One Vermonter explains what it's like to be underinsured
12/13/07 10:20AM By Leora Dowling
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(Dowling) I used to joke about my health insurance coverage. "If I get
cancer or hit by I car I'll be all set," I'd say with a laugh. I had a
$10,000 deductible. I was not quite 50, an adjunct college professor
and buying my own insurance. I figured if something catastrophic
happened I could pony up the 10 grand and the insurance company would
cover the rest.
I did get cancer, but my insurance didn't cover nearly enough of the costs.
I'm an underinsured Vermonter who found that after paying my deductible, 30% of all tests, and 50% for drugs purchased in a pharmacy, that my one year, out-of-pocket medical expenses were equal to a some peoples yearly salary. Since August 2006 it's cost me close to 24 thousand dollars to treat my breast cancer.
And I had to fight for some of the money - and coverage - I did get.
At one point I wanted to change my deductible - lower it to $3,500. Three employees assured me my ‘change' form was due February first. They were off by two months - in the wrong direction.
Thus began a series of letters - and phone calls where I got shuttled from Trish to Peter to Martha - when I wasn't at the hospital getting chemo, that is. Eventually, I was told, "yes, according to a review of the tapes, our employees misspoke," but my appeal - or as they deemed it, my grievance - was denied. Twice.
Their reason: three paragraphs in the Member Manual that superceded anything I was told over the phone.
I decided to find those paragraphs. I read the manual, all 132 scintillating pages of it. They were not there. Seems they'd sent me an obsolete manual when I'd signed up for my policy. Oops.
So, I wrote another letter, a 9-pager this time, and sent it to the Vermont Department of Banking, Insurance, Securities, and Health Care Administration, Consumer Services Section, etc. I sent copies of the detailed phone logs I'd made. I also sent photocopies from the manual pointing out that the copywriter had punctuated incorrectly and therefore their entire manual was, in effect, wrong.
In the end I managed to win that battle. I was credited $6,500. Some big wig even called me at home to personally apologize for the snafu.
But I can only imagine what happens to those who get the rejection letter and figure they've already lost the battle, or who don't have an advocate, or are even sicker than I was.
I learned some interesting things last winter - beyond the virtue of tenacity: I saw the power of a humble slash, and for the first time ever I was glad my conversations had been recorded "for quality assurance."
My prognosis is good and my medical bills this year should be lower. But the memory of reading "we're sorry for the inconvenience; we're retraining our employees so this doesn't happen to anyone else," remains fresh in my mind.
Leora Dowling is a motivational speaker and writer living in Ferrisburgh.