Read the Fine Print, and Don’t Forget About It

What!?Let’s set the stage for a tale of a 3-hour tour I took today. Imagine you have a physically and medically exhausting genetic condition that necessitates 16+ specialist visits per year, well over $2k/mo in prescription medications, and a PPO insurance plan that is just shy of costing the same as a second mortgage. Now imagine you just received a letter in the mail from your health insurance company that informs you that your recent doctor’s visit was not covered due to said condition and that no expenses due to said condition will be covered for the first year after enrollment in the plan.

My wife and I are complete and total medical opposites; she’s only been to the ER once, can count her lifetime usage of antibiotics on one hand, and doesn’t even like doctors. Every fiber of me wanted that for one year. Just one year.

That’s not exactly true, though, because there were fibers that were upset with the insurance, upset that I’d left my office job, upset that I might have chosen the wrong insurance plan, and upset that I am not independently wealthy to pay for my own condition by the age of 30. Okay, the last one was ridiculous, but those fibers were there, too.

After two hours of discussion our options and mentally and emotionally preparing to call my old boss, I looked up our plan details since our paperwork didn’t mention anything about that clause. After 20 minutes of searching, I found the page that states that prior creditable coverage within 63 days of enrollment waives the exclusion.

Shoot, we didn’t have any lapse at all! What gives!?

A quick call to customer service and I was in touch with a rep. within 3 minutes. I told her about the letter and that we had continuous coverage with them for the last 9 years, and wondered if that didn’t count as “creditable” coverage. She immediately saw my previous plans with starting and ending dates and was prompt to apologize for any inconvenience and anguish the letter had caused.

Now THAT’S customer service!

The company?

Aetna.

Our Little COBRA Insurance Nightmare

We’ve been up a mountain, into a trench, and back again since last evening when my gorgeous reminded me that she was going to write all of our checks for stuff due that we don’t do online. For whatever reason I suddenly remembered that the rates for our COBRA were going up for the April payment and did one of my quick freak-outs because I had no idea where that paper was any more. Baby did, of course, so I went and got it from the filing cabinet.

Then the night got really bad.

Before I even got downstairs I remembered the day we got this paper and I wanted to check off a couple of boxes and send it right back because it was actually the open-enrollment form for the next year of coverage. To NOT send it back was to NOT elect for coverage. We had a lot of crap going on at the time… like losing my job!… so we didn’t do it that night. Or the next. Or the next. Soon the paper got shuffled from one place to another to be filed in our drawer to know what the new check amount needed to be.

Fast-forward again to last night. I’m sitting there in complete and utter shock that our insurance was going to end in 6 hours. The company was moving COBRA to an outside vendor and had needed the form by February 25th and I knew right there that we were up a creek without a paddle because it couldn’t just be an inside oversight thing to let us continue. A call in the morning confirmed just that, too.

After 4 hours of calling this person and that and e-mailing and working myself into a tizzy and down into a depression over and over again, the benefits person did confirm that the Aetna sales department was correct that we are eleigible for HIPAA portability/conversion because we didn’t lapse due to non-payment but because of non-signing up and I had an e-mail copy of our certificate of continual coverage 10 minutes later.

I made a quick call to Aetna again to confirm that the deductible and out-of-pocket maximums listed on the plan would be the smaller number applied to my care if my non-sicky sick wife wasn’t making claims. That is the case, so our expenditures will mostly be premiums, and I can tell you we’re getting a lot back in taxes again this year with those costs.

Thankfully, ever so thankfully, even if I was hospitalized we could cover the deductible and the out-of-pocket for the entire ordeal and just pay the premiums and any copays for the rest of the year without having to decide whether to eat or get medical care. So long as this is as automatic of an application as it appears from the forms and from the sales department, we are going to be just fine.