Insurance

I've been meaning to write a long boring post about insurance. We've learned so much; we'd like to spare you some of the learning curve should you experience a major medical crisis.

But first, this just in. It seems that Alicia has asthma, since she's been wheezing. Shoot. Without even seeing the doctor, Alicia now has a nebulizer machine and pulmicort and albuterol. Her neonatal pulmonologist said that if babies are going to develop asthma, this is the time. She had three risk factors going against her: prematurity, chronic lung disease, and her mom has asthma. She may not have asthma for life though. Lots of babies grow out of it. If she still has it by kindergarten, then yes, she'll probably have it for life.

On to the truly boring stuff. Oh where do I begin?

Okay, when I landed in the hospital Josh and Toby were together on a cheap health plan (low monthly premium and high deductable), and I had COBRA. COBRA is a MN law that says when employment ends for any reason, the employee has the right to continue on the same health plan for 18 months and pay the full rate that the employer may have been paying. My coverage was through Mpls Public Schools, so the plan year is Sept 1 through Aug 31. I was pregnant when my contract ended, so I couldn't change to another plan. I started paying $400 a month for COBRA.

I landed in the hospital on November 6. This wasn't going to be a financial crisis for us (except that I wasn't working anymore) since the plan year is the school year. The maximum amount to pay per person per year is only $1,200 for my health plan. We had already been planning on paying that much when Alicia was born in March. But once Alicia was born on November 28, we had to find health coverage for her. On my COBRA plan it is one price for one person and another price for the whole family, it doesn't matter how many people you are adding. So after Alicia's birth we included all the Fullers on the COBRA plan. $1000 a month! The good news is that the out-of-pocket expenses were still only $1200 per person.

What about Josh's work? Well, Josh's company does have a health plan that is offered to us for less than $1000 a month. Each company, and occasionally a few small companies together, has their own pool. So if one person in this small pool had very very high expenses, it would raise the monthly premiums for that pool quite high. We didn't want to do that to them. But Josh's company did give Josh a hideously large raise that has helped us to pay this crazy COBRA premium while allowing me to spend time in the hospital instead of at work. Thanks.

Now here's another element. There are in-network expenses and out-of-network expenses. When I signed up for my health plan I chose a hospital and clinic network. Who is in and out of this network is decided by the insurance company. I first went to the hospital I had chosen on November 6, but because of specialized care offered at Abbott, I was transfered there. My first hospital, Methodist, and Abbott share doctors. While I was still at Methodist, they called Abbott a few times with questions about how to care for me. In reality, these two hospitals would consider each other in a network. But insurance doesn't. So when I was transfered (by ambulance), Medica (the insurance) actually began charging some of the Abbott expenses as in-network and other expenses as out-of-network. I said that we should only have to pay $1200 out of pocket per year per person; well, that's for in-network. There's another higher number you pay in addition for out-of-network. Ugh. I spent a bit of time stressing about how much we were really going to have to pay.

Here's the biggest thing I want everyone to know. If you were referred, (as opposed to just deciding that this hospital is prettier than that one) EVERYTHING should be in-network. You will need to keep a list of how much you pay out-of-pocket to make sure that you don't pay more than you think you should. Then you need to call the insurance company again and again to make sure that everything is processed as in-network. If you ever talk to a helpful person, get her name so that you can ask for that person again. The helpful ones are rare. You may have to call your primary doctor (even if that doctor has nothing to do with this ailment) to get a referral. Maybe multiple times. We had to do this for both my expenses and Alicia's. Then we call the hospitals and clinics to tell them, sorry, we're not going to pay you but we called Medica and hope they'll get it right soon.

So now we're trying to get out of COBRA. If you live in MN, this is what you can do. First we had to apply for an individual plan with any insurance company. For some reason, we chose Medica again. I must be on crack. Anyway, then we get a letter saying that we are denied because of Alicia. Next, we apply again without Alicia on the application. We've been accepted beginning August 1. Yeah! So then we cancel COBRA. Once COBRA has been canceled and we have a letter about that, we can apply for MCHA for Alicia.

MCHA is one reason that it's great to live in MN. It's Minnesota Comprehensive Health Association. The only two requirements for acceptance for this health coverage are MN residency for six months and denial of coverage from another MN HMO. A quirky thing is that in order for existing health issues to be covered, her current COBRA coverage needs to be canceled first. MCHA can backdate the coverage up to 63 days. Hence this crazy order of getting things done. Alicia's coverage will cost $145 a month with a $2,700 deductable per year. After the deductable we'll pay nothing, I think. The rest of us will pay a $220 premium with a $3500 deductable (which with any luck, we'll pay none of). This is still cheaper than the old $1000 a month.

A few more pieces. After Alicia was born, Children's hospital helped me fill out the papers for Social Security and Medical Assistance. Due to her birth weight, Alicia automatically qualified for SSI. We got $30 a month while she was in the hospital and around $600 the month she came home. Then they reassess to determine if there are still disabilities. Some families would qualify for ongoing support. We didn't. I never bothered to finish the paperwork for MA. MA will pay for anything that the primary insurer won't. Insurance plans have maximum amounts that they'll pay for, often around one million dollars. I think it's when you reach that, MA steps in to help. No one should need to go bankrupt in this state for lack of health insurance. That's just wonderful. There are some states that don't have these safety nets. The HMOs can deny you coverage and then you're SOL.

It makes me so sad, well, angry too, when Minnesotans talk about cutting the health coverage that the state will pay for. Alicia soon will be on a state plan, without which we could be in big trouble. Other state plan options pay for so many people with low wage jobs. If you shop at WalMart, you'd better be supporting state health plans. WalMart covers only 47% of their people. By shopping there, you are choosing your own low prices over the idea that employees should be paid decent wages and have basic health care. If employers don't do that, then the state needs to. I hear people blaming the low wage employee, saying that person should have gone to college to get a better job. Sure, but then someone else is going to have to work that job. If it's a job we want done (and I'm assuming you want your hotel clean, your chicken to be boneless and skinless, and the shelves at WalMart to be stocked), then we ought to be willing to pay that human being a livable wage that includes humane health coverage.

Anyway, even without the WalMart debate, health insurance is a complicated thing. Maybe someday we'll live in Canada, where you don't have to pay for anything and mothers get a full year of paid maternity leave, and spare kidneys grow on trees. But for now, Minnesota is a pretty good place to be.

One question people love to ask is, how much in medical bills did Alicia ring up in total? Well, it's hard to pinpoint exactly, but we can tell you the neighborhood. It cost somewhere between two thirds and three quarters of a million dollars to bring her to life. That's about average for a preemie of her gestation.

We think it was a real bargain.