When I was laid off from my job last month, I was eligible for continuation of my health insurance. I have enough money saved up that I can pick up the large portion of the premiums that used to be contributed by my employer. I was persistent enough, and knowledgeable enough, to navigate through the shoals of bureaucracy that lay between employer-based and formerly-employed insured status.
It was frustrating for several weeks. For instance, I wasn’t allowed to apply for continuation coverage while still insured. Then I couldn’t write a check for the first month of coverage until my application for continuation coverage was received, processed, and accepted. It took over a week after my check was deposited before my status was updated from no coverage to insured. Even after that change was acknowledged, it required a call to the PBM (pharmacy benefit manager), a business separate from the insurer, to update my prescription insurance.
When it all settled out, the insurance was reinstated retroactively to the first day of the month. But I still had to make sure that the claims rejected while I was in limbo were resubmitted (I haven’t yet contacted the lab that drew and tested a blood sample). Every one of those steps wastes money—customer service operators who could have helped someone else, clerks who had to open, photocopy, and file my applications, eligibility assessors who had to process my paperwork, personnel at my providers who had to send my claims to the insurer for a second time, computers that had to rerun those claims. It was only a little bit of money each time, but of course those infinitesimal amounts add up to big bucks when multiplied by thousands or millions of incidents. At least I get my EOBs electronically, so I didn’t kill many trees by generating all those papers twice.
My office visits and lab tests hadn’t made it through the providers’ billing systems by the time I became retroactively covered, so they had no visible impact on my wallet. Because the office personnel don’t know the alleged prices of their services, they probably couldn’t require up-front payment anyway. Not so when it comes to prescriptions … I had to pay the full retail price before I could get my medications. Once covered, I went back to the drugstore to have my credit card reimbursed for the cash I’d laid out.
As it happens, I take six “maintenance medicines”, prescriptions that I refill every month. All six are generics, costing appreciably less than the brand name versions of those medications. Even so, the full retail price of a month’s-worth of my meds was rather hefty — $445.74 (brand names would have run $864.67). After my coverage was restored retroactively, I went back to Bartell so that they could resubmit the prescriptions to my insurance. After applying the (appreciably lower) price negotiated by the insurer, and after accounting for the portion of that price paid by the insurer, my out of pocket cost for those six prescriptions came to just $11.98. I have very good insurance.
Similarly, were I not insured, the price of an office visit would be $219.00. My insurer had negotiated an allowed amount of $83.01 for that sort of visit, only about 38% of the alleged retail price. And my out of pocket portion of the insurer-negotiated price comes to a mere $12.45. To reiterate, I have very good insurance.
I knew it would work out as it did. And I had the resources to ease the difficulties of the bureaucratic delays. But suppose I didn’t have a credit card. Suppose I lived from paycheck to paycheck, with only a debit card and a meager bank account. Then, I would have had a problem. Then, I might have been required to choose between maintaining my health and buying groceries, or maybe even between medicines and rent. Forced into such a dilemma, filling prescriptions would undoubtedly fall behind food and shelter.
Being unemployed and uninsured, then, is a
- You have much less money coming into your bank account
- The bill for healthcare services is much larger than what an insurer can negotiate with the provider
- You bear responsibility for paying the entire bill
I could go on. I could mention the uncertainties faced by providers; because of the myriad insurers with myriad rules and myriad methods of bill submission, they never know how much they’ll actually receive in reimbursement for their services (and they must hire additional staff to handle all those procedures). I could argue for something like Medicare for all, or for a sensible healthcare system like those in civilized nations (there are many models to choose from, all of which are better and less costly than ours).
Instead, I’ll just thank my lucky stars that my layoff isn’t the kind of financial and health disaster that it could be if I didn’t have resources. And I’ll pay my insurance premiums every month.
[Cross-posted from Peace Tree Farm]