Tuesday, August 4, 2009

Health Care Needs to Change

The health care system in American needs reforming. This has nothing to do with Obama's plan. This has to do with the fact that medical related companies take advantage of the uninsured and being uninsured is awful.

After we got Jackson home from the hospital, Noelle remembered to check on adding Jackson to the insurance. She logged on and saw that Jackson was listed on the policy. Well, "Baby MacGregor" was listed. She was relieved and went about her business. EOBs (Explanation of Benefits) arrived and his bills were being paid. In June Noelle called the insurance company to find out how to change Baby MacGregor to Jackson MacGregor. After asking her 100 questions to make sure she was Noelle, they pulled up the plan, and told her it was easy, just to contact HISD. Jackson got sick in July. He went to the ER and had a follow-up at the doctor. Then, days later, he had his 2 month shots. The next day we received a call from the doctor's office stating that Jackson's claims were denied because he did not have insurance. After calling the insurance company, we were told he was added to the policy for one month and then deleted because we did not add him ourselves. He had been without insurance for over a month. We were horrified and could not believe it. After speaking to many "managers" we finally found out about an appeal process. We did not tell our family or friends because we knew our parents would worry. Nearly a month later, and many phone calls later, we found out (today) that our appeal was approved (and it was retroactive back to his date of birth). Living a month in fear that Jackson didn't have insurance (and couldn't be added until he was 7 months old) had us living in terror. Not having insurance is one of the worst things, especially when it's for a newborn baby.

In addition to not having someone pay part of your medical bills, the doctors actually charge you more, for the exact same thing, just because you don't have insurance. It's insane. If you get in a wreck, and you don't have insurance, the body shop doesn't jack up their price. "You're poor - let's change you more."

If you look at your EOBs you will notice that it shows two prices:
1 - How much the dr/hospital/etc would charge you if you didn't have insurance
2 - How much the dr/hospital/etc is charging because you have insurance

This is not taking into account the amount your insurance pays for you; this is just what the office is charging.

When Noelle had an epidural during delivery - the amount she would have paid if she didn't have insurance was $5000. Since she had insurance, the charge was only $755. We only had to pay a little over $100. The doctor does the exact same thing for both types of people and uses the exact same supplies, but would charge an insured person 15% what they would charge an uninsured person. Thanks to insurance we paid 2% of what an uninsured person would pay.

Something needs to change.

And we don't want to hear anything about your thoughts on Obama's Health Care Plan. We're just saying the system is broken, and it has been a very stressful month worrying about our son's insurance.


Bethany said...

That's ridiculous and it does need to be fixed. I'm just not sure the government can do it. That, as you know, is my issue. We need companies to be more socially conscious...I'm just not sure how we get there.

As for charging more if you don't have insurance...know someone else who does that? Auto body shops. Also annoying.

The Kemps said...

SO relieved for you guys. Also thankful for the heads up - by you sharing this story let's hope more first-time parents can avoid this scare.

The Carter's said...

I remember Will was automatically added to my policy for his first month, but I luckily had a very nice HR manager tell me--specifically--that after that month I'd need to add him myself or find other arrangements. They didn't want to keep him on mine if that's not what I wanted (adding an add'l member on my insurance policy is an extra $100/mo). I'm sorry you found out the hard way--it's scary thinking this tiny little person you're responsible for (who will need to see the doctor, often, at this point is life) was without that insurance.

I thought docs jacked up the price b/c, if you pay out of pocket, they're more likely to negotiate with you on the cost. Sort of like haggling down the sticker price. I'm not saying I agree with it...

Anonymous said...

Whew, that is scary...glad it worked out. I am going to tuck that little nugget of information away for the future.

penny Morris said...

I am glad that all worked out! That was scary!! When I applied for Neil's insurance, his card had the wrong primary health care on it. They wrote down Stephen's by mistake. I called to switch it and at first they were telling me that I had to wait x months. Luckily as he looked further he was able to do it. We didn't have to go down the road of that was your mistake because I filled out the form correctly. But I was panicking at first too. There are serious problems when my friend's husband would have to pay $700 a month to have a family of three insured! Ridiculous! And health care companies could care less what happens as long as they get paid. Greed is the downfall of many things.

Noelle MacGregor said...

We're very lucky they approved our appeal. I also added disability insurance, so I will get paid 66.67% of my salary next time I am on maternity leave! Better than nothing!

dougnlarry said...

That is total crap. The whole system is screwed up. I'm just not sure what the best way to fix it is.

I'm glad the appeal was approved. How scary for you all this last month or so.