My beef with insurance on THIS particular day

In My Humble Opinion
1

I am a federal employee with Blue Cross coverage for my family. My 3 kids attend 2 different colleges. Both colleges require that students pay for health insurance through the school unless they can show proof that they are otherwise insured. (This insurance is separate and distinct from the fee to receive care at the school clinic.)

Well, I figured since I already pay to have them covered by Blue Cross, I didn’t need to pay for another policy, so I started gathering documentation for them to claim an exemption and avoid the school insurance fee. Here’s where it gets interesting.

I had heard that Illinois is planning on requiring that insurance companies cover kids until they become 26, whether or not they are in school. Sounds great, I think. Until I call Blue Cross, and tell me that applies to everyone EXCEPT federal employees, wose kids lose coverage when the turn 22.

Whoops! Now I realize that we’ll have to figure our how to make sure my college senior is covered for the spring semester after she turns 22 in January, and then over the summer and during her fall semester of student teaching. Then, she’s on her own until she gets a job with benefits. I am not looking forward to either her or us paying several hundred $ a month for her to obtain insurance as an individual.

As far as my other 2 kids are concerned, if we claim the exemption from the school insurance now, and later want to get back on, we run into the possibility of exclusions based on pre-existing conditions.

So I really don’t know how my kid is going to be covered after next January, how much it will cost us, and how much time and effort it will take to figure this out. And I’m figuring that I am best off pissing away a grand or so per year to obtain completely redundant coverage for my other 2 kids, just to avoid getting screwed down the line.

Yeah, no way this system couldn’t be improved! :smack:

So what is YOUR current gripe with health insurance?

2

In my experience, there are no previous condition problems if you’re continuously insured. Isn’t that universal?

My gripe with insurance is that it doesn’t work where I’m currently working, unless I pay out of pocket then get hit for the out-of-network fee. On the other hand, false documentation is incredibly easy to get here; taxi driver even pointed out the zone as we passed through it!

(My company does have a private agreement with two private hospitals here, though, as well as medivac coverage, so I’m not really worried about it.)

3

Double-check your policy. When I was in school, my parents’ insurance covered dependent children until 18 unless they were full-time students. Being a full-time student kept me covered until I graduated college at 21.

4

I think that is technically true, but they have ways of getting around it. Private insurance companies can just refuse to accept you at all because of past health conditions. My husband and I have never been without insurance, but after he got laid off a few years ago, we couldn’t afford COBRA and started shopping for private insurance during his window of continued coverage from his employer. He was rejected by the first company we applied to because he has ADHD and had taken Wellbutrin for it in the past and was therefore a ‘mental health risk’ or something like that. If one of us had something major in our past like cancer I can only imagine we would have been uninsurable.

Luckily we were able to find another company that would take him. You can also get denied coverage for not filling out the lengthy questionaire (and answering the grilling from the insurance agent) 100% correctly, or even forgetting something in your health past, however innocuous. So if you get, say, breast cancer 1 year after taking out the policy, and they find out you saw a dermatologist once 3 years ago for a mole (even if it was non-cancerous) and forgot to tell them about it, they can deny you.

Thankfully we are now back on BCBS through my employer. Shopping for private insurance was a PITA and expensive.

5

It’s been about a billion years since I needed to know the answer to this, but check with your HR: I believe your daughter will be eligible for coverage via COBRA for 18 months after she is no longer eligible for group coverage because of her age or loss of student status. And hopefully by then she will have a job with insurance. But as a Federal employee, you probably have just about the best rates and coverage out there, so even with the admin charges for COBRA, it’s likely to be a pretty good deal for her.

6

Just a small note here, based on experience.

My grad school had a similar requirement: buy our insurance, or show us proof of equivalent insurance from elsewhere. When it came to actually proving to the school that you had outside insurance, the school was not especially strict about checking your alternative policy. As long as it looked like a proper policy drawn on a known company, they didn’t go too deep into details.

Obviously, you want your kids to be properly covered, but if their college works the same way my grad school did, you might not have to provide very much in the way of evidence.

Mine can be found in this thread.

7

(Note: I’m an insurance agent)

First thing to do, as has been said, is to make sure there’s not an extension for your daughter since she has full-time student status.

Is your daughter in Illinois as well? PM me, and if she’s in a state where I know a good agent, I’ll introduce you guys with specific instructions that you’re doing very, very preliminary research and are not looking for a sales pitch. If she’s not, then I’d be happy to talk with you about how to find an agent in your state who would be able to help you (in other words, how to find an insurance advisor as opposed to an insurance salesman).

By the way, those student insurance plans that some universities offer are generally pretty awful. Shy away from them if at all possible.

8

Oddly enough, my grad school only had an insurance requirement for foreign students. I took the health insurance offered through the school for one semester (craptastic major medical) and decided that after that I could use the $40 a month more than I could use health insurance that didn’t cover anything useful with deductibles and out-of-pocket expenses I’d never be able to pay for anyway.

9

I am an insurance agent, FWIW. My problem with insurance (well, one of them) is that you can only get affordable care if your coverage is tied to your employer but if your coverage is tied to your employer they hold your health care in their hands. I can’t tell you the number of employer groups we have had to terminate for not making payment for 45 days who were still collecting the employee’s portion of their insurance bill from the individuals who are insured. Then they have to go tell their employees that although they (the employees) have been making payments the coverage is being terminated. Then anyone who has COBRA through that employer is terminated too because COBRA is only active as long as the employer group maintains coverage.

10

I don’t have any gripes with insurance right now. Of course, this is because I don’t have any insurance right now. My COBRA ran out in February and I just can’t afford anything private. And since I have not 1, not 2, but 3 pre-existing conditions, I doubt I will have any insurance worth anything again before I qualify for Medicare. Oops, my bad, I just thought of a 4th pre-existing condition. :smack:

11

Take a look at student insurance plans. They don’t cover much but they offer some protection at a reasonable cost. With my hope of returning to college in the fall I looked into student coverage but alas, I’m too old. Non-traditional students are outta luck in this game.

12

What’s the problem with buying the college’s insurance when yours expires?

13

The problem with most college plans is that they’re very, very limited. Check out this plan offered to the undergraduate students of Georgia Tech. Note the following things:

  1. The language describing pre-existing conditions is poorly chosen, and is much more restrictive than with normal individual health plans. (Here, the language allows them to deny any and all coverage for, say, the flu if you’ve had it recently. Reputable individual health plans use language that is much more advantageous to the insured, not the insurer.)

  2. Referrals are required to go see specialists, even with the plan operating on a PPO network - weird. (This is normally a cost-cutting measure employed by HMO’s, so seeing it in a PPO plan screams “this network is populated by low-rent docs.”)

  3. $5000 lifetime maximum on durable medical equipment - pretty low. (Need an electric wheelchair? You get a cheap one, and if it breaks you’ll never be able to replace it.)

  4. $1000 per-trip ambulance maximum - far too low. (Average ambulance trip is anywhere from $750 - $1500, so sure, this seems about right…oh. This also includes life-flight bills, which average $6000 per trip.)

  5. A completely horrible and unacceptable $150,000 per-year maximum benefit. This is unthinkably bad. (An agent friend of mine has a client who had to see two doctors. The left and right hand were ignoring each other, and both prescribed medications to the client that interacted poorly with one another. By the time they figured out what was wrong with the guy, his bills were at $1.2 million dollars. He had a solid plan, so his total out-of-pocket for the whole thing was $3000. No matter how many times you say “it’ll never happen to me” it just isn’t so - it can happen to anyone, and it’ll be damn inconvenient when it does.)

  6. An exclusion that allows them to deny any claims based on injuries sustained while under the influence of alcohol. On a policy written specifically for college undergraduates. Seriously? (Admittedly, most plans do exclude stupid crap you do to yourself while in the process of committing a crime, so if you’re drinking underage, trip, and break your arm then they can technically exclude it. This option is almost never exercised, though. Really, I just thought this was kinda funny.)

  7. No organ transplant benefit. (It’ll never happen to me! Then stop wearing seat belts, because you’ll never be in a car wreck. Stop exercising, because you’ll never have a heart attack. Stop smelling the milk before you pour a glass, because it’ll never be sour. And put $500,000 - $1M aside, because if this does happen to you you’re boned.)

  8. $1000 maximum benefit on prescription drugs. (This is Georgia Tech, known for being a school with a tough curriculum. A large portion of the student body is on one form of anti-anxiety drug or another, and the costs can add up. A three month supply of Abilify can cost $2000. Try as I might, I can’t remember the cost of the stuff I took in college, but I want to say it was about $50 a month. That’s $600 a year, leaving only $400 for all other medications under this plan.)

This is by no means meant as an indictment of all college insurance plans - but it is representative of the ones I have personally worked with.

pbbth, I didn’t know that you were an agent! If I didn’t think it’d be such a hijack, I think you and I could have a great conversation about fixing the world’s problems - from your post, I think we have pretty similar feelings about things.

14

Probably! :wink:

I am so lucky to work for a non-profit health insurance company that is designed to help provide coverage to those people who need it most, the working poor. However, even though we are an awesome company that really, truly puts the needs of the people first there are still lots of problems like the one I mentioned above that fuck people over every day.

15

COBRA can be pricey though (a young person in good health may get better rates on her own, especially if she goes for a high deductible policy).

It’s “funny” that in this one case, being a Federal employee hurts you, benefit-wise. Frustrating as hell, I know.

Re the kids in college: I suspect that any pre-existing conditions would be covered because they can show proof that they were continuously-insured, should you need to switch them to the school policy.

The whole “turn 18/22” thing scares us a lot. Our older kid has autism, and will likely NOT be holding a job that includes health insurance when he’s an adult. We’re looking into what’s involved in having him considered disabled, for insurance purposes (that doesn’t include the 18/22 cut-off). Of course that’ll only work as long as we’re employed. When we hit Medicare in 15 years, he’s SOL :frowning:

16

Our daughters are both covered by BCBS individual policies, because of the way things have gone with insurance and my husband’s job. And the older is a grad student now, but has been out of school for the past year. Those policies are pretty affordable and they haven’t had a problem with coverage. Don’t panic, it’s probably doable.

17

But isn’t the school insurance a group plan, which wouldn’t check for pre-existing conditions? When I got it for grad school, I don’t remember them screening me at all.

18

A lot of group plans do exclude pre-existing conditions, at least for a time; I know when I changed jobs some years back, any pre-existing stuff would have been excluded for 12 months if I went with certain of the choices available to me. This was before COBRA, however; nowadays if you switch jobs or whatever and have continuity of coverage, most plans cannot exclude pre-existing conditions.

I don’t know how they enforce it, of course (maybe they contact prior insurers?).

19

If you get right down to the wire, check into short term, time-limited plans for your oldest. Several insurance companies used to offer these. We bought one of these when we were a) moving to a different state and b) would be uncovered for a short period of time due to job changes and waiting periods and such. We were both young and healthy, without any prescription needs, so I can’t remember or offer any advice on how limited the plan might have been (which is probably likely) - we just wanted some sort of coverage for the few months we needed it for piece of mind.

It was surprisingly affordable, tho’ it does expire after a short term - I think I remember 6 months being the longest term you could buy. We bought ours from State Farm, and I think it cost us something like $180 for three months or some such. It might be worth looking into if you can’t find anything else.

20

The downside of a policy like that, though, is that if you wind up needing to renew it (job with benefits doesn’t start in time or whatever)… anything you might develop during one short-term period will be treated as pre-existing in the next short-term period, and won’t be covered. Investigate such an option VERY carefully.