My Health Insurance Experience

There are millions of Americans who are not covered for health insurance because they can’t afford or their employer doesn’t provide it (or some combination of the two). I count myself lucky because I can afford it, even while working for myself (although it is far from affordable).

I’ve been in and out of health insurance plans for years, because I alternate working for myself (as a consultant, usually, but more recently as full-time here for Psych Central), and working for a company with the usual range of benefits. Whenever you leave a company that you’ve been with full-time (usually for more than a year), you have one of three choices:

1. Move over to your spouse’s health insurance plan, assuming he or she is working full-time and has good health insurance coverage;
2. Continue on with your company’s plan, under a thing called “COBRA,” but you have to pay the full premiums every month (e.g., what you were paying out of your paycheck, plus what the company was paying for you);
3. Become uninsured and hope for the best!

When I was in my 20’s, like most people in their 20’s, I didn’t pay much attention to health insurance, health care, or health coverage. I was healthy, had never been to the hospital, and my family is blessed with little history of health problems that weren’t directly attributable to an environmental cause. (Both of my grandfathers, for instance, died from complications of lung cancer and/or lung disease, from having worked in the coal mines around Hazelton, PA.)

But as you get older, you get married, you settle down, and especially if you have children, health insurance and your own personal health care is no longer an optional part of your life. You need to sit down, think about these things, and ensure that when you move around career-wise, you remain covered (either through your job, or your spouse’s). You can’t just take your healthy being for granted any longer.

So when I left my most recent full-time employment a year ago, I decided upon option 2, COBRA. COBRA gives you 18 months to find another plan (or another full-time job), which is plenty of breathing room for folks like me. What nobody tells you, however, is that COBRA is a system that, while supposedly guaranteed by regulations to offer you healthcare coverage for 18 months, does anything but.

Twice in 12 months — first, at the onset of the plan, and now, 12 months later — we’ve gone to have prescriptions filled only to be told, “Sorry, you don’t have any health insurance.” Huh?

There is nothing more frustrating or aggravating than to be paying large amounts of money for a service that is anything but reliable. And the problem with COBRA is that it’s nobody’s fault. It’s a well-intentioned attempt at ensuring health care coverage during people’s normal transitions in life. Here’s how it works, in theory.

For all intents and purposes, you’re a “special” employee of the company as far as the health insurance company is concerned. You still have the same benefits plan as when you worked for the company (and any discounts negotiated by the company on their employees’ behalf), but you just have to send them a check once a month for the pleasure of the coverage. As long as you do that, technically you’re supposed to enjoy “uninterrupted” coverage from the moment you leave the employer’s employ until 18 months later.

The difficulties began immediately. There is a 2-4 week delay between your leaving your company and the insurance company recognizing that you’ll continue to be covered under COBRA. Nobody mentioned this to us when I left the company. So when my wife went to get a regular prescription filled, imagine her surprise when she was told, “Sorry, you don’t have any health insurance.” Maybe this was the company’s HR fault, maybe it was the insurance company’s… Nobody knows, nobody takes credit for the failure to inform, you’re just left making frantic phone calls back and forth between the two trying to figure things out.

Fast-forward 12 months later. We actually began the process of obtaining our own healthcare benefits through another organization, but have a few details to work out. Meanwhile I’ve been dutifully sending in my monthly premium checks to the insurance company. Again, my wife goes to fill a regular prescription and, again, she’s told the same thing, “Sorry, you don’t have any health insurance.” A call to the insurance company indeed confirms that I don’t (even as I stare at the statement that arrived 2 days earlier asking for another $xxx.xx and showing my account balance as $0). They lamely suggest calling the old employer’s HR department. Ok, thanks.

A call to the nice woman who runs HR at the company confirms that the company made some changes to their healthcare plan late last year and the plan I was on no longer was offered. I was supposed to be notified of the change of moving me over to another plan, but that didn’t happen. I don’t care to point fingers here, as all I honestly want is my healthcare coverage back. So she puts into a call to the contact person she has at the insurance company, and now I await to hear when my coverage will resume (even though, according to my statements, it never ended).

When a company continues to take your money and cash the checks for your account, but doesn’t provide the services promised, isn’t that fraud? Yet the health insurance company, which tells me and thinks my health coverage terminated Jan. 1, happily cashed January’s premium check 4 weeks ago.

So when you’re wondering what’s wrong with America’s health care system, here’s just one more data point to put into that basket of yours. COBRA, a well-intended plan to offer ongoing (if not expensive) coverage to employees who leave full-time employment, is full of holes and lack of accountability. Nobody’s monitoring employees who opt into COBRA, and nobody really cares about them if something goes awry.

“Fixing” healthcare in America cannot be easily done. Period. It’s simply too complex and arcane, much like the American tax code. It has a lot of special interests involved that want to keep things the way they are (some, for very good reasons — implement a medical records system in a hospital and it crashes, people can very well die). You just need to do what you can to improve it, step by step, inch by inch. And have patience. Lots and lots of patience.