Uh Oh, I Didn’t Expect That: How Medical Surprises Affect Us—Part 2: Health Insurance

by Sandy Bregman

As I was saying in my last blog, all the debates about healthcare and insurance coverage for everyone these days remind me of some frightening issues I’ve faced concerning health and care and coverage.

In my last post I wrote about my experiences in Africa and the healthcare I received or might have received out of this country years ago versus the care my mother received on the last day of her life.  In this post I’d like to discuss what happens when you get sick and have no health insurance, and what legislators and news commentators are talking about when they say that “many people choose to go without health insurance”.

In addition to being a member of the Arizona Bar I have also been a member of the Oregon Bar.  When I joined the Oregon Bar I was able to obtain their Group insurance with Blue Cross Blue Shield, with good coverage for my family at a reasonable rate.  All went well for ten years or so until I received a notice that the Bar would stop carrying group insurance, but “not to worry” because policyholders would be able to transfer to a private policy at a comparable rate.  When I contacted the insurance carrier in Oregon I was told that they couldn’t help me because my primary practice was in Arizona.  The problem was that this all happened while I was in the hospital, and suddenly I was looking at possible financial ruin for my family.

I was in the middle of what turned out to be a two month hospital stay with three major surgeries, intensive care, continual tests, and the expectation of fourth surgery in the near future… And I wondered, would I still get those things when my insurance was cancelled?  I had great coverage when I went into the hospital.  Would the old policy cover the expenses as part of an ongoing condition and hospital stay until I got out?  Would I be in the hospital with no coverage at all?  Would I ever get insurance again?  Would I be able to afford the doctors, the medicines, the expected and the unexpected continuing medical costs?

An insurance agent we knew was able to get me a decent policy, but the cost was $2500.00 per month.  It was probably our largest monthly bill at the time.  That is a large amount even now, but 10 years ago it was outrageous!  But they accepted my condition as a covered event after the old insurance ran out, so we felt we had no choice.  To not take the policy would have meant we paid all medical bills out of pocket—and they were substantial.  We had co-pays and deductibles, but nothing compared to what the insurance ultimately would pay.  We would pay $30,000.00 a year just for the insurance until we could qualify for something better.  They still wouldn’t make a profit on me for a while.  How we would do it I had no idea.

My experience is very similar to the experiences of those going through a divorce. In a divorce the dependent spouse on the health insurance policy will not be able to remain on the policy.  The children may remain as dependents, but the ex-spouse must either convert to a Cobra policy or make other arrangements.  If you are that spouse and you don’t have access through your own employer or other group to obtain a policy in your own name, you may be looking at getting a Cobra policy.  This is intended to be a temporary stopgap solution when you lose access to a group policy.  But even Cobra is not a viable option for many people.  Those who can’t afford it will have to go without insurance.

In the debate over health care some will claim that these people “choose” not to take Cobra or to get health insurance.  But what choice do you have if outrageously expensive policies are forced on you by circumstances?  We all have expenses to be paid:  housing, car and gas, food, utilities, and children’s needs to mention only the most obvious.

Where does health insurance fit in the budget?  If you are healthy and have been in the past you may “choose” to pay for car insurance and gas to get to work every day rather than pay for health insurance, but it is a gambler’s game.  None of us can ever know when we—or our children—may need extensive health care.

Even if we were to vote for universal health insurance or healthcare in our country, there are a plethora of problems that will remain.  They are here now.  But we have to start somewhere and we have already taken so very long to get started.