What a HOT MESS...Health Insurance crisis in America

 I have done everything I am supposed to do, but I am still stuck with 100% of the bill.  I sent mountains of paperwork, requests for documentations, emails and phone calls and things are STILL pending after 8 months time.  I  have jumped through hoops, paid my premiums on time but to no avail. I feel like the only one listening anymore at this point is my own blog. So here I am. For what it is worth I need to document everything that has transpired for purposes of clarity in my own mind....if nothing else.  Hopefully this can help me somehow find a solution. 

I never thought of myself to be an expert on the topic of health insurance, but I have had personal experience...devastating, aggravating experience these past five years to be able to speak first hand on the topic and also knowing that so many people are in true need of better coverage and also better ways of processing claims. Good Lord, there must be a better way.

So to really get a grasp on my incredible frustration, it's good to understand why I have had 4 different insurance companies in the past 5 years.  My husband retired about 5 years ago and this affected my coverage because I was previously on his work place insurance plan. So I had to find my own insurance plan that we could afford on his pension and social security. My husband is currently happily using Medicare and has not had any difficulty.  I am still too young for Medicare so am struggling to find something workable in the mean time. 

Summing it up, I found that you either get great coverage but pay incredibly high premiums (sometimes $750-$800 for individual coverage!), or if you pay lower premiums (at one point I was paying $119.28 per month) it doesn't cover much and you end up basically with "Catastrophic Risk" only.  Although sometimes I was able to achieve a lower premium through the Marketplace, sometimes known as the Affordable Care Act.  This was all well and good...it was a great way to assure that people could have access to affordable health insurance.  In theory it was great, a "premium tax credit" was extended to you on a monthly basis so your monthly premiums were MUCH lower, making it easier to budget from month to month. But when tax time rolled around....Yikes, we had to pay all those credits back to the government. I guess you have to pay it now or pay it later. So that was a punch in the gut that year. Quite a shock to have to pay over $8,000 just in insurance premium credits.

So fast forward to the story of my current medical insurance crisis. With the help of a local insurance broker, I found what I thought would be good, basic coverage at a reasonable  cost:$527/monthly. Wisconsin Physicians Service (WPS) was the insurer providing the policy as "short term medical coverage". However when I made a claim for the removal of some endometrial polyps (which were non-cancerous...thank goodness!) they proceeded with a barrage of requests for documentation which ultimately resulted in denial of the claim as a pre-exsisting condition.  I have had a uterus all my life, does that make it preexisting?!? I never had problems like this until recently. 

 

I took the time, for my own records as well as accurate documentation of the "drama" with WPS to create a timeline of everything that transpired with the processing of this claim. I started with day one of when I started the policy and began paying premiums.  As a policy holder, and a person who paid all her premiums, I documented everything on the processing of this claim. Every phone call, every email, every letter. I was told by more than one person: "Oh, you have done everything you are supposed to do, you just have to wait."  It occurred to me however, that I have no way of documenting what did or did not happen at WPS or the hospital records department.  I did everything I could possibly do to properly process the claim. Looking at an overview of the timeline, (Which happens to be almost 4 pages long...)makes one realize all the crap I have been through in the last 8 months.   Somebody is dropping the ball, and it is not the policy holder.  Again, I did everything I was supposed to do and I still get stuck with the bill. Am I supposed to hire an attorney and pay them MORE money on top of all the premiums that have been thrown out the window??! I think NOT.

At this point, to appease the hospital's requirements for adjusting the total to an "uninsured patient", I have applied for state aid. I'm not sure what the future of this claim will be but I am incredibly frustrated because I feel my medical provider is missing the whole point: I was insured at the time of the surgery. Why should I be penalized because the insurance company did not pay a routine claim from a policy holder that paid all her premiums!

I am now dealing with being uninsured, trying to stay healthy and hope to Hell I can stay that way till I turn 65 and can be on Medicare. That is one thing in our country that seems to be working well....Thank you very much Lyndon B. Johnson.

I know there are no easy solutions for the health insurance crisis and escalating pharmaceutical costs that every American has to deal with, and I don't pretend to understand how to "fix" things. Of course there is also the issue of cost containment with medical procedures. There are several reasons that a 20 minute outpatient procedure costs $10,000 but for the life of me I can't figure out why....Yet, just understanding how this affects so many people in very real ways provides a pathway for change. Just writing this blog has been therapeutic for me; it allows me to put things in perspective and also confirms my supposition that Health insurance in America is a HOT MESS.

So I will end this blog the way I began....

 I have done everything I am supposed to do, but I am still stuck with 100% of the bill.

Julie E. Smith