Health insurance rant

Please excuse the following rant, which has nothing at all to do with libraries, yarn or technology.

I'm having some issues with my health insurance right now. Through Simmons, I purchased one year of coverage from No Brand Insurance Co. (seriously, no one has ever heard of these guys and that may as well be their name) for $2,350. I tried hard not to think about the fact that this amount is more than twice what I paid for insurance at my last job.

My first issue is the prescription coverage, which is via reimbursement — you send in a claim form, which does not have a spot to indicate that you are claiming a prescription, along with some other documentation, and six weeks or so later they mail you a check for the difference between the co-pay and what you paid at the pharmacy. That's assuming that you only send one prescription reimbursement per claim form — heaven forbid you send two. Then it takes them longer to figure it out.

When I got my renewal prescription this spring, my doctor wrote it out so I could pick up three months' worth at a time, rather than just one. When I picked this up the first time, I made sure that I put my reimbursement paperwork in the mail a couple of days later, figuring it would take the insurance company weeks to figure this out, and that if I got it in the mail immediately I *might* see the check within the next three months. Today (six weeks later) I have gotten in the mail a form from the insurance company that apparently references this particular claim. (I am smart enough to figure out how they develop their claim numbers and keep enough of my other documentation from this plan that I can figure out what's going on. If I were less bright and had more than one outstanding clam, I'd have no idea what they were referring to.) The letter informs me that the claim form must be submitted with every claim and tells me to fill out the information below and send the form in so they can process the claim referenced at the top of the letter.

I sent that form when I sent the paperwork for reimbursement. I've got the photocopy, and while that might not prove that I put the original in the envelope, I know that I did because I'm expecting to be reimbursed to the tune of $105. This is not small potatoes to me.

The company is based in Springfield, so it couldn't possibly have taken more than a week for the mail to get to them. The postmark on the letter I got today is the 13th — it took them five weeks to even GET to my claim? Or did they open it back when it originally arrived and manage to lose half of the paperwork in the meantime? Or is this just a scheme to get me to not bother pursuing the claim so they don't have to pay me? Why on earth does it take them so long to process these claims and cut the checks? Do they only do it once a month?
Anyway. Not only have I scribbled on today's form to indicate that it is a prescription (again, there's no spot on the form for prescriptions), but I have written a slightly snarky note informing the reader that a photocopy of the original claim form is attached, and that this is the same prescription they have reimbursed in the past, it's just three months at once rather than one at a time. Subtext: send me my damn reimbursement!

Issue two is the fact that my annual exam, which was conducted by a supposedly covered physician (she's in their provider list online, I checked before I signed up in August), was not covered and I had to pay for it myself. I am smart enough to have foreseen this possibility and put a chunk of my tax return aside to cover it. They've won on this, though — I'm not going to call them up and argue over why they choose not to cover the visit.

The feminist in me can't help but be disgusted by the possibility that this is an anti-women's-health thing — my prescription is a birth control prescription, and the exam was my annual gyno visit to make sure that, oh, you know, I don't have ovarian cancer (which I can only guess costs more to treat than the $333 they refused to pay for the visit). I wonder how quickly they turn around claims for regular doctor's visits and non-sexual-health related prescriptions.

I do know that if there is anything at all I can do to avoid purchasing this plan again, I will do that. I'll just pay for my birth control and my doctor's visit ($950 per year) and take the gamble that if I get sick or hurt I won't be covered (at this rate, I probably wouldn't be anyway). I would rather go without insurance than pay out all this money to not be covered particularly well, and to get irritated on a regular basis because they take so long to process reimbursements.

I don't know how the pending laws that require all Massachusetts residents have health insurance (most recent news I could quickly find here) will affect grad students. According to Simmons, current state law requires that all students carrying 9 or more credits per semester have insurance — I carry 3 – 6 per semester, so technically I'm not required to have insurance. If the new law doesn't affect this part of the current law, I may not get health insurance next year if this company is the only option.

They may well be, at least for me: a few weeks ago when I was digging around online trying to find this information for a project at school, I couldn't find anything that I was eligible for. I wasn't eligible for any of the state plans, either because my income is too high (ha!) or because I'm a student, I forget which.

So, this summer's project is to try to find decent health insurance. Know of anything? Let me know.

Also, if you're single, live in Massachusetts and have decent coverage for a spouse or partner (ladies, I'm talking to you, too), let me just mention that I am not above a marriage of convenience. I can cook, I can clean, and I would reimburse you (in a very timely fashion, might I add) for the cost of adding a spouse to your coverage.

No, really, I'm dead serious.

2 thoughts on “Health insurance rant

  1. I wonder how quickly (and how much) they reimburse for prostate exams. Or for Viagra.

    I think you’re right–there is a very icky feeling of right-wing anti-woman -osity to insurance companies. My fiance’s insurance (which I may have to go on should I choose to quit my full-time job and go back to school) *just 6 months ago* decided to start covering birth control pills. In 2005.

    The mind boggles.

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