more to cover myself for maternity if I paid for it "in case" I got pregnant than I would have to pay out of pocket if it just happened to happen, so I'm not doing it since it's not a planned thing.

spyscribbler 1/22/2009 09:40:00 PM  

Janna, I wish I did! That would have been awesome. I have been having cravings, but I'm thinking I must be getting the hormones swirling with all this baby thinking. :-)

spyscribbler 1/22/2009 09:41:00 PM  

Amen to that, Edie! A BIG Amen! I bet things would change REAL quick!

spyscribbler 1/22/2009 09:42:00 PM  

Aimless, thanks! I did look it up! But thanks to you and Rick's brilliant suggestion, I'm thinking of enrolling for a class at my local community college.

spyscribbler 1/22/2009 09:42:00 PM  

Melanie, from where I'm sitting, Canada wins hands down.

spyscribbler 1/22/2009 09:46:00 PM  

Sarah, thank you! I think I would skip Kaiser, because it links up with the Cleveland Clinic here. Aetna seems quite promising, though, if I go that route, because they use the University Hospitals system.

I knocked Glenn off the quote, and that helped. *cringe* Is that terrible?

spyscribbler 1/22/2009 09:47:00 PM  

Mary, Canada's looking pretty good from where I'm sitting. Cold, but good. :-)

spyscribbler 1/22/2009 09:47:00 PM  

Thanks, Robin! I hope it's sorted out soon. It's a mess!

spyscribbler 1/22/2009 09:49:00 PM  

Christina, it's scary! It really is. Regular medical care has never fixed any of my ongoing health problems, but if it did, I'd be worried.

I hope his job stays stable!

spyscribbler 1/22/2009 09:50:00 PM  

"My dad used to always say that insurance was a lottery that you hope you don't win and, like in all gambling situations, the house always wins. But you got to have it."

Lauren, your dad was a wise and very funny man! Isn't that the truth? I love that!

spyscribbler 1/22/2009 09:52:00 PM  

Kath, in my pursuit of quotes, I could find only a few deductibles of $500... the majority were in the $1,000 - $2,500 range, with a few stretching up to $10,000!

(We have no Healthy Ohio program. :-(

spyscribbler 1/22/2009 09:53:00 PM  

Aww, thanks, Georgie! Nah, I'd love to hear your insurance plan. It's like when you're on a diet and can't eat chocolate, the next best thing is watching someone else enjoy it!

spyscribbler 1/22/2009 09:56:00 PM  

Colby, that makes a lot of sense! I would take that approach, too, if I were you!

spyscribbler 1/22/2009 09:56:00 PM  

Ohmigosh, Rick, you are a GENIUS! That's BRILLIANT! Yes! I love it! I can get rates at about $150 a month, plus the class will only cost $330 per semester! I have to double check: the one university required 6 credit hours, unfortunately, but I don't think the other one does.

And maternity is covered! And you can enroll children!

I LOVE YOU, Rick! I KNEW there had to be a way! Thank you!!!!

mom2brie,  1/22/2009 11:33:00 PM  

Rick is brillant!!!! What a great idea!!!!!! {{{{{hugs}}}}}

spyscribbler 1/23/2009 12:54:00 AM  

Oh, mom2brie, I bet you can guess how happy a solution makes me! I was starting to worry that this was going to be an insurmountable problem. I still have to worry about a year or two down the line, when we hit the road, but... it's a start!

Georgie B 1/23/2009 07:15:00 PM  

Okay.

I work in state government (CT), and my premiums average about $150 a month. I usually see an increase of about 5% a year or so on my premiums.

I look at this from two different p.o.v.'s: as an employee, I get a lot of bang for the buck; as a taxpayer (and knowing what the state pays per employee because I do payroll), I feel that my premiums should be a bit higher, in order to bring us closer to what the private sector pays for health insurance.

Zoe Winters 1/24/2009 12:47:00 PM  

Okay, here is what I would do. But this is just me and I haven't read the other comments. So I acknowledge fully that my suggestion might be totally lame.

Start saving money in a health savings account. (They're special accounts that I dont' think can be taxed) Paying $700 a month, you'd have enough money for a lot of health-care issues after a year or two.

It also allows you to use the money for more alternative treatment if you want to go to a more holistic doctor and not use so much western medicine. (don't get me started on our "pop a pill and forget it's going to cause side effects that will require another pill" culture)

Paying $700 a month for health insurance with a $5,000 deductible is just wasteful IMO.

If you need insurance find out what the absolute highest deductible possible is, so you can have it just for catostrophic illness.

Most of the time a catastrophe is the only thing that will put you in real danger anyway. Even without insurance public hospitals have to treat you. And even if you pay $20 a month on your medical bills they can't do a thing to you.

Zoe Winters 1/24/2009 12:55:00 PM  

And OMG just reading through the comments, Rick IS brilliant. Holy crap on a cracker, dude! If not for Tom, I would marry him.

Zoe Winters 1/24/2009 12:57:00 PM  

Oh, and sorry for the triple posting. It didnt' totally hit my radar until i started reading the comments section that you were looking for insurance so you can have a baby.

My brain totally doesn't function inside the maternity zone.

So I'm sure my first post was a complete non sequitor.

Robin 1/25/2009 12:24:00 AM  

Rick is a friggin' genius. I would have never thought of that in a million years.

The insurance companies have rigged it so they don't actually have to pay anything. It's incredible. Our health care system has got to change. I looked all over, and my best idea was the VA. I couldn't find an affordable plan. The ones that show up on Google suck ass. What a racket.

Dal Jeanis 1/27/2009 04:16:00 PM  

I've been unemployed for a while and I'm just dropping my COBRA now, since I've entered a new deductible year. Not good to have such a big downside possible, but the upside is saving about $700 per month. In a typical year, I use about $1000 of health care, so that's about $7000 saved per year.

Understand that insurance is a business contract between you and a company, designed to average your costs with other people like you, plus pay for the investment and expenses necessary to administer the program, including the cost of providing the capital.

On average, your costs to buy insurance are roughly twice what benefits you receive. The other half is expenses and profit on investment.

On average, if you banked the cost of insurance and paid your own bills, you would save half what you would spend buying insurance. On average.

Now, the question of maternity coverage. If you intend to get pregnant, then the cost of your insurance, over the two years that will take, must be raised by the average cost of a pregnancy, times whatever the multiplier is. Double in my example above.

Which means that, if you buy maternity coverage in a group that only includes women who intend to get pregnant, you will pay for two average pregnancies across two years of coverage.

Option 1) You would be best off finding a group that you belong to -- such as an employee group -- where pregnancy is generally covered, but where few group members actually do get pregnant or suffer other major health conditions.

That will be your lowest cost of insurance.

2) A second possibility is to take your chances, pocket the premiums, and pay your own way. On average, you will save half the money. But it's a risk.

(If you do this, join one of those free medical plans or try to negotiate cost of services with a medical professional group in advance, otherwise anybody who walks into the operating room can add their separate bills to your costs, at whatever rate they want.]

3) A third possibility is to check with your state for high-risk coverage. States vary a lot, but there's usually a high-risk pool, and if maternity coverage is part of the standard high-risk package in your state, then it may be cheaper to join the high-risk pool than to have private insurance with a pregnancy rider.

4) And a final item - having medical insurance without maternity coverage can act as a backstop for some of the worst things that can happen to you and your child. Many states require automatic coverage for newborns if the mother is covered, and standard coverage may include covering some complications of surgery, etc. Check that out as a possibility in the mix.

Dal Jeanis 1/27/2009 04:24:00 PM  

And Rick has exactly the Option 1 group for you with those characteristics. Students are young healthy people who occasionally, but not often, get pregnant. Quite smart, legal and ethical all rolled up.