Just as Republican lawmakers have been hyping the virtues of purchasing private health insurance—-versus the evils of “Obamacare”—-my husband Jim and I needed to do just that. I had been writing a check for $659 each month to maintain health insurance coverage under my former employer’s plan, as provided by COBRA. After 18 months, it was due to expire. The time had come for us to venture into the Republicans’ fantasy land of the free marketplace for health insurance. We took a deep breath and dove in.
The first thing we learned is that you don’t really purchase health insurance. You find insurance providers in your state and then apply for coverage and hope they accept you. If they agree to have you as a customer, you then pay for the coverage. On some level we knew this, but it isn’t until we started to fill out the LENGTHY and DETAILED application forms that it sunk in.
Jim is a smart consumer and spends quite a bit of time researching product options before buying new appliances, investing our savings, and shopping for just about anything. He’s an economist and analyst by training. He’ll read and collect articles, make spreadsheets, and examine long-term performance. I’m glad to have him.
For at least six months before we even identified appropriate insurance companies in our State, Jim read and saved all kinds of articles with tips for applying for health insurance and things to avoid. Several suggested, for example, filling out the applications from several insurance companies and submitting them simultaneously. These lessons came from individuals who were denied coverage by one insurer, and subsequently had to disclose that denial on all future applications. We decided early on that we would apply simultaneously to at least three different health insurance companies, and hope that we’d be accepted by at least one.
I can’t tell you how many times I saw frustration on Jim’s face as he struggled to make data points about the different plans fit into a spreadsheet. My husband’s ability to turn any collection of information into a spreadsheet was failing him. He learned that trying to make comparisons between different health insurance options among several insurers is nearly impossible. Jim will be the first to admit after our experience, “buying” health insurance is not like buying any other good or service.
We decided to narrow our options to a high-deductible plan. It would (hopefully) save us from economic ruin if we became gravely or chronically ill, while we’d be prepared to pay large out-of-pocket deductibles for routine and emergency care, as well as prescription drugs.
As the expiration date of our current health insurance coverage approached, we began the application process. We preferred to complete the forms on-line, but had a little chuckle when we read that there would have been an additional processing fee had we decided to use the paper application form.
Another big thing we learned is that health insurance companies expect you to remember every doctor visit, every medical procedure, every presciption medication and dosage, and so on, going back 5-10 years. The applications have this scary language warning that your coverage (should you be accepted) may be rescinded retroactively, if you provide incorrect information.
“An act, practice or omission that constitutes fraud or making an intentional misrepesentation of material fact on this application may result in rescission of coverage.”
It’s one thing to read and understand that sentence, but it’s another thing when you consider the level of detail and memory accuracy these insurance companies expect of applicants. We first answered questions like this one:
“Has any person applying for coverage been advised, counseled, tested, diagnosed, treated, hospitalized or recommended for treatment within the last 10 years for the following conditions?
(a) “Migraines; headaches; carpal tunnel syndrome; seizure disorders; paralysis; multiple sclerosis; any neurological disorder, or any other disorder of the central nervous system.”
(b) “Attention deficit disorder; anxiety, depression or chemical imbalance; any behavioral, emotional or eating disorders; mental retardation; bipolar disorder or psychosis; psychotherapy; marital or any form of counseling?”
and the long list of disorders, conditions and symptoms went on and one. The next set of questions were even more broad:
“During the last 5 years, has any person applying for coverage had a physical examination (including check-ups), diagnostic tests, consulted a physician, chiropractor or therapist?”
Fair enough, but the moment you select “YES” on-line to any of them, something else happens. Another window pops up on the screen that insists you provide further details. (I say “insist” because you can’t proceed with the rest of the application without coughing up the additional info.) For each “YES,” the insurance company wants you to provide the following: (a) what was the specific condition; (b) date it started; (c) exact “day” of recovery; (d) was recovery complete?; (e) types of treatment, advice given, and medications prescribed including dosage and how long you took it; (f) name, address and phone number of the doctors and hospitals.
It’s as if these insurance companies think we have on-line access to a lifetime of our medical records. I sure don’t remember the date of my last bout of poison ivy rash, or when it finally resolved, or how much prednisone I took. Who keeps such records? Jim remembers seeing a physician for a numbness in his leg, but was that in 2007 or 2008?
It really makes me wonder about those Members of Congress (mostly Republicans) who insist our nation’s healthcare woes would be fixed if more people just had private health insurance. How many of these Members have applied recently for non-employer based, private health insurance? I’d like some of them to try to dig up the name, address and phone number of the doctor who treated their wife’s conjunctivitis a few year’s ago, or their son’s prepatella bursitis when he was a high school wrestler. I’d like them to try to remember the name of the anti-inflammatory pharmaceutical this son took, or the antibiotic prescribed to the wife.
Throughout our on-line application process (which doesn’t by-the-way offer enough options to save your work,) we remarked constantly how much more time consuming the process would be if either of us had any serious health challenges. We thought about our four elderly parents who are in ill health, and proposals to eventually give seniors a voucher to help the purchase insurance. Forget about the voucher for now, how in the world would your average senior pull together 10 years of their healthcare information in the level of detail expected by insurers’ for these applications? We also thought about parents with seriously ill children trying to fill out these detailed applications, or parents with just several children who experience the average number of aches, breaks and illnesses.
It was early March when Jim reserved a Saturday to use the on-line system to apply for health insurance coverage with Blue Cross/Blue Shield, Humana and United Health’s “Golden Rule.” It actually required most of his time on both the Saturday and the Sunday. With each application, we were required to provide our checking account information and agreed to have the estimated cost of our first month’s premium deducted from our account. For the high-deductible plans we were interested in, that cost was about $400. Each of the three insurance companies wanted that money in-hand before they would begin to review our application. We realized that if our applications were approved by all three insurers, we’d have to go through the rigmarole of asking for the money back from two of the firms. But because the pre-payment is required, consumers don’t really have another option. This could be a serious drain on many applicants’ checking accounts. A more typical coverage plan for a family would have been several more hundred dollars per month, and the cost of submitting multiple applications could tally several thousand dollars. Again I have to wonder, how many Members of Congress have actually applied for insurance recently?
After less than a week, we received a follow-up phone call from the insurance company with our top-choice plan. The agent asked additional questions about our health histories, and thanked us for being so thorough in completing the application. We were notified within a few days that we’d been approved by this insurer and our coverage would begin the first of April. Since this was the plan we preferred, Jim immediately notified the other two insurers and asked them to cancel our applications.
Despite our predictions that we’d have to nudge these insurers to return the first-month’s payments we were required to pay, at first it appeared the money would be promptly refunded. BlueCross/Blue Shield sent a letter to us almost immediately and it noted that our $400 or so dollar payment would be credited to our account. United Healthcare responded by just sending us a check. Jim deposited the $439.32 in our checking acount, organized the large file folder he’d used to maneuver through this health-insurance purchasing adventure, and tucked the file into his desk.
About a week ago, we received a letter with bold letters across the top: “COLLECTION NOTICE.” The sender was Receivable Management Services (RMS), a debt collection agency that specializes in servicing nine of the top 12 insurance companies. The letter began:
“This will confirm that you have been place for collection. This communication is an attempt at resolution of this account in the amount stated above.”
Here’s the deal. After we cancelled our application with United Health’s “Golden Rule,” we received a reimbursement check for our first month’s estimated premium. The check was made in the amount of $439.32. We deposited it, assuming it was the amount United Health deducted from our checking account. The collection agency’s letter indicated, however, that we should have only received a reimbursement for $399.75, a difference of $39.57.
Jim and I are wise to the ways of the world, and were not alarmed by the big, bold lettered “COLLECTION NOTICE” letter. We checked our bank account to confirm the error, and sent a check for $39.57 to the debt collection firm. The mistake was not ours, but that didn’t change the manner or speed in which the insurer referred their own $39.57 mistake for debt collection. Jim included a note to the collection agency saying
“It is not necessary to send us a threatening letter over $39, especially considering the mistake was made by the ironically “Golden Rule,” insurance company.”
Although we survived the process and were able to get approved for coverage, we know there are many, many individuals who have had nightmare scenarios of being turned down or otherwise been unable to obtain coverage. And that, sadly, is the private health insurance marketplace that many Members of Congress are so eager to embrace.
Celeste Monforton, her husband Jim and golden retriever Laredo live near Austin, Texas in the city of San Marcos. They know they are better off than many residents of Texas, which has the nation’s highest rate of uninsured.