Saturday, August 25, 2012

Living Without the Net

I wrote and posted this blog (but not on Facebook) originally because I was so outraged and upset by what had happened to us (and doubtless, many many others). I debated long and hard about broadening the scope beyond the handful of subscribers I have to this blog, because talking about money stuff is like throwing one's underdrawers out in the street.

I decided to go on and post it. I hope it will put a real face on this dilemma for some of my friends who are lucky enough not to have to worry about this, and maybe can't imagine that people they do know are wrestling with this.   

When my husband was unemployed for several months at the beginning of 2011 we were able to take advantage of COBRA. You know about COBRA, right? It's frightfully expensive health insurance gap coverage, one to which you become entitled under federal law in the event you lose or leave your job and find yourself uninsured and unemployed all at once. It's frightfully expensive: monthly premiums are in  legal excess of 100% of your previous rate.  In our case, that amounted to roughly $1,000.00 a month, an amount that an unemployed person really can ill afford, but as we learned all too soon, it's a necessary expense.

While he was unemployed Henry had a "significant cardiac event," and had to have emergency surgery to implant 3 stents. It was, his cardiologist said, a true fluke: one of those instances when all the arteries are just ducky one day and with no warning become acutely blocked by rogue plaque. The fact that he had had a heart attack back in 2003 had no bearing on this event, and, as the surgeon told us, this happens to people with no history of heart troubles, some of whom had received clean bills of health just days before, as was the case with Henry. Our COBRA coverage, while it still left us with a substantial deductible to pay, meant we did not have to consider bankruptcy.

Henry finally found a job late last spring. We were very excited about the new challenge, but things there just didn't pan out. Citing the poor economy, his employer reneged on the contract they had for Henry's pay. With no other prospects we were forced to make do, rob from Peter to pay Paul, and otherwise scramble to make sure we could keep our home. At the very least, the employer was covering insurance, and the rest was just the way of sorry things.

Recently, my husband was offered a job with a much larger operation, in a salaried position. Bonuses are possible, but the salary itself is the first time in his entire working life that it will be sufficient to cover our fixed living expenses, and a little to begin to rebuild our cushion, which was utterly depleted since his unemployment in 2011 owing to the COBRA payments, and the gaps in coverage for his hospitalization and surgery that we were left owing.

The downside? Henry's new employer does not offer their health coverage to anyone in their employ for a full three months. That means we cannot even apply for coverage with their provider until late November. Irritating, but hey -- we figured we could COBRA again, right?

Nope. Unbeknownst to us -- and to most Americans, it would seem -- COBRA only applies if a company employs 20 or more people. Henry's last employer did not, so no COBRA.

But there's now this pretty cool option called temporary coverage, offered by most of the large insurance companies, and all the marketing suggests that it's perfect for people waiting for new or first-time coverage to kick in. So, we applied. My application went through like grease through a goose. (More about this in a second.) Henry's was turned down today.

Why? Pre-exisiting conditions, which I could understand if the policy for which he applied were going to cover those. But it would not -- we knew it wouldn't when we applied.The policy for which we had to apply would only have covered accidents or illnesses unrelated to these two conditions.

If his coverage with the new boss were going to kick in during the next 2 months we would just hold our breath and wrap him in cotton, but insurance regulations require that a person has not had a gap of more than 63 days to keep them from having to go through an extended waiting period.

We have one option left, AHIP, which is offered through the state, and administered by the very company that has just denied him coverage, which happens to be the same company from which we have had coverage since 2010. AHIP coverage is not guaranteed: one can be denied, although none of the material I've read tells you what the criteria for denial of coverage might be.  **see update below

In 2013, this pre-existing exclusion will no longer be allowed for adults over 19. The only thing wrong with this part of Obamacare is that it didn't happen soon enough for us, and we are facing a scary future in which one illness could send us into bankruptcy, and I am not blowing smoke when I tell you it is a distinct possibility.

It is such irony that I avoid doctors at all costs, haven't had a physical in 3 years, have no clue what timebomb could be lurking in my body and I get covered -- completely, and for a pittance -- in less than 24 hours of applying for an temporary individual policy with UHC. My husband, on the other hand, who has had 2 physicals in less than a year (cardiac and general), both of which he passed with flying colors, cannot be covered, and if he breaks an arm here at home, or an uninsured driver hits him at a red light, we will lose everything.

Also ironic is that I had scheduled myself for a physical on the last day of this month, the day our existing coverage ends. The gentleman with whom I spoke from the insurance company to which I was applying for coverage advised me NOT to, because if something were to be found, or suspected, tested for, and later found to be a problem, my coverage would be cancelled. So. I could be fixin' to explode, but at least I won't know I need to worry about it, I suppose.

I don't care what your political leaning is, this situation is just dead wrong, and not just because it is happening to us. It is a problem that is surely sending a lot of good, honest, hardworking folks into foreclosure, bankruptcy, or early graves.

I'm not sharing this because I want your pity. I'm sharing this because Henry and I share this very real dilemma with more people than you can imagine, and most Americans do not know that these loopholes exist.

We are just praying the loophole doesn't become a noose.


We spent several days trying to slay this dragon. The first hopeful call went to an agency to which we'd been referred for folks who were not eligible for COBRA. That didn't work -- they required that you be uncovered by any policy for a full 90 days before applying with them. 

My last ditch attempt was a trip back to Google, wherein I typed in a string of words something like this: no cobra temporary coverage preexisting condition high deductible. There may have been other words, too, words I spoke loudly in my head but maybe didn't quite make it onto virtual paper. 

I came up with a website that sounds and looks all the world like a portal for State Employees only.  Since nothing else was consuming my every neuron, I started digging around, and clicked on a link that said AHIP. 

AHIP, as in Alabama Health Insurance Plan. I studied it carefully -- saw no fine print that this was just a program for State Employees, made a call, talked to one of 3 women (all my best friends, now) to see if what sounded too good to be true was too good to be true, and after faxing certificates of creditable coverage, a few health-related questions, and a copy of Henry's driver's license, plus one short phone interview with him -- bam. Covered. 

This is a last gasp coverage. Here are the basic criteria:  you have to have been under a group policy for 18 months. (We nearly got tossed out on this one, since he'd only been with the previous employer for 15 months. Thank goodness the COBRA we took out when he lost his job back in 2011 counted toward the 18 month period!) This is not available to folks who are eligible for other insurance through Medicare, Medicaid, or through their or their spouse's employer. (We will surrender this in November, when we will be covered by PepBoy's program.) Here's the kicker - Henry's pre-existing conditions are covered fully covered, after hefty deductible is met, of course. 

And here's the upshot -- it is well less than half of what we paid for COBRA coverage, and although our deductible is sky high, we at least have something in place to keep a complete economic disaster from happening in the event of a health emergency or accident.

What I want to know is -- why is this information so hard to find? Not a single insurer or agent or agency with whom I spoke even suggested this to me. At a time when I know full well there are surely hundreds of people who are riding in this same boat against a crushing tide, why are there only 3 women working in an office (each of whom were incredibly helpful, thoughtful, and speedy with every single bit of correspondence and phone call) that appears to be tucked away in a corner of what seems to be an agency that exists only to benefit state employees (when that is obviously not the case)?  

We have a happy ending to our story, or at least this chapter closes well for us this time. 


  1. Oh honey - you know that I share your frustration, and you also know to what lengths (and cost) I have gone over the last 5 years to keep Tom insured. It is absolutely criminal and shameful that in this great country this is the state of healthcare. I will be keeping my fingers crossed that there is some solution out there so that at the very least as soon as Henry is elegible he will have coverage. And I am sending you some virtual bubble wrap for some extra cushion.

  2. This is why I want to see a single payer system put in place. Where everyone in this country has at the very least basic health care provided. It goes againist my rather conservative nature. It goes against my feeling that we should work for what we get. It is just the right thing to do. I don't have all the answers, but I do know we need to fix this system.

  3. I'm sure you can guess where I come down on this, so I'll just say I am delighted you found coverage, and hope for continued good health for you and Henry!

  4. This election isn't just about Obama vs. Romney. It's about do we want a country where it really is (only) just "about the Benjamins"? Is money and consumerism all we are about? Or can we build a society where we realize we are all in this together, and when we pool our resources (taxes) and make sound decisions for the better of us all, we all can benefit. Or will it be the rich get richer, and leave the rest of us to fend for ourselves? The winners in this society need to pay it back, pay it forward.

  5. Neither side's plan is perfect. What I wish would happen is for a non-partisan task force, none of whom are political figures at all, to convene. Every corner of this solution is filled with people who are AFRAID to give an inch, fearing that their party will refuse to nominate or support them in elections. We, as consumers of health care AND as people who identify with a political party (perhaps), need to make ourselves heard loud and clear that we will continue to support our candidates if they THOUGHTFULLY and HONESTLY engage in discussions about this monumental problem. It's the child of years of screwing up by members of both parties, and I don't believe either one has the magic key alone.

    I'm weary of making this Republican v. Democrat or Haves v Have-nots. That doesn't get any of us anywhere.