Friday, August 24, 2012

Health Insurance and Heartburn


{Photos by Katie} 

I believe there are several 'necessary evils' in life, including, to a certain extent, taxes, pollution, and insurance. While I'm a firm believer in and staunch supporter of capitalism, I find it rather twisted that healthcare, specifically health insurance, has become a publicly traded, for-profit multi-billion dollar empire. This means that the people who happily collect your premiums, the people who should have your back if anything were to happen to you, are doing everything in their power to draft contracts with enough exclusions that they won't actually have to pay out when your ox is in the mire. 

Jay's employer does offer health insurance coverage, but we can't afford the extra $545/month it would cost to add me and Kate to the plan. As a responsible citizen, I believe in being insured, even if I have to pay for it myself. Unfortunately, it is impossible to buy an individual insurance plan that is equivalent to even the crappiest group plan. The specific problem I am running up against, of course, is maternity coverage. Of the hundreds of individual health insurance plans available here in NV, I've found two  (2) that offer maternity coverage: both HMOs, both with one year waiting periods for not only labor/delivery costs, but also for prenatal care. Meaning that if I wanted my prenatal care covered, I would have to pay for this plan for a year before I even started trying to conceive. Aside from the sheer audacity of some corporate entity trying to control my reproductive life, it is mind-numbing to me that insurance companies can pick and choose which parts of me they deem worthy to insure. Heart? No problem. Legs? No sweat. Uterus? Nope. Especially in an era where the law states a fetus is part of a woman's body rather than an independent life, doesn't it make even more sense that insurance should have to cover it?

Isn't it a complete contradiction that they will pay for birth control pills, sterilization, and Viagra, but not for pregnancy? It makes me furious to the point of trembling and tears that women's rights--my rights--have been so universally snubbed in this manner. I see several major issues with this practice; here are a few of them:
  • Pregnancy is a natural, common, physical and medical condition, a normal part of life. It is unethical, unfair, and wrong to exclude it from coverage.
  • Lack of coverage for pregnancy and delivery encourages abortion. 
  • Maternity coverage should not be optional. Optional maternity clauses encourage only women who are planning on pregnancy to seek coverage, which significantly increases risk that the insurance company will have to pay out. 
    • Women without maternity coverage are up a creek in regards to unexpected pregnancy.
    • If maternity coverage were included in every plan, the risk would be spread across a wide population and premiums would significantly decrease for women seeking maternity coverage and only slightly increase for everyone else.
  • If child-bearing women don't have access to maternity coverage, hospital prices will necessarily increase due to uninsured women unable to pay bills.
Another women's health issue that virtually no insurance plans cover, save a few highly expensive corporate ones, is infertility, a medical condition that affects the body and impacts quality of life. It can be reversed or improved in most cases with varying degrees of medical treatment. How does it make sense that insurance will cover self-inflicted injuries or lung cancer caused by voluntary tobacco use (as it should), but it will exclude coverage for a legitimate biological deficit? Some people have cancer or diabetes or depression or hormone imbalances. I have infertility. It's not something I brought upon myself. It's hereditary. It's something that's wrong with my body that I should be able to get treatment for under my insurance plan. 

And while I'm ranting, did you know women pay much higher premiums than men their age, even without maternity coverage? Like, 150% higher?

Does it make sense that erectile dysfunction and birth control are covered benefits and pregnancy and infertility are not? It's like insurance companies will acknowledge reproductive health as long as it doesn't deal with actual reproduction. Speaking of which, where are all of the women's reproductive rights activists? They march in parades for the right to abortion and easy access to birth control, but they're nowhere to be found when it comes to fighting for the right to conceive or bear a child. It's like they've forgotten "reproductive right" refers to having children, not just preventing them. It seems that women's health in politics is polarized into caricatures: the left pushing for abortion and birth control and ignoring that there are those who actually want to be pregnant, the extreme right assuming all women should want to be mothers and denouncing contraception and all abortion. Really, both issues are flip sides of the same coin. If all of the above are legal, it is ridiculous that one should be covered without the other.

I wish I had the ability to put together persuasive arguments with organized points, but as much as I love the written word, that's not my strength. So, though this is little more than a rant, I think it's important to put it out there--if nothing else, to increase awareness. 

I disagree with most forms of government interference in my life, but I am grateful that stupid Obamacare does make it mandatory for most insurance plans to offer maternity coverage. I don't agree with the majority of the other 1,500 pages of it, and there were better, easier, less invasive ways to bring about healthcare change, but if it had to pass, I'm glad that's in there.

And in case I made you wonder, I'm not looking to have another baby anytime soon, but I would like coverage all the same. And if you're wondering what our decision is to this dilemma, it's probably going to be cheap individual insurance without maternity coverage but with a complications clause. We'll save up to self-insure and pay for my infertility, my pregnancy, and the birth of our child ourselves.

31 comments:

  1. Here, here! I think it's ridiculous that maternity coverage is so hard to find outside of an employer provided plan. In Missouri, it is literally impossible to find a private insurance plan that covers maternity beyond complications. They simply don't exist, so the only fall back plan if you don't get insurance through work is to go with Medicaid or come up with the thousands of dollars yourself. As my husband wants to become a free-lance artist in the future, we just have to hope that we have all our children while insured through his work, or that we manage to have enough savings to cover any costs ourselves. And some women rant about how "unfair" it is to "require" them to pay for their own birth control! I tell you, having a baby costs a heck of a lot more than birth control does!

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    1. Agreed! Hopefully in the next few years it will become possible to get maternity coverage from individual insurance.

      If your husband does become self-employed and has an LLC, you will be able to set up your own "group" plan that you will be able to design to meet your needs, including maternity coverage. Something to keep in mind as it gets closer...

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  2. Hey! Lets start a group!! I forgot how feminist you were...Good rant!

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    1. Hazel, I miss you! Remember that time in Ostler's class when we made the Barbie movie? Good times.

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  3. society does not want you to have babies..just sex.

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    1. Exactly! The "pro-choice" people always think the choice is to have a baby or not, not to have sex or not.

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    2. So true. It's a backwards way of thinking.

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  4. I wrote the President a letter at the beginning of this year pointing out how anti-child his health care bill was by covering the prevention of children (contraception) but not the creation of children (infertility). The letter I got back was disgusting in its ignorance (http://www.missgiggles.com/blog/2012/05/the-problem-with-form-letters/). It's a sad commentary on our society that ED is more important than IF.

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    1. Very eloquent letter. It's astounding how anti-family insurance and healthcare legislation is, isn't it? They cover abortion and treat pregnancy like a disease and throw contraception at you, but they won't cover pregnancy or infertility. Makes my head spin.

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  5. Oooh this hit so close to home for me! Yes, welcome to Nevada where health care sucks! My mom tried to talk me into driving to St. George to deliver Nora, and I am not going to lie, I may consider it on the next one. Not that I don't love my dr. I do. We pay over $700 dollars a month for me and the girls to be insured through Neils office. I am not going to lie, it's more than our mortgage! Ridiculous. You will notice that a LOT of women around here have babies at home. My hospital/doctors bills for Nora came to 18,000 dollars. And I didn't even have an epidural or c section! Luckily once we met our $6000 deductible our insurance covered the rest. I do know a little about hospitalization insurance (like Aflac) that will pay out when you have a baby, since you are in the hospital. But you there are limitations about when you can have a baby after starting the plan, which is fine if you can really plan a pregnancy, but if not you could be paying for years on a plan that is not paying out. Sigh. So so frustrating. After almost 3 years of living here I think I am finally over it, almost.

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    1. Who knew I would start considering an unmedicated birth just to avoid the epidural bill?

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    2. Preach it, Lindsay! And they accuse the GOP of being anti-woman! I think there is plenty of misogyny to go around, thank you very much. I think this "war on women" would be more aptly named the "war on children." All the rhetoric about reproductive rights centers on the assumption that the most horrible thing that could happen to a woman is to have a child. And this is going on at the same time children have fewer freedoms than ever before. School officials across the nation keep having to cut recess as well as anything that makes life worth living for an elementary schooler (music, art, PE).

      http://www.dailymail.co.uk/news/article-462091/How-children-lost-right-roam-generations.html


      As it happens, I know two women in my vegas area who had two babies each at home. I could put you in contact with them if it's something that interests you. They will rave about how wonderful they thought it was. WAY cheaper than having the babies in a hospital. Unfortunately, the laws in Vegas are really unfriendly to midwives, so you can't even have a Certified Nurse Midwife deliver your baby in the hospital (which is how both my boys were born).

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  6. I'm standing right there next to you. I believe our health care system is a mess, this is just one of the many examples of problems. And of course it hits close to home because a) I love you, b) I'm a woman, too and c) I hope to have a child. The reason I fought, fought, fought for a W2 instead of a higher salary with a 10-99 is because of insurance. I was on my stepdad's plan until December when I turn 26 and I knew I needed to become insured. I am grateful for the insurance I have through work, so grateful. That being said I still don't feel 100% confident in my insurance, I know it's a pain to communicate with insurance companies and let's face it, you nailed it, they don't have our best interests at heart. This is a little big picture, but I'm starting to realize how dog eat dog world things are, and insurance is exactly like this. I'm saddened that companies aren't standing up for what's right. This was a great post Lindsay, you are so eloquent and I love reading your take on political issues.

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    1. So proud of you, Katie! It's crazy how we try to be responsible citizens but the system doesn't allow it. I know how you feel about not being confident in your insurance--it's sad. Necessary evil. But mostly sad.

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  7. You write so eloquently! This is an amazing post. I can completely relate, too. When we first moved to AZ, we used Jeff's insurance through school and it cost us so much! When we looked into covering me and the kids on our own, we had the same problem with maternity coverage. We ended up paying out of pocket for our 3rd child, and I was grateful that the hospital had a discount plan they could offer us. I did go unmedicated to avoid the epidural bill (and almost failed at that). I hope you are able to figure something out! (And thanks for letting me peek in on your life when you post. Kate is so cute! I love your writing too. So beautiful!)

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    1. Thank you, Michelle! It's a crazy, backwards society right now. Your family is beautiful!

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  8. We just pay a ton for family coverage... Insurance is a bummer sometimes.

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    1. It's true--and if it were a good insurance plan, I'd probably bite the bullet and pay the $545 (which I realize isn't expensive compared to what some pay). But under this plan, if I had a baby, I'd have to pay $60 copays for OB/GYN visits, meet a $5000 deductible for the delivery and then pay 50% coinsurance until I reached my $8000 total out of pocket limit. Plus, it's not HSA compatible. In the end, crunching the numbers, it's just not worth it.

      Insurance is definitely a bummer.

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    2. Yeah, not sure I would pay it either. Good luck. Our insurance isn't great, and this is by far our most expensive baby, but with out NICU bills coming up, I'm glad we had it...

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  9. I suggest you move to Wisconsin. Our insurance is a breeze compared to what we had in Utah. (we still get a random cancer related EOB) and our experience with insurance in Utah was pretty positive. Also, if you move to Wisconsin we could be neighbors, I could meet my namesake, and think of the cheese.

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    1. Katie, Josh also works for an awesome company that probably provides great benefits. Maybe the individual insurance plans are better there, too--who knows? I've heard great things about Wisconsin--maybe we'll just have to come visit!

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  10. I feel your pain! When Kevin was in dental school, and we wanted to get pregnant again, we didn't find one insurance carrier that offered maternity. It is so frustrating! I am just grateful that Kevin created a PLLC with me as his employee so we could qualify for a group coverage plan for maternity purposes. Healthcare is such a mess and such a hassle to deal with. Good luck with it all! You should just move to Corpus Christi and work for Vela, then your problems will be solved ;)

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    1. Ash, that is definitely one bummer about being an employee rather than a contractor! When we own a practice, though, we'll be able to pick out our own insurance plan like you. Just gotta hang in there a couple more years. And if you're here working with us, we can pick the plan together! :)

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    2. Why are we not all working together? And not in El Paso either... Sounds like a great plan to me.

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  11. I'm with you on this!! We were in your same position exactly one year ago trying to figure out what insurance to buy. We ended up with an HSA, but it has no maternity coverage, so we will be paying completely out of pocket when we have baby #2 eventually. I called up and got all the cash pay costs so we can know what we need to save up for. $1800 for all maternity care and delivery by midwife if paid within 30 days of first visit. $2,300 if paid after 30 days. That includes all care, 3 ultrasounds, etc. $3400 for a vaginal delivery at the hospital. Plus some random lab fees that I couldn't get an exact number for. An epidural will cost $750. And a c-section will be $6,700. Our insurance will kick in with a $5,000 deductible for an e-mergency c-section if that is the case. So needless to say we need to save up a ton of money before we have another baby. UGH.

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    1. Good for you on doing your research! I don't have a doctor here yet so I haven't been able to ask around about pricing. It all still makes my blood boil. And don't forget baby's hospital stay fee! I still can't figure out how they could charge so much for Kate's stay when she was with me 95% of the time. Other than a bath (which Jay did), vitals, and maybe a couple lab tests, we took care of her.

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    2. Good point! I know that included a 48 hour stay... but I don't know if that is just for the mother or if that includes the baby. Guess I will have to call and figure that out too! More to save for... oh joy!

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  12. I don't know if you remember me from Leon Valley ward, but I check in on your blog. Anyway, I have shed many, many tears over this. I would like to have a third kid but it is so difficult to figure out how we will be able to afford it! I ended up with the same insurance as Jenni. If I wanted the two boys and I to be on my husband's work insurance (which did provide maternity coverage), it would have been over $1200 a month!!!!! Yah right!
    Our state does have a plan for a vaginal birth that would cost just over $3,000 for doctor appointments, epidural and delivery, but you have to delivery at the county hospital downtown. I don't know how it would help if there were complications though-- because, you know, everyone can plan whether or not there are going to be complications...

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    1. Of course I remember you. I have certainly cried in frustration at the injustice of it. The system is blatantly anti-woman, anti-choice, and anti-family. I don't know how I'd feel about the county hospital delivery--in my experience, anything government-funded is generally crappy (facilities, service, prompt attention, etc.). Maybe it would be worth it. Have you looked into how much the insurance would cost just to add you and get a different plan for your kids?

      The other thing we're considering is if I happen to get pregnant around the time my husband's work insurance has an open-enrollment period, I'll jump over to his plan for the duration of my pregnancy. There's one month a year when you can enroll in the work insurance plan, and they will cover you even if you're already pregnant (at least in NV, but pretty sure it's everywhere). If you can time it right, that might be worth looking into...

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  13. Good news is, beginning in 2014, all pre-existing condition exclusions for adults will be be removed, including pregnancy. In the meantime, it is advisable that women get health insurance cover before they actually fall pregnant as all pre-existing health conditions are still excluded for cover when you join.

    Regards,
    Laura from medicalaidquotesonline.co.za

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