Our story about employer health coverage, COBRA, and Cancer.

Posted by on Sep 11, 2009 in healthcare

Everyone should be aware that this is likely to happen to them!

Back in 1/08, Byron asked the temporary agency for benefits information from “Company A” (Which he was considering taking a job with, but needed to know if the benefits were good enough) several times before making his decision to accept the contract. He finally got a list of benefits from Company A and, based on this list, decided to accept the contract, which was to run from 2/1 to 5/1/08 under the temp agency. He would have very minimal and expensive benefits under the temp agency for that 3 months and then was supposed to switch to Company A benefits on 5/1. This 3 months of poor coverage in itself was risky, considering he has a brain tumor and may need expensive surgery if it started to grow suddenly.

Instead, he was switched to full time employee status with a 2nd company “Company B” under the umbrella of Company A on 6/1 and told that there was a 3 month wait from 6/1/08 before Company B benefits began. Temp agency benefits ended, so he was forced to pay COBRA. He was also told at that time that he would still be switching over to Company A on 1/1/09, that the switch to Company B was temporary only for billing purposes. There was no acknowledgment that part of his conditions for taking the job were the cost and benefits of the health insurance plan and dates originally presented. No acknowledgment that switching carriers 3 times in one year would result in 3 deductibles. No acknowledgment that this would cost a lot of money and leave us with a ridiculous amount of paperwork.

So, he ended up having to pay $655 per month in Cobra for 3 months to cover just himself and one child. He couldn’t afford the $955 per month that it would have cost to cover our other child, so she was uninsured for 3 months. Then he found out that there never really was a 3 month wait, and he could have had insurance all that time through Company B!

This also caused an overlap in insurance claims. Some of our daughter’s and his appointments were billed to COBRA after Company B insurance was already in effect, resulting in several unpaid claims and lengthy phone calls. Phone calls that went like this….Call the billing Dr.’s office. Call the new insurance company. Call Cobra. Then call the insurance company and tell them Cobra had submitted the change. Then call the Dr. and tell them the 2 entities had been called. Sometimes this would have to be done more than once. This had to be done for each claim. This amounted to at least 2 hours of phone time per claim.

His insurance through Company B began on 8/15/08. Although, we weren’t told that was the case and were still paying COBRA until September. The new insurance has a $500 deductible per person. He had some expensive appointments, and then got a letter stating that he wasn’t going to be covered due to pre-existing condition. It was only after panicking for a day and then calling cobra to see if we could go back on cobra, that he found out that pre-existing clauses are reducible by law with your prior coverage. So we had to send proof of prior coverage. This was not easy to get, considering he had 3 insurance companies back to back that had to furnish proof.

He took the contract based on Company A’s list of benefits, which states that the company pays the premiums and there is no deductible. Expecting this to start on 5/1/08. Instead, he spent $2,000.00 on Cobra, $1,000 on deductibles for the temp agency’s insurance he had under Cobra (Really crappy insurance, I might add), and accrued at least $1,500 in deductibles on the BCBS through Company B. He also had one child with no insurance for 3 months, and paid $220 for her regular checkups during that time. That’s over $4,000.00 in a span of 4 months, and a lot of stress and confusion that he was under the impression he wasn’t going to have to pay and experience.

Luckily, they never switched him over to Company A as planned, so at least he did not have to pay another deductible and go through more overlapping claims.

He had brain surgery in December, and although we jumped through hoops in September to get prior coverage proof, the insurance company tried to say that he had a pre-existing clause that lasted until January. This would mean that he had a 4 month clause! They were just randomly picking a date to avoid covering the expensive surgery. They denied $100,000.00 worth of claims. While he was in the hospital, I had to get all the prior coverage paperwork AGAIN, fax it to them, and follow up with several phone calls. It is September of 09 now. One year later. I am still receiving denied claims from last year due to pre-existing clause. I have to call and have someone mark it in the computer that he has prior coverage proof, every time! What if you are alone, having this brain surgery? What if you can’t research every line of every piece of mail that comes to you because you can’t read or think normally due to your illness? You would just assume that you really owed all this money. They will do this to every claim in hopes that you don’t pay attention and fix it.

It should not be this difficult to pursue a better job. You should not be risking your life and your sanity and your financial stability every time you want to improve your career. This is just switching jobs. What about being laid off? Why do healthy people think they are immune to this? 1 in 2 men and 1 in 3 women will be diagnosed with cancer in their lifetime, and this rate is rising. Cancer will break you under our system!!! Even with good insurance and a good job. I should also add that out of the 5 insurance plans Byron has had, this one offers the best coverage by far. But only if you call and argue for it on every claim.

by Dana Turner

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6 Comments

  1. Globatron.org
    September 11, 2009

    Our story about employer health coverage, COBRA, and Cancer. http://bit.ly/Pp8rq

  2. Dana Turner
    September 11, 2009

    Our story about employer health coverage, COBRA, and Cancer. http://bit.ly/Pp8rq

  3. Teddy
    September 11, 2009

    This story is horrendous: maddening and sickening. I think that we are all lucky to have Dana’s patience, understanding, and commitment in not only supporting this issue, but in bringing it to the attention of many. I was about to leave for school, but instead I am heading to the bathroom to barf.

    Reply
  4. Globatron.org
    September 20, 2009

    Anyone have a U.S. health care story they’d like to share? Here’s ours. Please DM me if you have one and I’ll RT http://tinyurl.com/nvygk4

  5. Aeon
    September 25, 2009

    We have the opportunity to regain Our power and no longer leave any aspect of our well being in the hands of those who have proven again and again that it is only about them. As far as most insurance companies are concerned we are all a roll of the dice. But eventually we will all crap out. We can change that Absolutely change that today with some diligence and willingness.

    Reply
  6. Akbar Lightning
    September 25, 2009

    Aeon, although what you say is true, it is also quite vague, which makes it easier to make such statements.

    in other words change and willingness are words that imply something but do not indicate anything about its nature.

    i am merely inviting you to be more specific about what changes you feel are appropriate, what you mean by crapping out, and how that relates to what can be changed. my first assumption would be you are indicating personal responsibility, but i could be wrong, i hope i’m wrong because that is a simplistic response to a complex issue.

    the notion of personal responsibility is a fantasy, the mirror image of utopianism, the fantasy of a human being being fully self supporting. it is innate to our species that we are social and that we share the burden of community.

    again, this might not be what you were indicating, but i am merely throwing those thoughts out.

    akbar

    Reply

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