Health Care Reform Passes – My Medical Insurance Saga

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(I had another post planned for today, but yesterday’s passage of health care reform legislation by the House has trumped that one for another day.)

My wife and I met and married during college in the 1990s.  Our goal was to get her through graduate school at which time she would take a full-time position in her degree field and I would transition to being the stay-home parent once children came along.  We hadn’t been married long and she had already begun graduate school when an newly diagnosed health condition required her to have surgery with a hospital stay.  We were uninsured.  The surgeon worked with us on a sliding-scale to reduce the cost, but it was still many thousands of dollars, much more than either of us could afford so we got on a payment plan.  Now, not only did we have college and graduate school tuition debt, but we had medical debt too.  A lot of it.

I had earned my Bachelor of Arts in Liberal Arts with a major in Philosophy and minors in Creative Writing and Political Science.  None of these areas were very marketable, but then my job as primary income earner wasn’t the plan after all.  I job hunted for a while and finally decided to interview with the company I’d worked for through a temporary agency the summer before knowing I’d already established some connections there.  I was offered a job as the front desk receptionist for the company’s national customer service center call.  I answered the switchboard, greeted visitors, made travel arrangements for the executives, ran weekly employee call metrics reports, filed paperwork, etc.  It was honest work, but not my dream job.  It paid ~$22,000/year but it offered full benefits so I took the job for one and only one reason: insurance.  We needed coverage in case either of us got sick in the future.

Our first child, a daughter, was born in 1997.  At twelve days old we learned she had a heart condition which our Pediatrician assured us she was likely to outgrow.  Nevertheless, she spent twelve months taking Digoxin as a preventative measure after which she was declared ‘healthy’.  Having medical insurance made all the difference.

During the two years I worked as a front desk receptionist our family plans continued to evolve until we made the decision that I would be our family’s workforce partner for the long term.  I had already been sharpening my computer skills, but found advancement where I was impossible unless I was willing to move out of state.  Instead, I interviewed with the owner of a very small Information Technology consulting firm who was looking to expand his business.  He was still working out some of the details such as what his company’s health insurance plan would look like, but he could offer me a job if I was willing to wait.  The change mean increased opportunity and more money.  I accepted on condition that he agree to split the whopping $580/monthly cost to carry my previous insurance via COBRA so my family could maintain continuous insurance until his plan was in place.  If our medical insurance coverage lapsed it could prevent us being taken on by another insurer in the future.  COBRA would provide this for up to 18 months while my new employer put his plan together. So I left the front desk and began a career in Information Technology.

However, a little over a year later the owner of the IT consulting firm informed me that my daughter’s pre-existing heart condition would make the premiums for his company’s group policy too high (too high that is if I was a member of the group).  Therefore, he couldn’t afford to create a company group plan and I was on my own to find an individual health insurance plan for my family.  By that time we were expecting our second child.  As I called insurance companies for information I learned that under the pre-existing conditions clause not only was my daughter deemed uninsurable because of her previous heart condition, but my wife was also deemed uninsurable because she was pregnant which insurance defines as a pre-existing condition.  Only after my wife gave birth would she be eligible for insurance coverage as would the new baby.

I was devastated.

We were still paying the medical bills from my wife’s surgery a few years before, plus our half of the $580/month COBRA premium.  Now we were facing the prospect of paying for my son’s birth out-of-pocket plus the premiums we would be facing after COBRA expired to buy and maintain our own private insurance.

My son was born 4 days before our COBRA eligibility expired (so this meant our birth expenses were covered), after which we maintained only catastrophic health insurance so there wouldn’t be a lapse and because it was the only insurance we could get.  Two months later I was hired by a large company whose insurance plan was comprehensive enough it didn’t have any pre-existing conditions restrictions.  This October I will have been with that company for eleven years.

Thankfully for us this story eventually ended well.  It doesn’t for everyone.  And ours was no fairy tale ending.  Because of the current state of health care legislation I had to work like Hell to navigate through it all with hours of phone calls, filling out claim forms, monitoring and tracking rejections and appeals, just to provide a basic medical safety net for my family.

So please don’t ask me what I think about the need for health care reform in this country.  If you’ve read this post to the end, you already know what my answer would be.

Thank you President Obama.

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2 Responses to Health Care Reform Passes – My Medical Insurance Saga

  1. Abhishek Gupta says:

    John,

    It must have been a really tough journey for you and your family. Prior to reading your story, I was in impression, that US has one of the finest healthcare system in the world. I hope this new legislation bring more comfort to all American’s life.

    P.S –> I always used to thought, that you must had topped your Comp sc graduation. You were such a fine coder.

    Regards,
    Abhishek

    • Thank you Abhishek for your kind words.
      Regarding U.S. health care, I would say the U.S. has some of the finest and the most expensive health care available. Unfortunately, the U.S. health care “system”, as it stands, makes it difficult for many who need it to gain access to what’s available. Hopefully, we’ll now see that starting to change.

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