Monday, October 26, 2009

Healthcare Crisis

I called the insurance company, again, today to discuss, again, why services were not covered and we were billed. I never expected the answer I got...David has reached his LIFETIME maximum payout. What does this mean exactly? At the ripe old age of 6 months, David essentially is no longer eligible for insurance coverage through Brent's company. Less than 1% of businesses in the country have a cap on their policies - and Brent happens to work for one of those less than 1%. Were we aware of said cap? Well, in short, no. I suppose (well I admit) that's our mistake - not that it would have mattered anyhow. We couldn't have done anything differently to produce a better outcome. We thought there was a yearly cap - but now, unless Brent finds a different job, or his company changes insurance carriers or policies, David will simply no longer have benefits with them - ever. I only reiterate the point because for me, it was a little hard to believe.

I actually had a sort of panic attack on the phone and the representative told me to take deep breaths and compose myself. Ha - when I asked about the bill when I finally got a live person at the insurance company, I heard some typing, more typing, silence, sigh, and a whole different tone of voice - it was almost as if they were about to tell me that someone had died.

So this is not like a life term in prison - you do not become eligible for benefits after good behavior for 7 years or so, this is never - all claims from here on out will be denied, and there's nothing we can do to change that. Luckily, he has Medicaid until his first birthday. They have been notified. I got the same weird tone of voice change from them as well. Funny, the times I've interacted with them before, they acted like we were dirt on their shoes - that needed to be brushed off. Now, when they actually hear we've run into yet another problem, they finally show a smidgen of empathy and stop acting as if we are just sitting here with our hand out.

So, until April, we are ok. After that, we must purchase a separate policy for David in order for him to have any sort of insurance coverage. Thankfully, he will still be listed as insured through his primary for now. He will therefore not have a lapse in coverage.

Could I get a full time job and carry the babies on a policy through me? Sure I could. Unfortunately though, that would mean incurring the cost of not only that policy, but full time daycare for 2 fragile babies. They would almost assuredly end up with colds and sniffles from being exposed to other small children and germs which would increase their risk of immediate hospitalization and long term respiratory issues tenfold. For us, it just isn't an option. I can't make as much as Brent does, and for him to stop working for a period would be detrimental to his long term career.

I saw a commercial a few days ago. The man was staring at a photo of a woman while packing up a house. He unpacked the photo and put it on the sill of a window in a small apartment. The next shot was of him visiting the woman in the hospital. It asked for health care reform and wanted a clause or rule or whatever putting a stop to caps on payouts. I'm sorry - but how were we supposed to know we would have micro preemies needing such extensive care? Furthermore, even with years of warning, how exactly would or could we have planned for such care? At the time, the commercial provoked a bit of emotion - empathy for their situation as I've known more than a handful of patients who found themselves under my care at the charity hospital because of this exact situation. However, in my wildest of paranoid, downtrodden thoughts, I just didn't think I would be weeding through all of the legal mumbo jumbo of the insurance and medicaid systems desperately hoping for some sort of loop hole, or hoping that if I speak to a person one rung higher in the corporate hierarchy, that I'll get a different answer. I didn't think that we would be that family on the commercial.

Nope this is where we are. I write to inform, I write to record, to vent, but also to ask if anyone else has found themselves in a similar situation. I'd appreciate it if anyone has any advice or knowledge on the subject.

Ugh - I feel deflated.

And P.S. Mary Louise's cap is closing in - she has 150k left before she is in the same boat as David.


  1. I am so sorry you guys are having to deal wiht this. I worked in collections for a while for a doctors office and it is very common for policies to have a lifetime cap. However they are usually like $1,000,000 and one can never imagine meeting that so we just brush it under the rug and don't give it a second thought. If I had not worked in that area I would not have realized that policies have caps. Unfortunately I do not have any insight or advice. I just will pray for God to give you a solution to this problem. It is ashamed that if you were a single mother with no father in the picture your kids would be covered. But, since you are a little family trying to make it you get no assistance. ANGRY and FRUSTRATED doesn't begin to explain my feelings.

  2. One more thing I forgot. As long as they are part of a group plan, like with Brent's employer, they can never be denied for preexisting conditions. Now if they get on a individual or single family plan they may be denied coverage in the future for preexisting conditions. Sorry to add to the poopyness of the situation, but I thought you would want to be fully informed.

  3. talked to my mom about this...she has some ideas and can't wait to talk to you on Wednesday. Just leave her a message when you call, and she'll call you back. :)

  4. Unbelievable. I feel so sorry for you guys! The babies are absolutely beautiful though! (-:

  5. I am so sorry to hear about this. I could complain about insurance companies all day, but would that help, no. I don't have much advice for you. I was born with a preexisting condition and my Father's insurance through his work would not accept me. My Father's company was kind enough to seek out another insurance company that would accept me. I don't know how big of a company your husband works for. My Father worked for a small, family owned company, if that made a difference in the situation. I hope you find a solution. I know not having a gap in coverage should help in seeking out new coverage.

  6. Not that this will change your immediate situation, but forward your latest post to those who are working on Health care reform. Maybe by the time Mary Lousie and David have their own children, there won't be these insane things to deal with. Hang in there. I know with all my heart you'll find the strength to power through and find a solution. Until then, eat chocolate.