Tag Archives: Insurance

The Insurance Shuffle

4 Apr

A-one, a-two, a-hinka dinka doo.

April is “open enrollment” month, which is that single month of the year when you can make whatever changes to your policy you want for no reason whatsoever.  Rather than having some sort of sensible rule like “you can’t change your policy more than once in a six month period” or “your policy changes are dependent on the start date of your policy” or even “change your policy whenever you like, we’ll tell you whether it negatively affects your rate”, no.

YOU CAN ONLY CHANGE IN APRIL WE LIKE APRIL CHANGE IT THEN.

Bee bop a-rebop.

The amount an individual pays into health insurance over the course of their lifetime will always be less than the total benefit they receive.

Seriously.
It’s not even close.

“Hi, my name’s Jeremy.  I’m calling about my insurance plan because I know we’re coming up on open enrollment.  Currently, I’m in Elect Open Access and I was wondering if that’s the best policy for my wife and I to stick with.  Thing is, she’s pregnant.  It’s triplets, actually, and that means she’ll probably be hospitalized a while and there’s a chance the three babies will too.  Since we’re headed for this big life change, is there a switch I should be making?”

“Uh.  It’s up to you.”

“Right.  I know.  But could you assist me?  I don’t really understand the ins and outs of these policies.”

“It’s right there on the benefits sheet.”

“Yeah.  But if someone could maybe walk me through a couple of scenarios to see if… er… I’m sorry, can I get some sort of advisement?”

“Not really.”

“Not reallly?”

“I can email you the benefits sheet again.  How about that?”

Slide to the left.  Slide to the right.

Frustrated, I talked to my dad.  I probably should’ve gone to him first, since he actually sells this stuff for a living.  He looked everything over.

“Two things, Jer.  One: I’ve never seen insurance this expensive.  Is this typical for California?  It’s ridiculous!

“I don’t know.  I guess it’s typical.”

“Two: how much of this are you actually paying for?  What’s your employer’s contribution?”

“They contribute $125.”

“Uh huh.  You know what I’m thinking?”

“Is it along the lines of ‘Sayonara California’?”

“You said it, buddy.”

Step-ball-change.

It’s more or less a given that triplets are going to experience time in the hospital NICU.  Probably weeks.  Carey had heard about a special program in California in which the state takes on the financial burden of NICU care for newborns.  Of course, this is all dependent on a family’s income.  And since we’re part of the ever-shrinking middle class, having triplets, it’s very likely that we’re poor enough to need it desperately, but not quite poor enough to receive it.

Rather than messing with CalChoice (the network that networks HMO networks), I decided to start calling the HMOs themselves to get a straight answer on what this is going to cost.

“So, I’m looking here at the benefits and it says ‘Hospitalization Services’ includes ‘pregnancy and maternity care’.  $450 copay per day, with a maximum out-of-pocket of $1,800.”

“That’s correct, sir.”

“Okay, so I have a question on that.  And I apologize for how specific I have to be about this, but it’s the reality of what’s coming up for my family later this summer.  Here’s the situation: let’s say my wife has to go into the hospital for bed rest at 28 weeks.  She stays in the hospital until she’s at 34 weeks, at which point our doctor performs a C-Section and the babies are born.  Triplets.”

“Okay.”

“But there’s a problem, see, and two of them need help breathing and there are all sorts of weird complications.  They’re premature and they need to stay in the NICU for weeks.  Multiple weeks.  Meanwhile, my wife’s recovering from the surgery and on and on.  So, two months after she first went into the hospital, everyone goes home.”

“Right.”

“You’re saying all that… everything… that’s one, single out-of-pocket for us of $1,800.”

“Correct, sir.”

“!!!  Are you serious?  That’s incredible!  Months in the hospital and we get hit for less than $2,000?”

“Yes.”

“That’s the best news I’ve heard in months!  Wow!  Thank you!  We’re definitely switching over to you.  Ah, that’s so great.”

“Glad I could help!”

“Now, is there anything else I should know about that scenario?  Anything I might get surprised by?”

“Well, one thing.  Let’s say the newborns need to stay in the NICU longer than your wife’s recovery.”

“All right…?”

“Say your wife needs a week to recover, but the newborns need several weeks in the NICU.”

“Yeah, that could definitely happen.  That changes things?”

“The day your wife leaves the hospital, we need to start treating the newborns as separate copays.  They’re now individuals, requiring their own special circumstance.”

“No more $1,800?”

“Well, no.”

“What would I need to pay?”

“It depends on how long the newborns stay in NICU and what they need.”

“It’s suddenly a hell of a lot more than $1,800.”

“Well, yes.”

“How much more?”

“Well, let me look up your maximum annual out-of-pocket-for-family.”

“Because we’d definitely reach it.”

“Oh, sir, yes.”

Lean back. Lean back.

So, we’re now in April and I need to submit our Renewal Change Request forms in the next couple of days.  Unfortunately, there is no special “in case it’s triplets” gift basket from insurance companies and it’s all about keeping things as cheap as possible.  I’m looking at several options that all look good, all with different caveats that could turn evil in a hurry.

That California NICU money?  Who knows.  We can apply and see what happens.

Will Carey be in recovery as long as the newborns are in the NICU?  Doubtful.  But it’s possible if she manages to hang on to them for an exceptional amount of time before delivery/surgery.

Do I feel like I understand less about insurance than when I first climbed aboard this mad merry-go-round?  Would I prefer it all stop and take care of itself?  For just a minute?  Please?

Oh, sir, yes.

Cha cha cha!

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