Tuesday, January 06, 2009

Fixing up holes

When my husband first lost his steady job, I sprang into action and began looking for insurance. I knew the COBRA was going to be a killer, and furthermore that coverage had already been murdering us when the employer was picking up not only the premium, but funding the $4,800 into our HSA.

I was a little surprised by how hard it was to get insurance. Sure, I figured it was going to be a lot more expensive than the last time I had to provide my own coverage; I believe I paid something like $120 a month for an HMO back in the early 90s.

But I was stunned to find that we were simply flat-out denied coverage. No amount of money was going to get us an insurance plan. Based on her prescriptions (which are also used for asthma), Boo Bug was declined. Because once in 2007 he saw the doctor complaining of ‘shortness of breath’ (turned out to be seasonal allergies), my husband was declined. Danger Mouse, ADHD. Captain Adventure, PDD-NOS (which is laughable, because they refuse 99% of anything related to treatment of same as being ‘experimental’ or ‘not usual and customary treatment for this condition’).

And of course, my back/hips/knees were an automatic NO!, but thanks for calling hokay buh-bye!

The only person in this family who could easily get medical coverage is Eldest.

We were turned away from Blue Cross, Blue Shield, Kaiser and Sutter. We were told to try San Joaquin Delta because they were “forgiving” – we were too big a group of bashed up cackles for even them to stomach.

We looked into the state’s emergency coverage, designed for “uninsurable” folks like us. Yeah, uh-huh, the $3,000+ monthly premium was a tad much for us.

Finally, I put two very important pieces of information together.

One was that when it comes to group health insurance, you can’t be declined insurance based on preexisting conditions – in other words, if I had gone to work for roughly a third my usual pay and double my usual (already brutal) commute for Company X, we would have gotten automatic enrollment in their group health plan.

The other was that a group can be as small as two employees. Like, say…a partnership

It took two months of work, the collection of all forms and paperwork related to the business, a great deal of faxing followed by paying top dollar for a thick package of same being overnighted to the broker…but as of January 1, our Enterprises offers its employees a comprehensive medical, dental and vision plan, HSA-compatible. The Enterprises picks up the full tab of the premium, and funds the HSA for its employees each year.

If my calculations are correct, I just saved us over $15,000 this year.

My husband will finally get the new glasses he’s been needing but putting off because, well, we’re perpetually over-budget as it is, and the two Denizens who need them will be able to get braces (I’m sure they’ll be beside themselves with joy), and I will quietly enjoy paying nada out of pocket for cleanings, x-rays and fluoride treatments instead of $800 twice a year.

It’s a great way to start the new year, getting at least a partial patch on the medical care hole.

Now I suppose I should get on with collecting the income that pays for the coverage, huh…?

11 comments:

Mama Mara said...

Seriously, how could anyone read your story and not be in favor of universal coverage? Color me socialist and sign me up!

President-Elect Obama (I voted for you, yo!), hope you're reading this. We need help.

joylee56 said...

Can I push Mama Mara’s comment one step further? Go to Obama’s website and cut and paste your post into the spot where he’s asking for input on health care. Cause you are one of the *lucky* ones in this regard. Both my husband and I are self employed, but we’re in different businesses so no can do a partnership (or LLC so don’t suggest it). I’ve lost track of the number of health insurance policies we’ve had canceled on us because the company decided it didn’t want to do private coverage in this state any longer. Just because the state insurance commission had the gall to tell them if they were going to do business here they actually had to, you know, *pay* claims. Why the nerve!

And then there is the not so little matter of the premium.

So, yeah, we really need to light a fire under those guys in DC on this. Health insurance costs should not be the second biggest line item on my P & L.

Galad said...

We are in the same position with my husband and I owning separate small businesses. We are totally uninsurable on the private market.

Congrats on finding a way to get the coverage you need. I'm hanging on to my COBRA as long as possible and then we'll see what one or the other of the businesses can do.

Anonymous said...

You are brilliant! Congratulations, that is a HUGE savings!

meezermeowmy said...

what a wonderful use of the cunning all knitters possess. Who knew one of your proudest FO's would be an insurance policy?

Congratulations!

jwordsmith said...

I'm wearing $50 glasses from Goggles4u.com. (And I have the kind of prescription that makes Opticians say, "Ooh, this'll be a challenge". -14, anyone?)

Go there through the sidebar link on Glassyeyes.com and save another 5%.

You still need a prescription, but then you email it to them and a week later you're wearing new glasses.

Elizabeth L in Apex, NC said...

Wow. I honestly can't remember the last time I did anything at all that saved $15,000. :)

Firegarnet said...

Sometimes I wonder if you just saved (really put that money in a bank) the fees for insurance if perhaps *that* would pay more than the insurance would.

But I'm one of the uninsured who also can't afford to get, well, sick. Or hurt. Ever.

Insurance=legalized gambling. Methinks. And doesn't the house always win? Ah, cynical generation X.

Dysd Housewife said...

Girl I hear ya. DysdHubby purposely took a 5 thou paycut, to move to a job that offered a group plan. Blue Cross Blue Shield full coverage for a family of 6?? TOTALLY worth the paycut and then some.

Steph B said...

Oh my gosh. SO glad you were able to work all that out! I really think you're a genius. Wow.

PipneyJane said...

$3,000+ PER MONTH? That's daylight robbery! How do they expect people to actually afford to live and pay their health insurance? No wonder 45 million Americans have no health cover (also no wonder medical bills are the number one cause of bankruptcy).

The next time someone whines, "but if you have universal coverage taxes will have to go up", remind them that even if taxes went up by 10 cents in the dollar most Americans would be financially better off because their current health insurance costs so much more than that.

- Pam (believer in socialised medicine)