My insurance company called my son fat

Posted By on Sep 20, 2013 | 4 comments


I can’t stand hearing people discuss healthcare reform in a theoretical way.

I don’t think you can truly make a case one way or the other unless you have some skin in the game. If you have health insurance through your employer, it’s like you’re living in your parents’ basement — you might know something is going on and you might have some thoughts on it, but you’re insulated from feeling the full impact of the dangerous and expensive mindfuckery involved in getting your own health insurance.

And now some Congresspeople are wrangling over healthcare again, trying to hold the government hostage with the threat of another shutdown unless the Affordable Care Act, or “Obamacare” is repealed.

Come the fuck on, people.

For those of us who have to buy our own health insurance, there’s no theory involved here. I’m waiting with baited breath to dive into the health insurance exchange on October 1 to see if there’s any hope at all of getting a rate cut.

 

The real numbers

Here are some actual numbers for you to chew on. Hey! Play along at home! Plug these babies into your own budgets.

My health insurance bill for September was $687.

$278 for me

$197 for my daughter

$212 for my son

This is no Cadillac health plan that we’re on. We have a $50 copay every time someone has to go to the doctor. When I was figuring out our healthcare recently, I had to sit down and think about how many times each year the kids would have to go to the doc v. the cost of a higher monthly premium to get a lower copay. I had to gamble that they’ll be pretty healthy this year.

 

They fuck you at the drive-thru

Let’s talk about underwriting.

When you’re trying to get your own health plan, you can be penalized for anything in your health history that the insurance company thinks might cost them money in the future. If you have the luxury of getting a plan through your employer, yes, your insurance is still probably expensive BUT … you just sign up and you’re covered. No one is strapping on a mining helmet and probing your cornhole looking for reasons to upcharge you.

When you start shopping for healthcare, you get quoted a rate that stings a little, but they don’t give you your real rate until you fill out an extremely detailed health history for each applicant. It took me about three and a half hours to fill out the application for myself and the kids. And no pressure, but that history better be right because if it’s not, they can dump you from the plan or make you pay back money for treatments for conditions you didn’t disclose.

 

My fat, fat son

Warning: This is where it gets super fun!

When I got the real rates for my little family, I was told that my children were “rated up” based on their health histories.

Let’s look at my son. He got rated up for three things:

1. He’s been on Zantac (the generic version) for reflux since he was a month old — he takes it in the morning and before bed. It seems a little petty to rate him up over having one monthly prescription, but … OK.

2. Asthma. I can’t argue with that. He needs meds sometimes and they’re not cheap. What can I say? OK.

3. Height and weight proportion.

I took this photo this morning.

b

 

He’s a little on the short side — but just a little.  And certainly a person couldn’t be charged more for being short? So I guess they must think he’s fat. I mean, sure. Just took at him.

I was told I can dispute the upcharge, but I need an official doctor’s measurement to do so. I called my doc and asked if I could have Benjamin weighed and measured by a nurse without an appointment. They said no, they have to charge a copay if they do anything at all with the child. So it looked like I’d have to pay $50 to have my kid step on a scale. Then I figured out that I could schedule his well visit early and guess what? That visit was FREE thanks to Obamacare.

So now I need to write letters and fax stuff and cross fingers.

 

Sidestepping problems

Another unfortunate side effect of this brutal underwriting process is that it keeps people on independent plans from seeing the doc for certain things. For example, last fall I was having a pretty hard time. My life felt like a saggy pair of underpants that I kept tripping over because there was no elastic in the waist. I couldn’t seem to leave the house for, like, months. I felt like I was watching a movie of my life and I was getting nervous about how our protagonist was failing to handle her shit.

I thought about going to the doc to see if I could get a little something to make me feel like perhaps I should get dressed in real clothes and eat something other than Girl Scout cookies and also, you know, stop crying so much.

And then I thought forward to the day I knew was coming: The day I’d have to go through underwriting again. I decided that no matter how bad I was feeling, I couldn’t go to the doctor.

Why? Because if you have any hint of depression in your health history, I hate to tell you this, but you are totally and forever SCREWED from an insurance perspective.

Luckily, I’m OK. It was just my turn to stroll down Depression Lane after a few years of really Big Intense Problems. I found the exit ramp off that road. But not everyone does.

 

Give us a chance!

The ranks of the self-employed are only getting bigger. We need a fighting chance to be able to provide healthcare for ourselves and our families.

I don’t know if Obamacare is going to make things better. I’ve had hard time finding out concrete info on what will be covered, how it will be covered, and what it’s going to cost. October 1 is supposed to bring some answers.

All I ask right now is that no one cuts the lifeline before we get to see what’s at the end of that rope.

 

 

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4 Comments

  1. Could you just insure yourself privately and apply for CHIp for the kids? Or are you too wealthy for that?

    Post a Reply
    • The kids were on free CHIP when I was poor. Then they were on reduced-cost CHIP after I got my income up a bit. Now that we’re firmly middle class again CHIP is pretty expensive. I thought I could do better on a private health plan but in the end I pay slightly more for coverage that’s not nearly as good. And I can’t get back on CHIP at this point because — I love this part — the kids have to be uninsured for 6 months before you can get approved for the paid plan.

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  2. I hear ya! I went through the process twice to get rejected completely. One abnormal pap smear 5 years ago and acid reflux and I am completely uninsurable. Silly me doing preventative health care in the past.

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  3. Great, I’m pretty sure I’ll be uninsurable if I have to get my own insurance… I’ve been on meds for depression and ADHD for years! It seems stupid that, in order to qualify for health insurance, you have to not need it very badly.

    Post a Reply

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