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Posts Tagged ‘insurance’

M was home yesterday when I got some bad news, and he got the full force of my anger and frustration.  It wasn’t fair to take it out on him — he’s got enough on his mind at the moment — but he was there.

He was there because his company had sent him home with no hours.  Again.  It’s become a regular occurrence these past four months.  Every week like clockwork, when the pay-week comes to a close on Thursday, he gets up and gets ready, gets in his truck and heads out for work, and then they send him home with no hours.   Since the beginning of December, he’s had only three weeks of full-time hours, only three paycheques that really cover the bills.

My birthday is coming up in the next couple of weeks, and it’s a big one.  Apparently, Life Begins at this age.  M may be all manner of wonderful things, but he is not good at remembering me when it comes to  important occasions — I have not had a birthday or Christmas gift from him for three years running — so I have been reminding him of this impending event almost every other day since before the turn of the year, like a count down.  This is a Big Birthday, and I do not want to be forgotten this year.

I had emailed out my birthday wishlist to everyone who would likely find it useful but, knowing that M uses a computer about as often as a camel uses an umbrella, I have been coaching him separately for a long time.  More than anything, I want a Lendrum spinning wheel to replace the ancient, second-hand wheel that I have been using (and which has served me well) for the past 12 years.  But a shiny new Lendrum is nothing to be purchased lightly — it’s $622 — and so I’d hoped that maybe if everyone pitched in together, then what remained would be more within our grasp.

And just the day before, I’d made a furtive phone call to a local yarn shop to see if there were any places left on the knitting class they were offering this month with knitting guru Brandon Mably.  I had already taken this same class  six years ago — it was a treat to cheer myself up after I miscarried our first child — and I had enjoyed it so much out of it that when I saw that he was coming to the area, I immediately began to muse over taking the class again.   It was an expensive class, at least for me…  The amount left each month for spending money for me and the girls rarely tops $50 — and that includes everything: shoes, clothes, magazines, coffee — and this one class would blow that out of the water, but how often does one turn…  erm…  How often does Life Begin?  I felt guilty making the call to the yarn shop and I felt guilty at the thought of booking the class…  But there were spaces left!  And I wanted to take it — I really wanted to!  I decided  I’d wait a couple of days to be sure the idea settled right, and then — damn it! — I’d do it!

Yesterday morning I received a bill from the doctor’s office which treated my sprained ankle.  It wasn’t for much — almost exactly the co-pay amount — and so I assumed it was an error.  Somehow, the insurance company must not have realised I’d paid the co-pay on the day, so I picked up the phone to sort it out.  It was a beautiful day, sunny day and my husband was home — I’d get this out the way, it shouldn’t take long.

The lady on the phone sounded weary.  “That’s your deductible amount,” she explained, and then added, slowly and with a tinge of irritation, “You’re responsible for the deductible.”

“Oh, I know!” I said with deliberate cheerfulness, because the lady sounded like she needed it.  “I understand we pay the deductible but… I’m confused…  Before I went to the doctor’s, I spoke to a lady in your office who explained that my husband’s employer pays the first $1000 of the deductible.  Have we gone through a thousand dollars in two visits…?”

She tapped on her keyboard and then paused.  Then a deep breath.  “No, but I’m afraid whoever spoke to you got it wrong.  You’re responsible for the first thousand; your husband’s employer pays the second thousand.”

Oh.

My stomach dropped instantly, and then my mind began tallying, very quickly: doctor’s visit, three x-rays, the airboot, follow-up visit, three more x-rays, the lace-up brace…   How much had we run up?

The lady was tallying too.  “We’ve negotiated a nice discount for you on that bill…”  I could see that they had indeed — they’d reduced the bill by 75%.  “And I can see that you’ll also be receiving a bill from a rehabilitation equipment company…”  Yes, that’d be the airboot.  She told me the amount, and I winced.  “And… let me see…  another bill from the doctor’s office…”  The follow-up appointment.  “And another… oh, from the equipment company again.”  That’d be the brace.  “Let me add that up for you, ” she offered helpfully, her irritation subsided now that she realised I wasn’t going to put up a fight.  The amount came to around $400.

Four hundred dollars…  for one moment of stupidity.  Four hundred dollars, after months and months of short weeks and short pay.  Four hundred dollars!  If I had known that, I never would have taken off the tape that was holding my ankle still and let them replace it with a brand-spanking new lace-up brace.  If I had known that, I would have paused at the offer of the airboot, and grabbed my mobile to ask my mother if her old airboot would fit my foot.  If I had known how much it would cost us, I honestly think I might not have gone to the doctor at all — certainly not to that follow-up appointment.  M had said it was only a sprain and it would heal on its own, and he was right.  I could have gotten by without the doctor.

The day had seemed to have suddenly lost all its sunniness…  I felt sick to my stomach (again! again!) and deflated.  My hoped-for birthday gift now sounded extortionate, and the thought of booking that Brandon Mably class seemed frivolous, if not downright irresponsible.  Spend money on my birthday like that?  Spend money?!? What fool thinks she’d get to spend money on a milestone birthday?!?

And with that, deflation turned to anger — real, seething, boiling, red-hot rage — and  so I yelled.  I yelled and I yelled and I yelled at this country, at this joke of a “system”, at the waste and the complication and the confusion and the callousness of it all.  I yelled at the lack of transparency, at the miscommunications, at M’s lack of hours, at his too-short paycheques when he works so hard, at the recession, and at the ludicrous idea that somehow this is all ok, that this is the American Way.  I yelled because, apparently, going to the doctor when I sprained my ankle was my birthday gift this year.

M thought I was yelling at him.  And he came up and held my hands and, with tears in his eyes, he said, “Your birthday will be alright.  We’ll make it alright.”  And then I felt terrible for all the yelling, and tears came to my eyes too.  Sod my stinkin’ birthday — what I’m really scared of is losing the house.

The door woke me when M left this morning: 6.11am.  That’s early, I thought, and then drifted heavily back to sleep, hopeful that it meant he had a busy day scheduled.  He was back home again just after 1pm, having worked three hours, and then hung around for another three in the hopes that some more work would come in, before he finally gave up and drove back home to us.

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A letter came in the post last Friday and after I read it, all I could do for a few minutes was stare at it in shock.  I sat down and put my hand on the couch to steady myself, and then read it again.  It wasn’t so much the news that it brought — though that was bad enough — but the way it made me feel: vulnerable… so, so very vulnerable and out of control.  The letter was from the girls’ insurance company and it informed me that, due to “increasing [insurance company] financial losses”, the premiums for their cover will be increased from October by 350%.

The girls are covered by the state’s CHIP programme — the only long-term cover I could find that they qualified for when we lost our health insurance because M was suddenly laid off three months after we arrived in the US.  Because the girls are US citizens, they did not qualify for the insurance policies that are usually offered to incoming immigrants.  And because we had just moved from abroad, they did not qualify for most normal insurance policies which, I discovered to my utter bewilderment, all seemed to have “residency requirements” that disqualified anyone who had not lived in the US for the last 6 to 24 months.  My daughters had both been recently diagnosed with potentially life-threatening food allergies (my elder daughter to eggs, my younger daughter to no less than eight foods, which later rose to 12) which had had a huge impact on our daily lives, and I was desperate to get them onto a good, long-term policy that would give us some peace of mind.  We were still reeling from a string of devastating events that had begun almost as soon as we arrived and had consumed nearly all our mental, physical, and financial resources (besides M losing his job and our insurance, I suddenly developed incredible pain that debilitated me for months before we got on top of it, the medical bills started rolling in and  ate up half our moving fund, we found we had to pay the IRS a huge sum which wiped out the other half of our moving fund, the house we were renting was put the market, we were going through  all the stress, isolation, and disorientation that an international move almost always brings, and it felt like we were doing everything wrong).  Looking for insurance under these circumstances was turning into a nightmare and when I found out the girls qualified for CHIP, the relief  was so strong I burst into tears.

The coverage was excellent; the price surprisingly affordable.  The programme is funded by the state, but administered through a choice of several large insurance companies.  I picked the one that we’d been on with M’s previous job, out of sense of familiarity more than anything, and got the girls signed up as fast as possible.  Each month a bill arrived with bold letters telling me that one missed payment would result in permanent cancellation of the policy — I began sending the premiums in two months in advance just to make sure I never paid that price.  In a world that felt like it was falling apart, knowing the girls had such excellent coverage gave me a sense of stability that I clung to like a rock in a stormy sea.

So as I read that letter — and reread it, and then read it again — all that stability seemed to drain away and the horrid, terrifying, desperation of a year ago rushed in to fill its place.  Could they do this?!?  Could they just casually send me a one-page letter which matter-of-factly stated they were increasing the premiums not once, not twice, not three times, but a full three-and-a-half times what they were now?  No warning, no alternatives, no choice…  This is our only option, this is our salvation!..  Could they do this?!? I rang M up at work and he listened patiently while I told him the news, then began to cry, and then composed myself and told him I’d be alright and thanked him for listening.  My tears were more out of fear and uncertainty; we will  be able to make the new payments (just, and with sacrifices), but it’s what they represented — the lack of control — that put me over the edge.

When I told my mother, she was shocked, then horrified, and then began to rant.  Was this what Obama had in mind for the middle and lower classes?!? Or was it the Governor’s doing?!?  It didn’t seem ethical!  I pointed out that it wasn’t Obama’s doing — his reforms haven’t even taken shape yet, let alone been enacted — and it wasn’t the Governor’s either.  It wasn’t to do with the CHIP programme itself at all.  It was the insurance company’s doing: they take the money the state gives them and then set their price within an approved range — but times are harder now than were before, there are these “increasing financial losses”, and so they’ve raised their price.  And, no, I told her, it didn’t seem ethical… but I don’t know that I think ethics plays any part in this.

I have to admit to feeling rather annoyed with her, to harbouring some deep-set and mostly unjustified feelings of blame.  I had been concerned about healthcare before I moved back to the US… concerned… afraid… frightened…  But my mother and my father and my sister had all assured me that I was making a mountain out of a molehill.  It’s fine, they told me.  It’s a system!  It’s not the system you’re used to, but it’s a system.  As long as you work hard, you’ll be fine.  My husband, I thought to myself, does work very, very hard.  And I do too, in my own way.

My had mother added that she didn’t know anyone who had a healthcare problem.  What about my sister?, I asked, pointing out that she’d gone for years without health insurance, avoiding going to a doctor even when she needed one.  “Oh… yes… ” my mother’s voice trailed off, and then came back again with strength, “But she never had a problem!”  I felt misgivings at that, paused, and then… brushed them aside.  It would be fine.  It would be fine.  …And so if there is blame to laid, perhaps some goes to my mother for closing her eyes to the problem, but some goes to me too for choosing to believe.

There is series of ads for one of the largest insurance companies in the region which they run on television all the time.  It shows someone walking a dog, or jogging, or riding a bike.  At some point the camera closes in on the person, and they look directly into it, before raising a hand and pressing it with palm forward and fingers spread, so that it appears to be just on the other side of the glass of the television screen.  And as the person fades out of focus, the handprint remains, glowing blue and pulsing gently, and a warm and reassuring voiceover says, “Giving you a greater hand in your health.

As I sat there staring at this letter, with its incredible, horrible news, I had to wonder: is that hand meant to be pulling us up… or pushing us away?

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Today I am grateful for:

  1. The very good news that the girls will at last be covered by the state CHIP program come August.  Now I can focus on getting M and I sorted.
  2. A lovely newsy letter from a friend I haven’t heard from in a while.
  3. The peaceful house at naptime.

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Today I am grateful for:

  1. A roof over our heads — though from all indications, I honestly don’t know for how much longer we’ll have it.  I hate that unknown, especially with the house we were considering turning out not to be The One.  We start over now from scratch, and that means time, and I’m not too sure how much time we have left in this house.  If we don’t get the timing right so that we have a house to move to by the time we have to get out of here, I really don’t know what we’ll do.  But we have this roof over our heads for right now, and I’m grateful for that.
  2. That everyone seems to be over the virus we were all fighting all of last week, without it turning into anything more serious that would have required medical attention whilst we are still all up in the air insurance-wise.
  3. E1’s kisses and giggles today while we were shopping.  I was carrying her and asked for a kiss, which she promptly gave.  So I asked for a bigger one, and got that too.  So I asked for more and more and more, and got great big smacking kisses and fits of giggles — and a great deal of unburdened joy that my heart has been so desperately needing in the last couple of days.

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Let’s bask for a moment in the good news: M has landed a job! He has done a few ‘ride on’ days with a local company, so they could see him in action and assess his skills — something of an audition, if you will — and today he had his interview with the company owner. It went well, he got good reviews from the employees he worked with, and they have offered him the job! He starts on Monday. It’s wonderful news. Wonderful! And to make it even better, it appears that the work the company does is actually more suited to his experience than the last place. Sink back in the chair, take a deep breath, and relax. He has a job again.

So I didn’t understand it at all when we sat at the kitchen table and just looked at each other, with faces awash with fear and trepidation. We’ve been waiting for this day — I was expecting that wave of relief and euphoria, but it never came. Something didn’t feel right, and we both found ourselves staring at each other across the table with our stomachs in knots.

The thing is, getting a job was only part of our problem — and, really, it was the relatively easy part. The more worrisome things were securing a high enough payrate and getting the health insurance sorted out. And we’re neither of us really sure that’s been done. M managed to negotiate a slightly higher wage than he was on before — full kudos to him! — but the insurance arrangements at the new company are not as generous, so the net effect is that we will actually be worse off each month, both because the higher monthly premium, and then again when we use the insurance because of the higher deductible. The previous company was also going to cover M’s tuition for the night-classes he needs to take to get his local qualifications, but now these will come out of our pocket. Given that his last job only just covered our basic expenses, leaving us with nearly no spare change, these extra expenses are a bit worrying.

And, this being America and health cover being considered a benefit, there’s a delay before it kicks in. This new company insures the employee after 3 months, the spouse after 6 months, and the children only after a year — before that point, it’s up to employee to find (and fund) private cover. Aside from the fact that I find this practice of witholding basic benefits to be utterly sinful, we have been warned that the COBRA cover is prohibitively expensive, but when we look for other options, we keep running into that same problem we had before because we have not been resident in US long enough to qualify for most insurers’ policies. When M explained this dilemma, the company offered to insure the whole family after a six-month delay instead, and I have spent most of the day on the phone, trying desperately to find companies that will cover us for either of those periods in order to determine which option would be better.

After I mentioned it to my mother, she was quickly on the case and evidently began by plugging our details into various websites because, within the hour, I was receiving phone call after phone call from insurance sales agents. I began every conversation by explaining that we’d only been in the country for four months, and that brought most of the calls to a screeching halt. Now and again, there were rays of hope: a travel policy that might be able to cover M, a high-deductible catastrophic policy for me and the girls. One call was particularly promising — the first one that had a plan that could cover all of us! And right away! And for a reasonable price! I was transferred to a senior agent because of our ‘special circumstances’, and he began to explain the coverage. The company was a huge insurer, I was assured — huge — who usually only worked with large corporations but offered 5% of their policies to a limited number of individuals… This sounded odd, and the cover sounded even odder. It wasn’t being laid out the way other policies were: there was no deductible, no total-out-of-pocket figure… Instead, we would get a set reimbursement when we went to the doctor and while it paid 70% of hospital costs, I heard nothing about a cap on the other 30%. I asked if I could have the details in writing — I wanted to digest it slowly, run it past my father, as he’s much more experienced in this than I am — and was told that an email with all the details and my ID card would arrive within the hour of my signing up. No no no, I said, wasn’t there anyway to read all this before I signed up? The reply sent alarm-bells ringing: this was not offered to the public, so it wasn’t on any website. It was a limited offer, and if I didn’t sign up now, they might fill their quota before I rang back and I’d have lost my chance. Mmmmm… ok. I explained that I did not intend to sign up now but I’d take his number… This resulted in more urgency: I did realise, didn’t I, that I had no other option? The COBRA would cost ‘millions’ and no major medical will take us without meeting the residency requirement. Didn’t I realise I had no other choice? I suddenly wanted this conversation to end, and I should have hung up then, but I am inexperienced at this health insurance lark, so I carried on. I insisted I was not going to sign up now, I was willing to take the risk, on my head be it. Ok, he said, he couldn’t do anything, but would I hold while he talked to a colleague…?

Moments later, the thundering voice of Bill, the Enrollment Director, came on the line. He understood there was a problem… what was the problem? I explained I wanted to think about this policy before signing up, look it over in writing. He repeated the same guff about missing my chance and I repeated that I was willing to take that risk. “But I don’t understand,” he said, “This is your only option. You have no other choice. You don’t qualify for major medical coverage. We are offering you and your family a chance to be insured…” I was sick of this and wanted off the phone, and said that I felt I was getting the hard sell and… He cut in, “No, not at all! We are just trying to offer you the chance to insure your family when no one else will…” He was beginning to become angry, his tone rising. “Do you realise there are 50 million people in the US who are uninsured because they don’t qualify? Just like you. You don’t automatically receive insurance in the USA! This isn’t…” he spat the words, “socialised medicine!!” He was lecturing me. He was lecturing me! I started to say that this was beginning to… but he cut me off, not even trying to hide his anger now, “Listen, you know what?!?…” I knew what was coming but I listened anyway, frozen in shock and disbelief. “We’re going to offer this chance to someone else. We don’t need you as a customer. Good luck getting insurance!” and he hung up on me.

I was shaking. I went in the other room and cried for awhile. M came to look at me in sympathy and uselessness, but I sent him away again. This isn’t what I came to America for. This isn’t what I’d jumped through all those hoops for. I didn’t expect it to be so difficult to do… well, everything! I don’t know what I’m doing here. I don’t understand how anything works here and it takes so much time and energy to figure it all out. I am tired of discovering that my car is due for an inspection I didn’t know about, tired of being suddenly surprised by the local municipality’s tax bill, tired of having to read the small print on every single thing because I have no previous experience of any of it. It’s hard work and it makes everything so slow. And then… and then… and then I get to talk to assholes like that as well, trying to bully me because they know how vulnerable all this makes me.

I hid for a long time in the other room so the girls wouldn’t see me crying. After awhile, an email came through from my mother with a link to the CHIP programme, which I knew required children to be uninsured for six months before they were eligible to enroll. That fact had angered me so much when I’d read it back in December that I hadn’t looked at CHIP again, but my mother had re-read the small print. There was a chance the girls were eligible now because our new situation was involuntary. Still unable to control my voice completely, I gathered my nerves and rang the number.

I spoke to a lovely man who treated me with courtesy and perhaps even a little compassion — my voice, I expect, was betraying me. I explained M had been laid off — did that make my girls eligible? He asked whether we were insured at present. Well, I began, I’m not sure because we have the option of COBRA but the paperwork hasn’t arrived yet (M has chased it with his previous company four times already!) — it should be here this week — and our normal coverage ended on 31 May… “Ok, you have no insurance — you are uninsured,” he said. “Your girls are eligible. You need to fill out a application and send it in. It will take about an hour to do, and then four to six weeks to process. If you take up the COBRA option in that time, your daughters will no longer be eligible. The coverage with CHIP is very good. It includes…” I was overcome with relief that my girls could be covered — it ran warm over me. But his first words struck a chill in my heart: we are uninsured.

Somehow I hadn’t fathomed that, even though I knew our coverage was ending. Because we had the COBRA option, and it had been explained to M that COBRA can be enacted retroactively up to 30 days after the insurance cover ends, in my mind I still thought of us as being ‘covered’. We’d been told that if we were ill or in an accident and needed medical care within those 30 days, we could apply for COBRA afterwards and the bills would be covered. Ok, so the insurance ended this past Saturday but, with the COBRA option still live, we weren’t uninsured. Not really.

But when he said it out loud — you have no insurance, you are uninsured — it became suddenly, terrifyingly real. My eyes dry now, my senses sharp again, I walked back out into the kitchen. E1 was eating her dinner, swinging her legs back and forth under the too-tall chair. E2 was standing on another chair and, with a look of mischievous delight, perching one knee on the table in an attempt to climb up. I looked at my daughters, so blissful… so blissfully unaware. They trust that we will ensure they are taken care of.

We are uninsured. After four months in America, we have joined its 47 million uninsured. Looking at my daughters, the realisation hit me like a slap in the face.

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It was all too raw on Wednesday, so we did nothing but let it sink in and be a support to one another.

Yesterday, M began jobhunting in earnest. He was hampered by a sinus attack which set in on Wednesday morning and has yet to let up its grip, but he carried on regardless. It slows him down and dulls his responses, but we don’t have the luxury of him resting until it goes away. He made phone calls to several of the companies who interviewed in back in October — some had moved on and had nothing to offer, but one is still hiring and asked him to re-apply. At their request, we filled out their online application form last night after the girls had gone to bed — starting at 9pm, we finally finished it at 2am. M collapsed into bed. I couldn’t sleep and laid in the dark, staring at nothing for another two hours.

Today, M was up early making calls. When he woke me up, he was beginning to lose his cool. He screwed his face up and then buried it in my shoulder. “I don’t want to be here. I don’t want to be here anymore. I don’t want my girls growing up here where…” His voice broke and he pulled me into him hard so his face was deeper in my shoulder, hidden from my gaze, “…where people are so vulnerable. You don’t take a job for the job, you take it for the insurance. It might be a job you hate. It might not pay enough, but you take it so your kids aren’t uninsured! What is wrong with these people that they live like this?!?” So many of the companies M spoke to offer insurance to the employee, but did not cover the family. On the starting wages he is looking at, private insurance costs for us would be crippling.

My mother and I are taking the girls out now — I don’t know where, but just out from under M’s feet, so he can make more calls, try to follow more leads. His sinuses will not let up and give him a break. But, then, neither will our circumstances.

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I’ve just realised that I never finished the story on our impossible immigrant insurance situation and wanted to just quickly correct that in case anyone is ever reading this blog because they are trying to find a solution to the same dilemma.

We finally found that Assurant were able to give cover to the girls and me on a short-term policy because we are US citizens. If I recall correctly, they were the only company who were able to do this — all the other insurance companies I contacted had residency requirements that meant that we didn’t qualify. If it weren’t for this one company, I honestly don’t know what we would have done — and I find that deeply concerning in an overall sense.

Assurant were also able to offer M a “travel policy” which would cover him. It’s called the Patriot America version of the Patriot Travel Medical plan from IMG-Global. Again, that was the only* policy that I found to cover him and, again, I don’t know what we would have done if it weren’t for Assurant.

I am utterly stunned and more than a little concerned that there seems to be only one source that provides a solution to this problem!

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*I did find something called the “Inbound Immigrant” plan which would cover DH but not us (ie, non-US citizens) but would only go up to $100,000, which is inadequately low — more like doll-sized insurance than something for a full-grown person.

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