The snake in the grass.

2019 was definitely a challenging year for me, as you have learned if you’ve read through my posts. Unfortunately, some of my challenges have spilled over into 2020. In the fall of 2019 I was in the midst of caring for my dying ex-husband, selling my house, navigating my disability application, and changing from Cobra Care insurance to a supplemental plan. To say I was discombobulated and stressed out does not even begin to explain how I felt. My priority was the human being in all of this: my ex, John. I figured everything else would have to wait or be a little delayed.

Most of the issues did work themselves out. Sadly, we lost John, and my family and I are still grieving that loss. In the midst of that we sold the house, luckily before John died. I was approved for disability and started getting paid. The insurance situation, however, continued to be a thorn in my side.

After many months, two different customer service reps, and $700+ payments per month to Cobra, I finally got approved for a supplemental plan that would be in addition to the Medicare coverage I’m paying for.

As a reminder, when a person goes on dialysis, they are eligible for Medicare Part A and B coverage to cover deductibles. After 30 months, it flip flops and Medicare becomes the primary and private insurance becomes the secondary. And I’m required to carry a secondary insurance.

So, with the assurance that I would have newer, cheaper coverage (about $190 a month, not including my payment to Medicare premiums) I cancelled my Cobra Care coverage as of January 31st, 2020. Great! Can’t wait to start saving money, especially since I’m on a limited income now with disability.

Not so fast! I am still getting emails from my health insurance under Cobra with an Explanation of Benefits (EOB). An EOB is just what it sounds like…a statement telling me what is covered and what is not. My statement for January was quite shocking. Benefits denied! And I potentially will owe an astronomical amount of $127,000! I know my dialysis is expensive, and I do see statements indicating charges of well over $100,000 in one month, but of course it’s always covered. Why no coverage this time?

I check another document in the cue that states my coverage ended as of December 31st! WRONG! So now I get to do my favorite thing in the world…call the insurance company to complain and get to to the bottom of this. I’m getting good at this apparently, feel like it’s my full time job. It kind of is, come to think of it.

Anyway, first I call Discovery Benefits, the organization handling the Cobra benefits, to confirm that I cancelled coverage as of January 31st. Yes, indeed, that is correct. My coverage ended January 31st, 2020, not December 31st 2019.

So then I called the private insurance company, and got through pretty quickly to a very polite woman who apologized for the inconvenience. (Yes, terribly inconvenient to go into debt to pay my healthcare bills!)  I no longer have my insurance card, but the the representative was able to access my account without that information. She confirmed that coverage had ended at the end of December. Here’s how it went:

Me: But I cancelled my Cobra coverage with Discover Benefits on January 31st.

Her: Then you’ll need to call Discovery Benefits.

Me: (Blood pressure starting to rise, breathing and heart beat increasing, teeth clenching) I already called Discover Benefits, they confirmed the January 31st cancellation date, and said I had to call you. Please don’t make me call them again! (as politely as I could through clenched teeth.)

Her: May I put you on hold?

Me: (teeth clenching more) Yessss. (I’m just hoping I still have dental care with all this clenching.)

5 minutes later.

Her: Thank you for holding, I will send an email to accounting to get to the bottom of this.

Me: (In my head: Send an email?? Get to the bottom of your mistake? I’m telling you that right now!!) Ok, may I have your name and number so I can follow up if I need to. (Something I’ve learned to do along the way, very helpful.)

Her: Certainly. (Gives me her name and direct phone number) I will call you back tomorrow to let you know what is going on.

Me: Thank you.

Her: Is there anything else I can do for you today?

Me: Hmmm, well, what’s your blood type? And are you a smoker? You sound pretty healthy! How’s your kidney?

Her: ???

Kidding, didn’t really ask for a kidney.

That was a Thursday. On Friday I heard nothing. On Monday I called and left a message. On Tuesday I called and left a message. On Wednesday I called and left a message. On Thursday, I actually had other things to do, so I didn’t call and leave a message.

On Friday, finally, a phone call from the private insurance rep! And a pretty short phone call too. She said my coverage indeed should have continued through January, and that it would be reinstated. I asked if my bills (many) would be resubmitted. She said yes. I asked for confirmation via email. She said I would get that. Great. We will see.

So for now, it seems I am covered, and I won’t be going into debt to cover my medical expenses. From a disease I did not bring on myself. A disease that has caused me to quit my career, become dependent on other people and pretty much change my whole life. But oh well, those are the cards I was dealt.

But come on! I shouldn’t have to worry about paying for my medical bills, whether or not I brought on those health concerns myself. No one should. I won’t turn this blog into a political rant about the state of healthcare in the US. But I do want to say one more thing.

My experiences with private health insurance has been a nightmare. It’s always been a struggle, even before I was on dialysis. In fact the year before Medicare kicked in I paid $9,000 in out of pocket expenses! And I’ve had to fight for my coverage with various companies over the years. This means hours of time on phone arguing about coverage. Several years ago, I had one company tell me that my general practitioner, who I had been seeing for 10 years, was a specialist, so they wouldn’t cover the visit. It ended up being a coding mistake. The bill was paid after hours on the phone.

My experiences with Medicare and the Social Security Administration? Exemplary. Never have to fight with them, coverage happens, good customer services, and so far NO errors. In fact when I was applying for SS disability online, it took a lot longer than I thought, so I paused the application to finish another day. After a few days, I received a call from Social Security, a lovely woman from the St. Paul office, who asked if I needed any help with the application! She gave me her name and number and said if I needed any help…just call. I did, and was able move through that process pretty quickly.

These are my personal experiences, you may have  your own. But when I hear about people being “afraid” of Medicare for all, I can’t help but think their fears are ungrounded. I worry a lot more about my private insurance.

All. The. Time.

A transplant is expensive, but overall my medical bills will go down once that happens. So if you would like more information about how you can help, contact susanna.gust@allina.com by calling 612-863-8886 to request a packet of information and to undergo screening. Living donors may be related or unrelated to the recipient, but type O is preferred. Donors who are not type O should ask about a Paired Donation.  Visit http://www.allinahealth.org/Abbott-Northwestern-Hospital/Services/Kidney-Transplantation/ 

 

 

2 thoughts on “The snake in the grass.

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