From the Blog

Fun With Self Employed Health Insurance, The Final Part (Contains Swear Words)

Okay, sorry. This was supposed to be one post about getting health insurance, and it was supposed to be this actual story I’m about to tell. But I guess I was pent up about all this, and it resulted in me writing Part One and Part Two. So here’s the story that got me thinking about health insurance, and I promise tomorrow, I’ll go back to writing stories about cat puke.

We quit our jobs to build our own company. So that meant we needed to get independent health insurance. Researching health insurance is a HUGE PAIN IN THE ASS. I did use healthcare.gov and it was helpful. But when I entered our parameters, and searched for coverage in Oregon, I got a list of 113 plans. And then, if you’ve been out of the loop, or this is the first time you’ve had to “shop” for health insurance (see yesterday’s rant on the phrase “shop for health insurance”) healthcare plans can be completely baffling. Co-pays, deductibles, co-insurance, out of pocket, providers, premiums, coverage, etc. How can you possibly tell if one plan is better than another? Or maybe, on paper, it might seem one is better than another, but then there are loopholes that might not be readily apparent. That’s what happened to us.

We used a broker and he was very helpful. Since we were moving to Astoria, he recommend an insurance company I had never heard of, but he said they were independent, non-profit, local, and they serviced the smaller market on the coast. I liked the sound of all of that.

Then we needed to pick a plan. Dave and I are healthy (see my first rant on freaking out about being “healthy”) and we are under 40. And not knowing what our income was going to be, we wanted to stay under $500 a month for premiums. That seems like an outrageous amount to pay each month. That’s like, a nice car. Not a BMW, but a pretty nice car. But that’s how much shit costs. What are you going to do?


Our broker recommended a high-deductible plan where the out-of-pocket maximum was met as soon as you paid your deductible in full. The deductible was $5000. But as soon as we paid it in full, we would have no further costs until next year. The broker said this was a good thing.

I had to think about this for a while and let that $5000 number roll around in my head. I think you could probably add up all my medical costs for the past 15 years and it wouldn’t have been $5000. Dave is a different story because he’s a boy and he’s broken things while out being “athletic.” He’s also gotten stitches from various incidences in college, but none, he says were from being drunk (maybe just bruises while drunk).

We took the $5000 deductible plan, and our monthly premium was $325. Someone turns 40 this year, and the premium then goes up to $411. I filled out all the applications, got all the info, did all the research, made all the phone calls. We got accepted for coverage and it was a huge weight off my mind.

Except. When all the policy stuff, and the cards, and everything else came in the mail, it was all under Dave’s name. It was “David M. Strom + Wife.” So while I was glad that we had coverage, why in the fuck did they put Dave’s name first? And I was just “Wife”? Not even a fucking name? He had to call them and make sure I was actually on the policy, and that the card would even work for me because MY FUCKING NAME WASN’T EVEN ON THE CARDS. They assured him that I was covered and the card would work, because all they needed was HIS name and my number.

Okay? It was right around this time I wrote about now that I’m married, I’m a little less of a person. I can’t be a complete human being anymore, because I got me a husband. Maybe some women find this romantic, I sure fucking don’t. I filled out the application as “Heather J. Goguen + Spouse.” I don’t know who decided that Dave came first. Dave certainly didn’t. He has no patience for filling out forms and talking to strangers. So he has his loudmouth wife do it.

So I never really calmed down about this. I don’t think about it all the time, but it’s a nagging irritation, and I am reminded of it every time the bill comes in Dave’s name and I write the check to pay it.

So it seems like I ought to be done with this story about health insurance by now, right?

Nope.

Dave and I had a continuous small debate about that $5000 deductible. As we were picking plans, he was doubtful that we would each be $5000, instead of the combined “family” deductible of $10,000. This seemed counterintuitive to me, because it was just the two of us with no kids. Either he or I could fill up our $5000 requirement in a year, and then the plan would start paying. I was sure of this, but I called our broker just to be sure. He confirmed, yes, it would be $5000 for each of us, not the $10,000 “mixed” deductible.

To be extra sure, I called the health insurance company and spoke with their customer service. I gave the representative our policy number and she looked it up. She confirmed that it was $5000 per individual. I breathed a sigh of relief. I can deal with $5000 for one of us, but if we had to pay $10,000 up front, it would be too much. I said the policy language was confusing since it seemed to say we had the $10,000 family deductible. And she said, “Oh wait, hang on…”

And I waited. I waited to hear what she had to say. She said, “Oh, I’m sorry, you’re on an HSA plan. We almost never see those. You do have to pay the $10,000 deductible.”

So like, I’m not an angry person. I don’t live with a lot of anger. I know there are some people who turn their anger into an art form, sculpting their world view and relationships with the hammer and chisel of frustration and bitterness. I sometimes almost envy people who are so well attuned to their anger. I wish I could tap into those energy surges and release violent, primal howls that would lay waste to my enemies, and flatten cities and forests.

Who was I angry at? The health insurance company? The broker? At the HSA plan that said nothing about individual verses family deductibles? Somewhere, we were misinformed. We would not have chosen this plan if we had known the deductible would be combined. Because then, what is the point of us being on the same plan? It made no sense. And plus, I was mad that Dave had been right all along. That NEVER happens. It was all completely bullshit.

I called the broker. He apologized, but didn’t claim responsibility. And because I’m not an angry person, I didn’t press. I told him that $10,000 was too much exposure and we wouldn’t have chosen this plan if we had known. I just asked if I could try to switch policies, without jeopardizing my current coverage. He made a phone call and said I needed to re-apply for coverage because I was upgrading.

So that’s what I fucking did. I re-applied. I sent all the same information. I filled out all the forms, I sent in all my medical history, all the same shit I sent them before. I applied for coverage with a $2,000 deductible, on a separate plan from Dave. He is about to turn 40 anyway, so the cost of my upgrading was actually less than if we stayed on the same plan together. And the funny thing is, they could have actually turned me down for the upgraded coverage. And wouldn’t that be a goddamned laugh riot?

It did take forever for me to hear back from them. But there were no further questions about my medical history. I waited a month and called a few times. The silence was deafening. I finally called after five weeks and they told me I was approved.

So now, I have a separate plan with a $2,000 deductible, I will have a co-insurance of 30% after the deductible, but the out-of-pocket maximum is $5000. Dave is on our original plan by himself, but with the $5,000 individual deductible we were expecting.

So there is the potential that we may still pay $10,000 in a year if something horrible happens to the both of us at the same time. But what is the likelihood of that? Maybe a car accident, or our apartment explodes. Or maybe we are attacked by TWO hungry bears at the same time. Fine. We’ll shell out the money.

I got my policy card in the mail and it finally had MY OWN FUCKING NAME ON IT. It’s about fucking time.

Comments

  1. Insurance speak is so confusing their own employee can’t understand it. I believe I once read in a policy that the insurance company could not be held responsible for anything their consumer rep said. This was the rep you would call to clarify policy questions!

  2. From what the Internet tells me, the best way to keep from being attacked by bears is to stay away from the produce aisle.

    • OMG, Mary Sue! I was already staying away from Alaska, but wow! And he cried at the end! How scared he must have been!

  3. Aunty Laurie says:

    And WHO has Allowed These Insurance Companies to Mislead and STEAL from us like this????

  4. My college, that took me 14 years to pay off, decided once I was married my college magazine and other correspondence should have only my husband’s name on it. They don’t get my money anymore. (Mostly because Anthem Blue Cross gets it.)

  5. Don’t EVEN get me started … = )

    Our (The U.S.’s) insurance industry is the single biggest legal racket in the history of the universe, an ENORMOUS bureaucracy, and the single best argument FOR a universal health care system. When I deal with health insurance – not unlike my attitude about fast food restaurants and auto mechanics – I go into expecting to be disappointed, and if I leave without getting completely screwed, then I actually leave in a decent mood.

    But yeah. Don’t get me started.

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