Friday, June 08, 2007

Insured

Last Saturday, we received a letter from KayTar's amazing insurance company. Through all of the testing, all of the claims, all of the specialists, we have never once had a problem with them. No arguing over what was covered and what wasn't. No refusal to pay. No arguments over pre-existing conditions. We have saved between ten and twenty thousand dollars in the past ten months. Sure, we pay a pretty penny for this coverage, but if you do the math, it is not even a drop in the bucket compared to what we are NOT having to pay our of pocket. A single blood test ran approximately $3,000 dollars. One test! Do you know how much we paid out of pocket? $0.00. Labs, all labs, are fully covered. No co-pay, no percentage, no stipulations on what tests are covered. It was just paid for.

Back to the letter, KayTar's insurance is being canceled. Not only KayTar's, but the entire program. In nine months, it will cease to exist. The company sited many reasons; after offering the program for six years, they haven't generated enough interest; they have the one of the highest premiums in the individual market; and so on. Those things don't matter to us, though. We don't care how many members there are, or if we have to pay higher premiums because of it. We don't care that the premiums are so high, because the quality of the coverage is invaluable. Okay, maybe not completely invaluable, if what we had paid in exceeded their coverage, then it would be a problem, but our premiums are not close to having equaled twenty thousand dollars over the past ten months. Not close at all.

And so we have nine months for find a new insurance company. Nine months is a long time, I understand that. It is the length of a human pregnancy. Ask a pregnant woman, nine months is a long time. I am thankful that they have given us nine months to birth an new insurance policy, but I am incredibly stressed about finding comparable coverage. I am worried that so many of KayTar's issues will be stamped with "pre-existing condition" and the company will refuse to pay. I am worried we won't find a company that covers our pediatrician (who I will not give up) and all of her specialists. I am worried that her therapeutic needs will not be covered. I am just worried.

The current insurance company continues to be amazing, they have sent us information on all the companies who provide individual medical coverage for children and they have even offered to provide us with an agent to help us find coverage. They have established a fund to assist families with children who can only be covered with pricey high risk pool insurance. They have sent lots of information to help us through the transition. But once we come out from under their umbrella, I am concerned that KayTar's care will be more difficult, that we will have to fight to get her proper services, and that we will be paying much more than we currently are out of pocket.

The next time I speak with our pediatrician, I'm going to request knocking out any additional tests in the next nine months, when we are sure she is adequately covered. I'll also find out what plans her office accepts and KayTar's specialists accept and cross check those with the list our provider sent to us. Once I have that list, I'll call those companies and ask them about their coverage in the areas I am most concerned about. I know we can handle this and get the best outcome possible from the situation, but I am concerned that the best possible outcome will not measure up to our current situation. I wish we weren't being forced into making a switch at all.

12 comments:

slouching mom said...

Oh, that IS tough. I so hope that some of her issues don't fall in the category of pre-existing conditions, which category throws a spotlight on all that is wrong with health insurance in this country.

That said, I am glad that thus far you have had wonderful coverage. It could still be wonderful... Here's hoping.

~aj~ said...

Oh Kyla...no other way to say it, that just plain sucks.

What a blessing to have had an insurance company so wonderful thus far (few people can say that!), but I know it is going to be a major headache to find someone new and just hope for the best.

Good luck with it!!

Christine said...

Best of luck finding something new. How rough. Hang in there, lady.

NotSoSage said...

Kyla, that sucks. That sucks and I'm so angry for you even though, as you say, the company is doing everything they can to help.

I'd offer to adopt KayTar so that she could be covered up here, but then I think she'd have to live here six months out of every year (not that that would be a bad thing).

Anonymous said...

It's a good thing that you have HIPAA on your side. Basically, HIPAA (Health Insurance Portability and Accountability Act) has two parts. It's the first one that is most important to you. It's the Portability part. Basically, as long as you don't have a gap in your insurance coverage (63 days or more) and were covered for 18 months or more, group health plans can't say something was pre-existing condition and not cover it. (If your coverage is less than 18 months or you have a gap of 63+ days, then you can get a reduction in the time that you have to wait for coverage of a preexisting condition by the amount of time you were insured.) Also, they can't charge premiums or create eligibility requirements based on health status, medical history, genetics or disability. (The rules are a little different with regard to individual health plans, but the preexisting condition with 18 months of coverage still holds true if you're not eligible to be covered under any group, state, or federal health plans at the time you seek individual insurance. So you may be covered.

There are other plans out there that will cover things 100%. I wish you luck in your search.

Mad Hatter said...

"pre-existing condition?" Damn isn't that why the majority of people need health care in the first place. Try as I might I will never understand why the richest country in the world refuses to offer its citizens universal health care. I know that our system up here has so many cracks but we have it.

This sucks, Kyla.

Jenny said...

That totally sucks. Sigh...maybe we all just need to move to Canada.

On another note though...can't wait to meet you!

jen said...

and of course, in your typical, graceful style, you are taking it in stride when others would be losing their marbles.

someday, sister, i want you to write about how you are so consistently grounded. there is a lesson in that for all of us.

and i am truly, truly sorry.

Julie Pippert said...

Oh rats that stinks! As if you want this to worry about. I will wish you loads of GL findng new insurance.

I am amazed at the utter lack of ALL CAPS and BOLD and POTTY MOUTH in this post. Really, your "okay this is this now let's solve it" is awesome.

Someday I hope I grow up like this. :)

ewe are here said...

Oh, losing medical coverage was always my nightmare. I hope you find another solid plan for KayTar quickly.

The US really needs to revamp its healthcare system to include all citizens, regardless of income. I've told my husband if we move back to the states, good health insurance is a necessity. Otherwise, we'll stay in the UK.

MotherBumper said...

OMG, I just cringed when I read this post. I cannot imagine what that is like since I live in a country where that is almost all covered (but we all pay taxes through the nose on everything). I really really REALLY hope it all works out and that the leads and help your current company has provided work out.

Karianna said...

Ooooh. Very scary.I certainly hope there are some creative solutions to this.