So my wife's employer had difficulty paying the insurance company so our family insurance was suspended. Had my wife not been 5 months pregnant, this would not have been a problem. We found out about the suspension when we started receiving bills for the doctor-ordered ultrasound.
We decided not to wait around for my wife's employer to get back on its feet and bring payment up-to-date. Instead, we opted to buy our own insurance from Blue Cross / Blue Shield of Michigan. This should be simple, we thought. We're already using Blue Cross...we'll just take over the payments and choose a policy.
After several calls to Blue Cross I was directed to their website, which outlined a number of policies. While checking one out I clicked some button that made like I was going to request more information from Blue Cross, when in fact it directed my information to a third party agent who would "help me" select the best policy.
Suddenly the phone rang. It was some random agent on the other side of the state. I told him I was already in contact with somebody at Blue Cross and he said "Well...I'm an agent for Blue Cross, they train me about their policies. The people you call, they just answer phones. They really don't know about the policies." Having gotten three different answers from three different people at Blue Cross, I believed him. Okay...let's do this, I said:
So he spat a bunch of numbers and policy names in rapid fire succession, weaving in and out of policy descriptions in non-linear way until I wasn't sure what policy did what. Finally, after about a day of this, I said I wanted just the standard Independent Blue package for a family, which would do the usual co-pay deal for our health stuff...they pay some, I pay some. NO! he said. This was a lousy choice, since the FlexBlue with the Maternity rider would pay ALL OFF MY MATERNITY EXPENSES.
WOW! ALL of our maternity expenses? He sent me the information. There it was. Right in the HTML e-mail description generated by Blue Cross..."Maternity Pre and Post Natal Maternity Care Covered -- 100% (in network)." This description is also found in a brochure of policies held by my wife's employer.
So we got the policy, shelled out $1334 to Blue Cross, we got our cards and heaved a huge sigh of relief. Phew. Pregnant wife is insured. Ahhh...
A week later...our ultrasound claim came back as Not Covered. WHAT? The bill read "Ultrasound - Pregnant Uterus" You can't get much more Pre-Natal than that. So I called Blue Cross and asked what the hell was going on. Turns out, when they said Pre and Post Natal stuff is COVERED. What they MEANT was Pre and Post Natal stuff is NOT covered until after the deductable...
Here's why that's a problem for us. We opted for the FlexBlue plan which has a nasty $3000 deductible...the insurance pays nothing until the deductible is met. To make matters worse, the deductible is reset to ZERO on January 1st, and baby is born February 7th. So...we pay out of pocket for every ultrasound, doctor visit, pre-natal test until January 1st. And THEN we pay for the delivery and nursery. That's a massive assload of medical bills.
WHY would we choose such a CRAPPY policy? Because our agent told us ALL Maternity is covered.
Well it's F#$&ing not.
But here's the thing...SOME people at Blue Cross knew that, and some didn't. Some were absolutely sure it DID cover it. Some were absolutely sure it DIDN'T. Nobody knew for certain. Today I called Blue Cross and the lady, assuredly telling me I was covered.
"Are you SURE?" I asked
"Can you send me a copy of my benefits so I can have it in my hand?"
"Yes. We can print one for you and mail it to you in 21 days."
"21 DAYS? I have a baby coming and I need to change my policy now if I don't have what I think I have."
"I understand. Let me..." She stopped in mid-sentence and said "huh...I have two different policy descriptions for the same policy here."
Aha. So...for ONE policy there are multiple possible policy descriptions?
Blue Cross / Blue Shield, it turns out, had "accidentally" printed two different versions of the same policy.
The question is this...if the very people giving out information at insurance companies, and their agents, can't give out accurate information about THEIR OWN POLICITES. How can we as consumers of medical insurance POSSIBLY hope to make an informed decision about our consumer habits?
The system we have is Messed Up. It's not a free market system. It's a free market humunculous...some twisted, perverted version of free market practices. There can't be a claim of free market supremecy of our medical system, because market pressures do not apply to our current medical system. Choice, consumer transparency...they don't exist. Compared to our current system, state funded health care offers a much more viable solution, especially for small business people who don't have the option of negotiating with insurance companies. Our current system chills entrepreneurialism and leaves the unemployed or underemployed to the wolves.