Insurance Woes

I'm sure I don't have to tell you that the American health care system sucks. The quality of care keeps decreasing as costs keep increasing.

I can't even imagine having had my surgery or my son without insurance.

At the same time, insurance companies are near the top of most people's least-liked lists—mine included.

My very first job out of college was with an incredibly small company, so my company-provided insurance was an individual plan. From the start, I learned all about preexisting condition exclusions when the insurance company said they wouldn't cover: my back (I'd had back trouble and treatments for it in high school), my thyroid (because I once had a swollen gland on my neck that wouldn't go away for quite some time, so I had it checked out, only to have it go away on its own), my kidneys (because I had small kidney stones that required no treatment), and any allergy treatments (because I took prescription medication for seasonal allergies).

Ack. Can you imagine if I actually had something seriously wrong with me?

Fortunately, not long after that, the company grew rapidly and we were able to get group insurance.

But a few years later, when I left my full-time job to finish my master's degree and work as a freelance writer and editor, I once again had to apply for an individual insurance plan.

Fortunately, I was on the plan for many months before my ovarian cyst became known, so my doctor's appointments and my surgery to remove the cyst were covered. A few months after the surgery, we applied for maternity coverage, knowing sometime in the near future we'd want to start a family. I was flat-out denied because of my cyst and endo diagnosis.

Fortunately, not long after that, I ended up landing a job I loved (that had good benefits). So once we finally were ready to have children, I had maternity coverage.

And then (bet you never know where this is going), a while after our son was born, I went back to teaching part-time, freelancing part-time, and staying home with our little angel part-time. So, yes, I'm once again on an independent insurance plan.

I learned my lesson after the first few times and now pretty much don't go to the doctor for anything if I can help it, so I didn't have to report anything on my health insurance application aside from my cyst surgery and a breast lump I had to have biopsied (that was fortunately benign). Miraculously, all of that happened long enough ago neither the endo nor the breast lump were considered preexisting conditions that could be denied coverage. Whew!

Based on all of that (which only happened in the span of about 7 years), it should come as no surprise that I've been a supporter of the healthcare reform bill, optimistic about the fact that people with preexisting conditions will get the coverage they need and that women on individual insurance plans can get maternity coverage.

Yet last week I almost changed my tune, when I found out that multiple insurance companies weren't willing to offer me maternity coverage right now. My current insurer said it was because of my ovary, endo, and breast lump. When my dedicated insurance agent pressed them on why they weren't worried about those things enough to deny coverage of them when I first applied for my insurance plan, yet now they were listing them as preexisting conditions for denial of maternity coverage, the insurance company said it was because they'd had to make their guidelines more stringent since I first applied in August. Whatever.

So we decided to apply to other companies, big and small. They all denied me too, but not because of preexisting conditions. They said they denied me because of the new health care bill.

It turns out, insurance companies are now required to cover any children born to a woman who has their maternity coverage. So rather than risk getting stuck with sick babies, they apparently decided to stop offering maternity coverage until the rest of the health care law kicks in starting on Jan. 1, 2014 and they have to offer it. Or at least that's their excuse.

Yes, that's right. Even though I'm willing to pay double—or even more—per month than I am paying now for health insurance and am willing to wait an entire year before I even try to get pregnant (which guarantees the insurance company at least one year and 9 months of that gargantuan monthly rate—and that's only assuming I would get pregnant immediately), they're still not willing to offer coverage.

I started doing some investigating to find out what other options are out there and how things might change once the health care law (officially called the Affordable Care Act) is completely implemented.

It doesn't help me at all in this situation, but I did learn that some states (including Illinois, where I live), have state infertility insurance coverage laws that require coverage of infertility treatments, so if you are concerned about fertility coverage this site from the American Society of Reproductive Medicine is worth checking out.

Many states, including Illinois, also have Medicaid and other programs designed specifically to provide coverage to women who meet certain income requirements. Unfortunately, that doesn't help me either, but it is an incredibly important benefit offered to many women across the United States.

Finally, to bridge the gap between now and when the rest of the Affordable Health Care Act is rolled out in January 2014, people who have been denied coverage because of a preexisting condition, have been uninsured for at least 6 months, and can afford to pay insurance rates can enroll in the Pre-Existing Condition Insurance Plan (PCIP). Since I currently have insurance—just not maternity coverage—this doesn't help me, either. But I bet it's a lifesaver to others out there.

The best news, of course, is that beginning on Jan. 1, 2014, maternity care will be considered one of the 10 "essential health benefits" that most individual and small-group plans in the United States will be required to offer—and people who apply for insurance can no longer be denied or charged ridiculously high rates for preexisting conditions or maternity coverage. I'm not alone in rejoicing over this fact.

Once I finished fuming the other day and started to think about my current predicament a bit more, I realized perhaps it's for the best we were denied maternity coverage now. We had planned to start coverage Feb. 1. So in a year, when we could finally try to have a child, the Affordable Care Act would already have been in effect for a month.

Instead of forking over all that extra money for the next year, I guess I'll keep my cash and try to apply for new insurance coverage next January. With my luck, some sticky situation will come up that will somehow exempt me from maternity coverage again. But in theory, next year I should be able to get the coverage I need without paying exorbitant rates or dealing with a waiting period.

We'll see.