The Trouble with Health Insurance, a First Hand Account

So my beautiful Lady and I discover we’re pregnant in June 2010. I immediately freak, because having a baby is simultaneously as glorifically grand as it is frightening. My next step is to investigate insurance options. Pregnancy, mind you, is considered a “pre-existing condition”. That’s right, being human, specifically creating human life, is considered in the same vein as cancer and other illnesses. So I go out on the hunt.

I am contacted by Shawn Smith ( from Premiere Health Plans who tells me about this healthcare plan that covers maternity and it doesn’t matter than she’s already pregnant. So I get the insurance from Premiere Health Plans.

Now, that doesn’t not mean they’re our insurance provider. No, it turns out that they sent us to Homeland Healthcare, who I then assumed was our provider. Not so. Premiere Health Plans are our “agent”, which means they did nothing but get us signed up in the first place. Homeland Healthcare is a, self-described, 3rd party that handles customer service. Our actual insurance company was a division of AIG (never revealed to me at the time of purchase as I wouldn’t have sent a dime to those bailout bastards) by the name of Pittsburgh Union Fire Insurance Company. Hmm, fire insurance for a pregnancy. Oh well, I’m self-employed and have been without health insurance, gladly, for years now, so I went with it. Now, we are actually being billed by Homeland Healthcare, so as far as I am concerned, that’s who I’m working with.

We pay our bill, they cover doctor visits and everything seems fine, we think they’re great.

Then, in December, Pittsburgh Union Fire Insurance Company drops us from their policy. They don’t tell us, of course, because they only deal with Homeland Healthcare, who also does not tell us, but instead signs us up for a new plan – since our old one was dropped. Here’s the real zinger, the new plan they put us on does consider pregnancy a pre-existing condition. So all of a sudden, we’re not covered for the day we go into labor. Which was February 11th, 2011, and no one bothered to tell us.

We had to wait until our doctor called us and dropped the news: your insurance company isn’t paying the bill.

The $15,000 bill. Yeah, that one.

I call the claims department – which is neither Homeland, Premiere, or whoever replaced us after Pittsburgh Fire Company whatever dropped us, but another agency altogether in Washington State. That’s right, for one individual health insurance plan that costs $219 / mo, we’ve got four companies (at least) involved. Why we couldn’t have just dealt directly with the company in Washington in the first place, shaved off their overhead, cut down on our costs, is beyond baffling.

An entire day worth of phone calls to every one of these companies produces nothing more than this resolution, from a supervisor named Sarah at Homeland Healthcare: “I’m truly sorry to hear that. If you send us a letter we might be able to refund your premiums.”

But refunding my premiums is not what I signed up for, not quite at all. We had come to an agreement – I would pay them monthly and they would then pay if anything big happened. If nothing big happened, then they would make out. I made it clear that we were pregnant before we jumped on board. So essentially, all they offered us was this: “We’ll treat your monthly payments for the past year as simply you providing us a loan.” The problem is, I am not a loan company.

Sarah just kept saying over and over again, “We [Homeland Healthcare] can’t pay your bills, because we are not your insurance provider.” Ok, understood, but Homeland is the one charging my credit card, so I’m buying a service from them. If I go to a restaurant, order a burger and the meat is bad, the server doesn’t tell me “Sorry, call the farm we bought the meat from.”

If you’ve read this far, surely you’re baffled at the number of companies involved in my simple one person insurance policy. No wonder prices are so high. Forget doctors getting sued, people not paying hospital bills, it’s because of the ridiculous overhead by the multitude of private companies involved. I’m not here to praise Obama or push for his healthcare plan, but this is a ridiculous system we have going and anyone who’s ever actually been involved in it – not just blindly received healthcare through their employer – can see that. See this study conducted by the Council for Affordable Health Insurance, which shows on page 6 that overhead costs for Medicaire (government run, in case you didn’t realize) are 5.2%. Overhead for private insurers comes in at 8.9%, and if you include premium taxes, commissions and profits, that number shoots up to 16.7%. It’s more than 3x as expensive for private companies to oversee health insurance than it is for the federal government.

Put your fears aside of the government mandating what type of healthcare you can receive (um, private insurance companies already do this anyway) and that you’ll be left in the cold if the government doesn’t think you qualify for a treatment (again, private insurers do this all the time), and realize that fighting against health care reform is just screwing over Americans. If you already have insurance, through your employer or otherwise, you’re getting footed with the bill when these insurance companies screw people like myself over (yeah, because I’m not paying a $15,000 bill that my insurance co. agreed to pay, so guess who’s paying it – every tax payer).

My final conclusion is simple, but harsh: if you’re against health care reform, even government run healthcare, you’re simply not living in the reality of the fact that it’s bad business all around, and is costing you money.

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