Wednesday, October 13, 2010

Foreign Language Study: Health Insurance

Health insurance is like an impossible foreign language that I seem to be  totally incapable of understanding. I can read two different Japanese alphabets and identify hundreds of Chinese characters, but I can't understand health insurance. In two more months I will graduate with two advanced degrees, but I'm pretty sure I still won't be able to understand health insurance. 

Also, trying to figure out health insurance is like a full time job for which I do not have time (or energy). But, over the past two years since getting diagnosed with RA, I have made at least a little progress in understanding what is covered by my own student health insurance plan. Or so I thought. 

When the health insurance paperwork arrived in August, I actually went through it instead of just signing up for it the way most students probably do. As far as I could tell from my scrutiny of the paperwork the university provided, it was the exact same plan I've had for the past two years - the one where I needed to come up with a way to pay an extra $800 a month for my Enbrel

So imagine my surprise when APL and I went to pick up my last 4 dosages of Enbrel and we only got charged $60. And this was without any additional support from EnbrelSupport or any other program!! Not that I'm complaining - obviously my inability to understand my own health insurance actually worked out in my favor for once! But I just couldn't figure out how the exact same health insurance plan could give me such different benefits this year.

Finding the answer wasn't easy - it took a whole afternoon of calling and searching through convoluted health insurance websites. But, eventually, I figured it out: the university student health programs used to be undewritten by Aetna, but now they are underwritten by United Healthcare. And, even though the school documents show it as essentially the same plan as last year, apparently United Healthcare has way better prescription coverage than Aetna did. In this case, it has worked out awesome for us - $60 a month we can afford!!

But it got me thinking about health insurance more generally, and I find the more I think about it the less I understand it. As someone with a pretty major (and pretty expensive!) preexisting condition, I am never going to have much choice in my health insurance (unless there are some pretty big changes in our health insurance system as a whole.) I will only be able to get insurance through my school, my job, or my husband's job. (I'm already 27, so no luck for me on Obama's plan to give you coverage under your parents until 26). Because of my preexisting condition, I pretty much have to take the best insurance I can get and run with it - right now the best I can get is student health through the university.

Which got me thinking: what if it had gone the other way? What if the university had switched from United Healthcare to Aetna? What if my co-payment for my Enbrel had gone from $60 to $800? I would have no choice in the matter but to pay the higher co-pay - the one I definately can't afford. Under the "same" student health plan, I would suddenly go from being able to treat my RA to not being able to afford to treat my RA. 

How does that make any sense at all? How is that fair? Like I said, I don't understand health insurance.


Anonymous said...

Today I'm very fortunate to have good insurance through my husbands job at the hospital. Without it, in time, we'd have a bankruptcy I'm sure. With it, we have managed for the first time to stay on top of what we owe. I get frustrated at insurance time as it's just too much to take in. I can't sacrifice one for the other, not with my conditions. So I understand how you feel about this.

By the way, brava for speaking & understanding Japanese. That's pretty daggone cool. Hugs. Tammy

Rebecca said...

God, there's nothing that makes me fee like a moron faster than trying to understand health insurance (unless maybe it's trying to pick a retirement plan). Sucky suck suck.

But yay for cheaper drugs!!

Anonymous said...

Ugh, tell me about it! I swear, the people who write insurance policies must do it on purpose because there is really no reason for it to be so complicated.

But hooray for $60 biologics! I look back on my days of United insurance with much fondness, let me tell you. :P

~Mariah~ said...

Well, I'm glad I'm not the only one who's confused!!!