Time for me to vent a little--ok, a lot. One of our kids is thinking about having another child. So, what is the problem, Pat? That is a good thing, right?
The issue is their health insurance. When they had the first baby, my daughter in law was working for a company that offered health insurance. She has since been laid off and started a small business of her own.
They are now both self-employed and have a private family plan. But, get this, there is no maternity option. I mean, none! I was sure there would be a rider you could purchase extra, but no. How in the heck can you have a family plan without the option of making a family? Only one insurance company in the state of GA offers a maternity option with a private family plan--and it is new in the past month or so. Now if they worked for a company and had group insurance, no problem.
So we called the Insurance Commissioner's (John Oxendine) office. What was their response? "Really? We have not heard of this problem before now?" REALLY? Shouldn't the insurance commissioner know what the insurance companies in his state offer? I'm just saying. They did offer to "look into it". All my daughter in law had to do was send in a letter of request and wait several weeks for their review of the matter.
Now, you all know that I am not a fan of universal healthcare. It causes more issues than it solves. But this type of BS, excuse my language, is why so many people are supporting it. The insurance companies wail about the perils of universal healthcare. But they are causing a big part of the problem. Lawsuits are another issue that cause this disconnect with the needs of the insured--but that is an issue for another rant.
The insurance company representative told her that most couples are paying for the prenatal care and the birth, then the insurance kicks in after the mom and child are discharged from the hospital. Also the insurer said they will pay for a "medically necessary" C-Section. Of course, they could not tell us what is deemed medically necessary since each "each case is measured on its own merit." Whatever that means!
All this is well and good (and expensive) if it is a perfectly normal pregnancy, delivery, and baby. The parents would be out of pocket $5000-$10,000. But what if something goes wrong? Oops, too bad for you. The costs just skyrocketed.
It is despicable. This hard working couple cannot have another child until this gets resolved. They are great parents who pay their bills and pay their taxes. They provide a loving home and a good example for their child. They are active members of their community and just really good people. They would love to have their kids close together, but now it is looking like that may not happen.
But anyone on welfare can have as many babies as they want, whenever they want. They just go down to Grady and walk out with the baby--and no bill. The tax payers have paid it. This is just wrong. Can't my share of the tax money go to help my own? And why isn't the Georgia Insurance Commissioner on top of this? Why aren't they supporting the entrepreneurs of the state instead of treating them like second class citizens?
Has anyone else had a similar problem? I would love to hear about it. Also, we need to be letting our insurance commissioners know that this is not acceptable. What do you all think?
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7 comments:
I have not experienced this type of problem but I think almost every citizen of this country has at least one gripe or two about our health care policies. Costs are outrageous, control of our own health options rests in the hands of some bureaucrat we've never met, and the drug companies just keep raking in the big bucks. Something needs to be done, for sure!
I know you are not a fan of the universal health plan. But maybe, just maybe, with the tweaks needed we will go uphill in this battle. All deserve health care that need it. Might be helpful to join some advocacy groups that are addressing the same issues specific to maternity care for the self employed. I would check online with an existing Ning network, etc.
Much success for your daughter. I am also hoping that she is able to make the money in her business to help with the cost.
Also, the medical director of the insurance company should be able to tell you what is "medically necessary.It should be written somewhere in the criteria. Don't give up!
Pat, does the insurance even reduce the cost?
My biggest gripe about hospital bills is that they charge so much if you don't have insurance. With insurance it is a much reduced cost.
I looked at a bill that came in today, $5000 physical therapy, but because I have insurance the cost is $1000. Now my insurance will pay 80% of that, but those without pay the full amount!
My daughter and daughter-in-law both used midwifes for their 2nd babies, very happy with their choice. Their insurance didn't include paying midwifes, just the higher hospital/dr bills. Midwifes are worth checking into, but find a good one.
Eileen--totally agree. The system needs a big overhaul.
Rosie--love the idea about the advocacy groups. I will look into that. And thanks for the encouragement.
Heidi--no discounts unfortunately. I have an HSA and get discounts on my out of pocket costs. Theirs is not that way. And a midwife is probably out. she is very tiny and had to have a section last time--couldn't deliver the baby. So we are looking at another section most likey. Still looking into options.
Thanks all for your feedback.
Well as someone who lives in a country with EXCELLENT universal health care, I am so saddened at this post and the situation that you're daughter and son-in-law find themselves in.
Canada, as you know is not some dark communist or socialist regime we are about as capitalist a society as our American neighbors (y'all - lol!). But our political leaders at the early part of the 20th century decided that healthcare ought to be a right, not a privilege. I'm every so thankful for their wisdom.
I married an American and lived in Ohio for several years before returning to my home town of Toronto. I can honestly compare both systems without any hype or ridiculous stories that I heard thrown about during the U.S. health care reform discussions.
No health care system is perfect but our Canadian universal health care in my opinion is far better for citizens - especially entrepreneurs.
All I can say is I'm sad your president wasn't able to put into place full health care reform due to all the political pressure. Your daughter and son-in-law might have had better choices. Praying your daughter's business does improve and these costs can be addressed.
I am not in this situation YET--but as my husband's contract comes to an end, I will find myself having to look at alternative options. It is a sin and a shame that the Insurance Commissioner of yor state doesn't seem to have a clue. I support universal health care because I truly believe the insurance companies have ripped us off LONG ENOUGH and it is past due time for some serious regulations--or as some people want to call it, "government interference."
Here here to all the above comments. Health care in the U.S. is a farce. Everyone deserves care and our welfare system drives me as batty as our health care, or lack thereof.
I'm ashamed of your insurance commissioner, and he should be ashamed of himself. What a poor representative he is.
If anyone can create noise and a resolution to the maternity clause, it is you Pat! You do it!
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