Health & Science
I Have Insurance. My Pills Still Cost $1,000 a Week.
Reader stories of health insurance hell.
Sarah Wildman’s story about her awful experience with the individual health care market has hit a nerve. Wildman is testifying today before the Joint Economic Committee on Health Care Reform and she has inspired several of you to send similar tales of health insurance nightmares. Some of you couldn’t find any affordable insurance, others have been nearly bankrupted by mental-health care or medications you need to survive. Here is a sampling of your stories. Some have been slightly edited for readability. Please send more to doublex.slate@gmail.com.
Couldn’t Even Get Crappy Individual Care
During the 2001 economic downturn I was laid off from my job at a Fortune 100 company. As a healthy 30-year-old I could not get health insurance. I had no medical issues, was within the healthy weight range and yet I couldn't purchase individual health insurance. I could not get approved for insurance because five years earlier before I had a test that came back negative. That's correct: Because the doctor ordered a test to be sure she didn't see anything—and she didn't—I couldn't get insurance.
Continuing health insurance through COBRA was not an option because the cost was significantly greater than my total monthly unemployment compensation, and would have quickly depleted our savings. As a result, my husband and I eventually settled for catastrophic insurance. My husband continued working toward his graduate degree; I was out of work for six months and relied on Planned Parenthood for my annual gynecological exam and access to birth control. When I finally found a position at a much smaller firm, my health care premiums were three times what I had been paying at the larger company.
— Cecily Welch, via e-mail
Bills for Depression Cause Even Greater Stress
Despite being relatively young (mid-20s), I have never considered skimping on health insurance. The fact that I have had a well-paying professional job with full benefits since the moment I graduated from college meant that it never seemed like an issue. Four months after switching to a job with a smaller company, and just a couple months before my wedding, I was hospitalized for depression. I had never had any mental health issues previously, so it never occurred to me that coverage for that would be any different.
It was such a nightmare. ... The insurance company ended up covering 80 percent of my $7,200 hospital stay and $400 emergency room trip, but only 60 percent of the $300 ambulance trip (they wouldn't let my husband drive between the ER and the hospital for "insurance reasons") and the $250/week follow-up psychiatrist visits. Of course, I say "ended up" because I got a letter informing me that my hospital stay was not covered at all a few days after I returned from my honeymoon. It took about six months to resolve everything, and I'm sure some people in my position would not have been able to deal with the weekly phone calls I had to make to get any coverage.
What I have learned since is that most insurance policies have completely separate rules for mental health coverage. Higher co-pays, lower caps, and generally less coverage. Most people don't know this until they need it, because no one ever thinks they will need it. More frightening still, it is nearly impossible to get coverage on the open market if you have any history of mental health problems. I'm incredibly fortunate: I had coverage then and I have better coverage now. (I switched to my husband's insurance through his employer, which is much larger.) I could afford the $3,000 plus I paid after insurance that year, and I was able to keep my job through all of this. For so many others, this is not true, and these are people least able to handle the stress.
—via reader e-mail
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Comments
COBRA
By: TammyG | Sat, 08/22/2009 - 10:54
I am out of work waiting for disability to hopefully be approved. There is a new program that will decrease your COBRA payments for nine months. Instead of paying the full amount you pay 35% of the full amount. There are some date guidelines that you must meet. Secondly I have a suggestion for anyone out there who is out of work and has a decreased income and COBRA (or you don't even need to have Cobra)and high out of pocket expenses such as copays for medications or copays for frequent doctor visits. I applied for Medical Assistance as a secondary insurance and I qualified. The Medical Assistance now picks up almost all my copays for meds and doctor visits. The one downside may be that your physician may not accept Medical Assistance but I was spending out of pocket almost $300/month for meds that is now covered by Medical Assistance. I never thought I would be in this position but things happen and I need all the help I can get. Contact your county to find out how to apply. Good Luck to all of you.
Depressing Health Insurance for Depression
By: MLO | Mon, 08/17/2009 - 18:23
I'm lucky in that my insurance covers my depression medication and the psychiatric visits required to renew those prescriptions. However, since I started CBT (cognitive behavioral therapy) I've always paid out of pocket for my visits. If I were to submit claims for my sometimes bi-weekly, sometimes weekly visits, I would quickly exceed the maximum allowed visits per year, and since it is vital that my psychiatric visits are covered (so that I can continue my medication) I can't afford to submit CBT claims to insurance.
Rather than argue the claims with insurance...something that would only make me more depressed...I pay out of pocket. And sometimes go without therapy for those weeks I can't pay out of pocket.
Unemployed = no insurance
By: Janipurr | Tue, 08/11/2009 - 20:11
I was recently laid off (for the second time in over a year). I am in my 40s, but I am generally healthy with no preexisting conditions. I have noticed over the last 8 years that my employers funded health insurance has become more and more expensive and been worth less and less. Now, my Cobra payment is literally 1/4 of my unemployment check. I already can't pay rent with what I get from unemployment--I guess I'll have to go uncovered until I can find another job. I hope that doesn't take too long.
More on Lovenox
By: aurora88 | Sat, 08/08/2009 - 10:17
When my father needed Lovenox a few years ago, it cost $100/day. We looked around and wound up ordering it from a Canadian pharmacy for $40/day. Still expensive, but a substantial savings. The truly ridiculous part of the whole thing was that when he was in the hospital, the medicine was paid for, but not when he was out.
pre-existing conditions make no sense to me
By: juliettelucie | Fri, 08/07/2009 - 15:13
I live in the Netherlands where health care is done by private insurances that are all required to give a government-set minimum coverage to anyone asking, at a maximum price of around 120 euros a month, but can make more developed packages that most people take in the end.
I'm surprised that this isn't an example used in the American debate, as it seems a good compromise between single payer, public option and private insurance only.
Also, i'm completely baffled by the whole "pre-existing" condition thing: how can anyone not have a pre-existing condition, following what we read? Asthma, allergies, blood-clots, I don't know anyone who hasn't had one of these problems... I think we can agree that receiving decent health care is a human right - how can this right be denied on account of pre-existing conditions?
To the woman with blood clots...
By: shanendoah | Thu, 08/06/2009 - 16:23
Call your insurance company and ask for their Appeals department. You want to file an expedited appeal. (Expedited appeals are different legally than regular appeals. The company is required to get you a decision generally in less than 24 hours, but it depends on your state's laws.) In most cases, even if your coverage only carries generics, if there is no generic, they have to cover the name brand. You just have to know how to make them.
Contact your doctor and let them know you've requested the appeal so that they can be ready with the medical records.
Look up your state's Office of the Insurance Commissioner (OIC). They should have a lot of information about patients' rights. Contact them if you get the run around from your insurance company.
I work for an HMO, and work closely with our Appeals department. It is their job to make things like this right. But the likelihood of anyone at your insurance company telling you this is an option is low, so you have to ask.