Health Insurance

Now the thing about health insurance is, they are a for profit organization, not a savings plan. Yes you have and are paying those loverly premiums monthly, and one would assume that therefore they, the insurance company, would be there to assist you in your hours of need. Think again.

My case in point, when I was employed with W.W. Smith Construction, one of the perks was that Bill Smith (my employer) not only paid my premium, he covered the deductible as well. I know, unheard of in these days & times, then again he was that sort of person. We were insured through HUMANA, our policy had a $5,000,000 lifetime cap, and you needed to be preapproved in order to qualify for the transplant program. I went through the entire preapproval process, and HUMANA has a special division of their company just for transplant patients.

About 10 months after my transplant I received a call from Bill’s office telling me that they were being forced to terminate health coverage for the employees. Seems that HUMANA was now raising his rates $2600 per month because of claims paid on his account (I had used $273,586.41 of the five million benefit).

I was then put on MediCal, as with my preexisting condition all private insurance was priced through the roof. Medical in their infinite wisdom assigned me a monthly spend down of $864 (this is out of pocket expenses), as I have so much income (my SSI disability). I have since qualified for Medicare (being disabled with lung disease). I was told to consider a ‘Part D’ plan to cover medications in addition to the Medicare Medical coverage I have. However once you do the math, I would be spending a lot more on my medications with that coverage (as I would then lose my eligibility for patient assistance) than without. Catch 22 revisited.

Dealing with MediCal has retaught me the meaning of patience. Calling the local office with a question will typically get you 45 minutes in the phone tree, after repeatedly answering the same questions you will get a case worker who will then ask the same questions again. After going through your case history (workers are assigned on a random basis – each time you call), you are then told that you should call the state office in Sacramento, who will then refer you back to the local office, and you begin again.