Issues with the American Healthcare system with examples of problems with health insurance and COBRA and how it puts even middle class families in peril

American Healthcare on Hold: A Year of Health Insurance

Fitness and Wellbeing Lifestyle

Issues with the American Healthcare system with examples of problems with health insurance and COBRA and how it puts even middle class families in peril

Healthcare wasn’t something I thought about; it was something I took for granted. My father worked for the government, so growing up we had great insurance. When I went to college, the ACA and its policy to have young adults covered by parental policies didn’t exist so I was kicked off my parent’s healthcare. I got health insurance through a program for college students which had any services from the campus health center 100% covered, emergency rooms completely or almost completely covered, and other services… well, I never found out because I only used the coverage for sinus infections, birth control, and one time when I thought I truly injured myself but actually just pulled a muscle from coughing.

After college, I got on whatever insurance my job provided and it seemed fine because I was fine. Annual visits with my gynecologist, the occasional health center to X-ray a twisted ankle, nothing major. When Karl and I married, I got on his work insurance which was low-cost and high reward.

I didn’t start thinking about insurance until my husband quit his job and it became my responsibility to protect us. My current job had insurance that was twice as expensive as what my husband paid and offered maybe a quarter of the benefits. I had to visit one of their health centers instead of the general physician I saw for years. It didn't cover my gynecologist, the closest one that took my policy and didn’t have horrible reviews was a 25-minute drive away.

Healthcare Issues in Corporate America

I changed jobs, and one reason was insurance. Health insurance was a factor determining if I would apply, and health insurance was the deciding factor in choosing my new position. With my new job's insurance, I could see my old favorite doctors, go to a high-rated hospital if need be, and since we were thinking about having a child, I saw I could see midwives and go to a birthing center and my insurance would cover it.

And it was great insurance; I didn’t pay a single dime through the whole pregnancy or the birth, even with it taking four days and multiple specialists to get Emerson into the world. A friend had a baby a month after I did; I was at her house when she got the bill for her hospital stay. After insurance, she still had to pay almost $3,000 and she was only in labor for a couple hours without any intervention. I was grateful for having great insurance.

And then our company changed insurance plans. Now, we had “patient-managed” plans. We had a buffet of options – HMO, PPO, varying deductible rates, varying needs. It was incredibly confusing and HR didn’t know much more than I did. I did research, made calls to the company, and chose a plan that seemed as close to my old one with Blue Cross/Blue Shield though it cost me twice as much per month. We now had a child to care for, I didn’t want to go bankrupt if she had some medical issue and I didn’t want to have to take her to a lower-quality hospital or doctor because our insurance limited us.

Luckily, our child didn't have a health issue so she didn’t use the insurance past annual visits, vaccines, the occasional cold, and dental appointments. Even so, we paid anywhere from $35 to $100 out of pocket for an appointment that wasn’t her annual visit, including vaccinations. I had strep throat, went to my GP essentially to get a prescription for antibiotics. Out of pocket, I paid $85 for the visit and $45 for the medicine. Running to catch the Metro, I tore my calf muscle; it cost me almost $300. Annual mammogram? $350 out of pocket. I wondered if I made the wrong decision with insurance and should have just gone with a cheaper plan that had fewer options and benefits.

Health Insurance and a Medical Crisis

Then I broke my right arm slipping on ice. I went to the in-network emergency room closest to my home, had the surgery done by an in-network orthopedist, follow-up appointments at his in-network office two towns away. Even so, each month I was getting bills after insurance did their part for at least $100. I reached my high deductible in just two months. This was a good thing as insurance covers everything after the deductible is met.

And then my arm broke again due to the in-network doctor and hospital making mistakes. Come to find out, insurance is able to decide what they think is essential and what isn't.  Many of my procedures and appointments to repair this damage was considered “not essential” and I paid out of pocket. And then the new year happened and I had to again make my deductible for insurance to cover anything, including the twice-weekly physical therapy sessions to get my arm and hand working again.

At the end of all my arm surgeries, therapy, and appointments I paid out of pocket over $22,000. I wiped out most of my savings, put essentials like gas and groceries on credit cards so I could have enough to pay the monthly bills. I delve more into my healthcare issues and costs with my arm in this blog post from 2015.

Last year, overwhelmed at my job and with the blog, I thought a therapist could help. I searched for an in-network therapist that took my insurance and found one… an hour away. My insurance informed me I could go to a therapist on a list they provided, submit the bills myself and be reimbursed for part of the cost. I found a therapist so close to my office I could visit on my lunch hour. I got my bill, submitted it, and was told oh sure, they would reimburse 50%… after I met my deductible. That was not explained on that first call. After two visits and $450 out of pocket, I quit my therapist.

Healthcare Issues when Self-Employed

A few months later, I quit my job. The biggest fear I had of doing that was insurance; I knew it was so expensive when you were on your own. A friend recommended an insurance broker; I shared with her my current job insurance, how much I paid, and my deductible. She recommended I get on COBRA, a federal act that extends an employee’s insurance for up to 18 months after leaving a job. Thing is, with COBRA your old job doesn’t pay a portion of your healthcare. I'd pay over $1,400 a month to continue this mediocre insurance. Anything cheaper available through the ACA was what is called “catastrophic care,” or “the basics so you don’t die and don’t go bankrupt” care.

This first year of self-employment went without major health issues. My daughter got braces which isn’t cheap, but COBRA dental covered a portion and the orthodontist has an interest-free payment plan. Insurance continued as before, even with the same insurance cards. Payments just now went to a different place.

Early November, my husband had a dental issue. He went to pay and found he was no longer on the family dental plan.  He paid $275 out of pocket for the visit. I called our insurance, they said November 1st my policy switched from a family plan to an individual plan. Then I called COBRA, they said I was still paying a family rate and said the insurance was wrong. It took a week on the phone and at the local Staples becoming BFFs with their fax machine to find out when my COBRA renewed November 1, some idiot typed it in wrong and removed my husband and daughter from our dental plan. Over two months with weekly calls and still no resolution.  In fact, I am writing this while on hold with COBRA.

When Open Enrollment began for the ACA, I took a look. I found that rates were far more reasonable than the previous year. We found a plan essentially the same as our current one, but almost $300 less each month. It only took about 30 minutes to register. My state's site for the ACA was a bit clunky but the process was easy and clear.

Taking Insurance for Granted

When you work for Corporate America, it’s easy to take insurance for granted. It’s also easy to judge those who do not have insurance. But acquiring insurance in the United States isn’t always easy, and the monthly cost is more than many can afford. Even if you have insurance, it doesn’t protect you from crippling debt, lifelong health issues, or bankruptcy. American healthcare stories often focus on those below the poverty line, but many successful business people are uninsured because they can’t afford the monthly fee. I know many who “suck it up” when sick or injured because they can't afford the cost for an appointment or prescription.

I wanted to share my experience to show that the American healthcare issues aren’t affecting just one demographic. Some with great jobs and insurance are still crushed by medical costs. You can start your own business and be successful with it and still not be able to afford insurance. And you can write over 2,000 words about insurance during the time you are on hold with your insurance company.  Something NEEDS to change.

17 Comments

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17 Comments

  • Lisa January 7, 2019

    My mouth gaped at reading $20k
    I am just gobsmacked that with insurance you could be that much out of pocket.
    I’m so sorry you have to deal with this. Americans deserve better!

    • Alison Gary January 9, 2019

      Thank you for sharing this, I am going to add it to my Weekend Reads.

  • L H Carter January 7, 2019

    Thank you for writing about this.

  • Kathleen January 7, 2019

    Long time reader, first time commenter. THANK YOU for writing this whole story out. It illustrates just a few of the huge issues facing Americans when it comes to health care. I hope that if we all keep bringing these things to light, it will shame our elected officials and insurance companies.

  • Georgie January 7, 2019

    Your post is so accurate it’s scary. We all need to revolt against the costs of treatment. In the past the cost of treatment or medicines wasn’t discussed. Now it has to be. We have to create competition for our medical dollars and drive costs down. $90 for an inhaler is crazy. Somehow we have to find a less expensive source for treatment and medicine so we can hit them where it hurts and force treatment to be more affordable and then maybe insurance will become more affordable. I’ve heard recently that people are traveling to other countries to have affordable procedures instead of having them here in the US. Wishful thinking I know. If only I was Queen.

  • Ann January 7, 2019

    Health insurance concerns have pretty much run my career. I have a chronic issue that I need covered, so since I was a teenager, I’ve been aware of insurance. I tried freelancing in the pre-ACA era but insurance costs were too expensive so I had to go back to a corporate job. I live in terror of the current administration removing the ACA’s requirement that all insurance plans cover pre-existing conditions.

  • Beth January 7, 2019

    Eight years ago we dropped our traditional health insurance: it was just too expensive! My husband works for a small business that does not provide healthcare. We chose to join a healthcare sharing ministry and it has been the best choice FOR US. Healthcare sharing is definitely not for everyone but is an option to consider. We choose whatever doctor we want to see, even natural health care providers. Our monthly costs are very low. We had our third child while with healthcare sharing and paid about $500 out-of-pocket for all maternity and delivery care.
    https://www.turn2thesimple.com/pros-cons-healthcare-sharing/

  • Michelle January 7, 2019

    When we moved from London to New Jersey 10 months ago my Husband and I were aware we had to pay for health insurance. What we didn’t realize was how eye watering expensive it would be and how little it covered!
    My daughter is asthmatic. If she doesn’t use her inhaler she’ll die it’s that simple. These inhalers are super cheap to produce, in Australia they’re $5 over the counter no prescription needed. In the UK they’re free for children on the NHS. In the great US of A they average at $90 each!
    My daughter uses 1 a month, quite normal for her condition which is very common by the way.
    I’m on HRT which is equally as common and ridiculously expensive every month.
    I really don’t understand why the American public put up with being ripped off so blatantly. The con is real people, vote for politicians with affordable health care at the top of their agenda and not some lame arse wall keeping out imaginary terrorists. I think you’ll find the crooked government is secretly terrorizing you more than the the Mexicans

  • LC Bat January 6, 2019

    I’d be terrified to dip my toes into freelancing without David and the knowledge his health insurance, through the university, is better than mine. I’m still not sure I’ll ever be brave enough to take that leap, even if things are someday going well enough to quit my day job. Entrepreneurship would be served by a robust publicly-funded health program, like every other “developed” nation has.

  • sue January 6, 2019

    Hello Allie,

    Thank you so much for writing about this. I am also trying to stay as healthy as possible so that I do not have to access insurance. Which is kind of ironic because this is the first time in my adult life that I have good coverage. I am old enough to be on medicare and young enough to still work at a job with great union benefits.that pick up my copays. When our four kids were very young, we could pay all our medical bills without insurance. But the youngest has autism and also was severely mentally ill. Even with insurance we were paying thousands of dollars for her care every month. It was a bitter time for us, as my husband’s income increased and he worked very hard but we got poorer and poorer. I see so many with kids with disabilities and how we (they) struggle. It is digusting not to take better care of “the least of these.” It is also disgusting that insurance determines ultimately what kind of care you get from your doctor. Again, thank you for showing us your different experiences. I will share this.

  • Lee January 6, 2019

    Thank you for writing about this! I’m constantly amazed and disappointed by people in this country who seem to believe that only a certain few deserve good health insurance or that it’s your own fault if you can’t afford health insurance. I work in public edu the and when I started 20+ years ago, my insurance was really good. The district made the full cost for my policy and I was healthy so I rarely used it. However, the legislators in my state have constantly de-funded the educator health insurance, it’s gotten so expensive. Many of us avoid going to the doctor as much as possible. And don’t even get me started on how expensive it is to add a spouse and/or kids to the plan.

    It’s a myth that this is the greatest country in the world. We’re not great when we choose to let people suffer and or die because they can’t afford health care. It’s sad that insurance companies spend their money and time buying off our senators and congress people so that they actively work to NOT pass legislation that would give us all affordable health care.

  • Monica January 6, 2019

    In this country, in the 21st century, it’s a shame and a travesty that access to good healthcare is basically a matter of luck and employment. I have two chronic conditions, both of which are blessedly under control, but I’m keenly aware of how quickly that could go sideways if I lost my health insurance. I work for my state, and have decent coverage, but like Allie I would have insurance at the top of my list of concerns if considering a new job elsewhere. It shouldn’t be this way.

  • Jane January 6, 2019

    I like that you are getting the word out that even “good” health insurance doesn’t work for everyone. It is very expensive and only used when one is sick or injured. It is not like people are using it for fun. Also, isn’t ACA ending soon?

  • Chelsea Henderson January 6, 2019

    We had such a similar trajectory and realization! I paid about $15,000 out of pocket when I broke my ankle and was in the wheelchair for 3 months in 2016. Like you, my insurance deemed “medically unessential” a follow up visit to see my surgeon, denying me access to the transportation benefit my plan said it provided. I had to pay $200 out of pocket for a private company to come get me before my dad rented me wheelchair ramps for my house so my sister could get me out and into the car.

    Before all this, in 2014 I was on COBRA after leaving my job but the administrator “forgot” to charge me Aug-Oct and I was kicked off the plan, which I didn’t find out until a bunch of doctor bills came pouring in. Luckily my former employer and BCBS intervened on my behalf and the administrator reluctantly reinstated me retroactively.

    I’ve been on the ACA exchange since 2015 and in my big healthcare year, had bumped down to a shitty silver plan that in the end didn’t save me money at all. I went back to gold in 2017 and each year it’s gotten a little cheaper as more people have joined.

    Over the holidays my sister said something about Obamacare sucking because it’s so expensive. I explained that it only sucks if more people don’t get on it. The more the merrier and the cheaper the premiums. I scolded her for making it more expensive for others by choosing to go health insurance free.

    Like you, I will never take health insurance for granted again. But for the self employed, it’s a huge bill (second only to mortgage) and it can be stressful during lean months.

    I hope you are off hold now!

    Sending love and vibes for good health!

  • Susan January 6, 2019

    Thank you so much for posting this. I am a professional with an advanced degree. I had good insurance until I decided to go back to school. When I graduated, the market for my profession was terrible and I have worked as a contractor ever since. No healthcare until the ACA said the temp agencies I work for had to provide it, and then the bare bones catastrophic policy. At one point, my employer policy had to tell us they weren’t legally allowed to call the policy health insurance in Massachusetts because the plan covered so little. So I have been on my husband’s policy for years. He works for our state as a teacher. The coverage was good at first, but as our state chipped away at school funding, they also chipped away at our health insurance benefits. Health insurance is our biggest bill now. I recently had to have some testing done for a chronic health condition. I met my deductible. But insurance has barely paid anything, and I have huge bills. I am close to the same age as you are and am focusing on getting as healthy as possible in the new year, because I can’t afford to be sick.

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