Saturday, January 5, 2008

Why I hate health insurance companies, part twenty

I know, I know. My health insurance saga is not a pretty one.

My husband and I are both writers so we pay for our own health insurance. Because we live in NYC's unofficial 6th borough, Hoboken, we have to abide by NJ health insurance rules rather than NYC ones (even though all our doctors and our hospitals of choice are in NYC--best health care in the world.) From what I understand, and I could be absolutely wrong, so correct me if I am, NJ is so expensive because of medical underwriting. Get sick in a NY hospital and need a kidney transplant and insurance can deny it. Do it in a NJ hospital and they have to proceed. That's why it's so much more expensive.

This means our insurance in extraordinarily expensive because we have to pay for it ourselves. It also means a high deductible and fighting the insurance company on just about every issue. I've gotten used to using the phrase, "well, my attorney says..." and I now am armed with this fantastic woman whose job is to fight these companies for the coverage they categorically deny.

This means that The Writers Union won't insure us because it's too expensive for them to insure anyone in NJ, plus they've had far too many insurance companies cancel coverage for their members in midyear, so now they are only insuring NY.

This means the Author's Guild won't insure us because it's too expensive--well they will if we want to pay $2550 a month for insurance. Isn't the Author's Guild job to HELP writers who are not exactly rich?

This means that TEIGIT (the entertainment industry insurance) will ensure us for a mere $1600 a month.

Our insurance now is only 80 percent hospitalization. Think that sounds good? Last year I had a high fever and went into the hospital for one day. The bill was ten thousand dollars, and it would have been more but most of the tests they did were done in the Er which was fully covered. Turned out the fever was nothing and I had to get a pay plan from the hospital.

But wait, there might be hope on the horizon, and I don't just mean a democratic president--though I am not overly impressed with any of them, to be really truthful. Working Today, the Freelancers Union is a fabulous organization. They offer health insurance where the rates for us, while not cheap, are at least doable. But we need to prove billable NYC client hours. I'm not sure if selling a novel counts and how can you prove how much time you spent reading books to review them for NY sources? It's confusing, but at least it is a glimmer of hope., another fabulous place also offers insurance, but I'm waiting to hear from their agent. Of course, as soon as I said New Jersey, there was that pause....

I hate doing this every year when the rates rise and rise and rise. I hate having to research plans because I don't really understand them. I hate having to learn to understand them. I hate having to pay exhorbitant sums for insurance and then have to still fight the company to get anything paid for.

If anyone knows cheap decent, non HMO (oh, the horror!) insurance, please contact me and I will knit you a silk scarf or mittens or bake you cookies or edit your novel. You can call me on the phone and I'll listen to your personal problems for three whole weeks!


M said...

I'm glad you got a lawyer to help you fight the ins. cos. As for affordable, decent health plans, it really is tough, isn't it? Our system needs a lot of work. I don't have any answers unfortunately. I have very similar problems myself, but I wish you luck. And I pray our system changes thoroughly and quickly because more and more Americans are going to struggle with these types of problems--so many already are. We are truly long overdue for a serious overhaul.

Unknown said...

Have you ever heard of an HSA (health savings account)? i imagine you have, based on your legal contacts, but this might be news for someone else like it was for me. i just learned about HSAs in july, and have since started putting money into mine. i wish i'd learned about it sooner, because the money is tax deductible and can be used to pay not only for dr. visits, dental & eye care, and prescriptions, but also for many over-the-counter meds, etc.... i think the maximum yearly investment is about $2,800 for a single person (not sure for a family). it is like a savings account because the funds are invested and accrue interest, and the money does NOT have to be spent by any yearly deadline. the thing is, in order to have an HSA you must have a 'high-deductible' (for me that's $2,500) insurance policy; sounds like what you have. the difference is that i live in austin, texas, and my blue cross/blue sheild HD policy costs $175 a month. [given this state's politics, i think they tried to change the name to red cross/red shield, but could not for obvious reasons. even more astonishing is that my car insurance costs $300 ... per YEAR!!!] BTW, i'm a friend of Peter Salzano's, and have been since high school. (you and i have met.) i lived in nyc for over 25 years before coming to austin to start a business in '04. i went without insurance for two years before i could even afford what i have now. clearly there's a price that comes with living in the '6th borough.' for me it was imperative that i leave manhattan - arguably the '1st borough' - because i was burned out on the city [well, there were a lot of reasons, but living in 300 sq. ft. for so many years was surely one of them]. the gift of being a writer (and i think you'll agree there are not many gifts associated with that profession) is that you can live anywhere. aren't there other places in the country that appeal to you? now if, in addition to being addicted to knitting and chocolate, you are addicted to Hoboken, then you and your husband will be in my prayers. [have you both considered drug or alcohol addiction? all-in-all, i think they would be cheaper.]

Caroline said...

Hey RIP, thank you for the long and thoughtful resonse (any friend of Peter's is a friend of mine.) Having a child makes moving more difficult, because there are always schools and his community to think about--plus the places we'd want to live (NYC, San Francisco, Boston) are just as expensive. Austin is pretty cool--I could never consider it Texas, though, and I rememer the bats with great fondness.

You know, I have heard of an HSA, but for some reason I thought they didn't cover as much. What happens if you need to go the hospital and your bill is half a mill? And you only have $5,000 in your HSA? Is that covered? I think I'll go look tht up more--maybe I'm wrong.

I'm so jealous of your health insurance policy--let'
s hope the country turns blue and something is done about this whole mess!

Sarah Lin said...

insurance companies give respect when we are trying to get insurance, when it comes to claims irresponsible work will shown by them.

Anonymous said...

Health Insurance has been a major problem for every one but its better than having something than nothing

The Insurance Toolbox Blog said...

Hey Caroline,

Have you consulted an agent in NY? A good agent is free to use and a good one may find options that you did not know about.

I don't know NY, I only know CA insurance but I would highly recommend consulting one or a few seasoned agents who could help you. Don't do all the work yourself,