Saturday, August 15, 2009

Ho-Hum

I'd like to tell you about our health insurance.

But first, let me back up a second. If you're reading this, you probably know all this about us, but I'll give you a quick rundown anyway. Matt and I are college-educated adults with no pre-existing conditions. We don't smoke. Our kids are strong and healthy.

As long as Matt and I have been married, we have been covered through his unions' health insurance plans. The carpenters union in Minnesota, in particular, has an excellent, excellent plan, because the union itself administers it. Contractors -- that is, union members' employers -- have nothing to do with it. As things came up to get covered (mostly for me, including two babies, an antidepressant, and a sleep study with resultant hardware), there was never, ever, EVER any hassle. We had no co-pays. I could pay for prescriptions with the cash that was in my jeans pocket.

We were a little spoiled. On the other hand, we have also, because of slowdowns in construction, had to pay hundreds of dollars a month out of pocket to buy COBRA coverage, and we have gone months without health insurance altogether.

When you have kids playing hockey, that can get a little nerve-wracking.

Matt's current plan is a very good one. There have been some hiccups because of his furlough. He is now covered again, and will be now even if there is another furlough. His coverage ended on June 2, and began again on August 2. A few days ago I went in to pick up a prescription for allergy medication for him. The pharmacist said our coverage had apparently expired.

"Oh," I said. "You know, my husband was on furlough and if you don't have his information on record anymore I'll just bring the card in again and you can run it then."

"OK," the pharmacist said.

In the meantime, Matt checked our health-care company's Web site to make sure we were covered again. We were.

I went back today with the health-insurance card and the prescription coverage card. The pharmacist typed all the information in again, but it wouldn't go through. So she called the prescription-coverage company to talk to someone. She went through a huge phone tree and ended up being told that no, we weren't covered.

"My husband checked two days ago and it said we were covered," I said.

"Is this on the insurance Web site, or the prescription Web site?" she asked. "You'll have to call your insurance company and check with them."

WTF? So I went out to the parking lot and called the prescription company. I got stuck in a phone tree that didn't offer me what I wanted ("answers"), so I called the insurance company. That phone tree actually connected me back to the prescription company, but in a different phone tree. I finally got ahold of a real person. I explained that while I was sure we had health coverage, for some reason the prescription company didn't know that.

"Oh yeah," the guy said. "You're going to have to call the employer's benefit line and have them make sure they tell your health-insurance company and have them call us to tell him he's covered."

Do what now? That makes three separate companies that for some reason have to be reminded to communicate to make sure my family is covered. Three companies, and suddenly it's my responsibility to make sure they are talking to each other.

It's not a hugely compelling story. No one is dying because of this little annoyance. But of course this scene is being repeated thousands and thousands of times across the country. And there are people who are being delayed and denied the coverage they are paying for because of the terrible bureaucracy our health-insurance industry and health-care system has become.

I do not fear government-run health care. The talk of "death boards" and so on is laughable and disgusting. Private companies are making the kinds of decisions right-wing scare squads are hyping every day, and so far my family has been lucky that the only problems we have are having to wait two extra days to pick up an allergy prescription. Best health-care system in the world? It's the best system that couldn't possibly get any worse.

5 comments:

  1. That was my experience every.single.time Mr. Stang tried to get any Rx or doc. visit last year after the benefits person at my company screwed up and spelled his name wrong or something on the initial enrollment.

    What gets me is the pharmacy doesn't even give you the option to pay out of pocket for the Rx and puts it back on the shelf. I ask "how much without insurance?" and it's like I'm speaking a foreign language. But our copays are so high, the extra $5 or $10 to pay out of pocket is worth the time I'd spend trying to straighten everything out.

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  2. Oh my Lord yes. It's ridiculous. Basically this same thing happens every damn time I get a new prescription. The ones that are ongoing and mail-order are fine, but every time something out of the ordinary comes up, it's like starting from scratch.

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  3. Let's you and I get together over a beer and bitch about this topic. You can talk about health insurance and I will share the mystery that is my car insurance. (Why does it go up $20 every month or so for with no explanation? Magic?)

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  4. Amen to all of that! And I think about how hard and time-consuming it is for you or me to spend hours going through one phone tree after another... then I think about people who are working back-to-back minimum-wage jobs that don't allow 30 minutes at a time sitting on hold waiting for a call-center rep... how the heck are they going to navigate the system?

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  5. MS -- I could pay out-of-pocket and then send the bill to the insurance company, but I find that so annoying I just don't.

    Grace -- I know, right? And MS, too -- why is it like the first time every time you go in? Aren't computers supposed to make our lives easier?

    Mach1 -- You said beer, I said OK.

    Eth -- Exactly. I have the time, resources, knowledge and confidence to follow through and get to the bottom of the hassle. So many, many people don't.

    That reminds me of once when I called in to unemployment many years ago to request Matt's benefits. Well, you yourself have to request your own benefits. By calling between 8 a.m. and 4 p.m. I explained to the terrible man I was talking to that Matt was on a construction jobsite and it was difficult if not impossible for him to call in. "Doesn't he have breaks?" the guy asked sarcastically. "Doesn't he have a lunch break or something?" Yes, but you're assuming he has a cell phone, or access to a work phone that the bossman will let him use. He was just so rude I wrote a letter to complain.

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