Slipping through the cracks in our health care system

Between the cracks is a frightening place to be.

During the course of trying to improve our family’s financial stability, my husband and I were blind-sided by one hidden detail: We’d face $10,000 in costs to continue my husband’s serious medical treatment because we found ourselves unexpectedly without coverage for 30 days.

This was money we simply did not have. We had been prepared to foot the full bill for good health insurance, but that wasn’t even an option, thanks to the circumstances of our career transitions and my husband’s health.

I was leaving my job of 10 years to begin a satisfying new position that came with excellent health care coverage. It was a beneficial move that would offset my husband’s impending loss of insurance as his employer downsized and prepared to go out of business. We knew the end result, but we didn’t know the timing. It just so happened that his coverage ended the same month that I began my new job, leaving a gap of one month before my new coverage would begin.

With this routine employment-benefits formality before us, we knew we’d have to purchase coverage. We had hoped to buy a Cadillac COBRA plan, given the circumstances that require very expensive care. But we learned that an out-of-business employer is not obligated to offer COBRA, and our plan to continue the same level of coverage at our expense was not available.

I then checked with my previous employer, whom I had left just two weeks earlier, to weigh my options. I had none, because, at the time of my resignation, I hadn’t been enrolled in that employer’s plan. At my new job, I had already initiated my flex plan withholding so I was too late to set aside pre-tax dollars to help ease the burden.

Because of my husband’s serious pre-existing condition, we were almost certain we wouldn’t qualify for insurance anywhere, and if we did, the price would likely be out of this world. With billing statements in hand, we began to panic about the outrageous price of care and the irony of trying to improve our lives through better jobs—a situation that led to our falling through a nearly invisible crack in the health care system.

The decisions before us were scary: suspend treatment for one month, potentially jeopardizing my husband’s health and setting us back even further in the long run, or find a way to pay $10,000 for his medications, hormone injections, lab work and doctor visits. We chose the latter.

Luckily, our doctor knew of some possibilities that might help. One was to enroll in a medical study that would cover all expenses as part of the research. Unfortunately, an additional health condition made my husband ineligible to participate. The doctor also told us about our insurance company’s conversion plan, which guarantees coverage (albeit less of it, with no drug benefit). The company charges a higher premium in exchange for the forfeiture of underwriting. Though the coverage was greatly reduced, we decided to purchase this nominal safety net for my husband while I took the chance on my own health by not buying coverage for that one month. (As luck would have it, I then contracted pneumonia. A purposeful delay in diagnosis and treatment happened just as I was beginning my employer-provided coverage.)

Finally, the doctor knew of a pharmaceutical company’s program that provides free medication to those who cannot afford the treatment. We applied, slogged through the red tape, waited with wringing hands, and received word that we were accepted. That was a godsend. Today, my husband’s health is nearly perfect and we are back on track to providing everything our family needs, including health care coverage.

When we slipped through the cracks in the health care system, we were emotionally taxed at a time when we could scarcely handle any more stress in our lives. Of course, we’re grateful for the excellent care and the help we had to patch together a plan of action we could afford, but we were taken by complete surprise when we viewed the costs from deep inside the crack.

Kelly Cheramy is the wife of a man with a chronic illness.

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  • http://pulse.yahoo.com/_VM5ZKYTEEAO4KZZG23W3HL2ERQ marc

    Sounds like a nightmare and of course many Americans do not have a happy outcome. It’s hard to see how opponents of healthcare reform can defend these situations, but they certainly do want many people to carrying on suffering like this. 

  • Luana Thermos

    Kelly, when a company goes out of business, there is no COBRA because there is no longer a group plan; however, there is an option for insurance with a pre-existing condition that’s called a HIPAA-eligible plan. They will be more expensive than a typical individual plan; however, they’re usually not too much more than what COBRA costs. 

    As long as you can say yes to the following criteria, you (or husband) qualifies for a HIPAA eligible plan.1) Have elected and exhausted health insurance benefits through a COBRA or similar group, state, or federal continuation. 2) Have 18 months of creditable coverage with the most recent coverage under an employer-sponsored plan, governmental plan, church plan, or a health benefit plan offered in conjunction with any of these plans. Certificates of creditable coverage must indicate at least 18 months of aggregate health insurance coverage.3) Have no more than a 62-day break in coverage.4) Be ineligible for Medicare A or B, Medicaid, or any other employer-sponsored plan.5) Not be covered by any other health insurance plan.6) Not have had prior coverage terminated because of failure to pay the required premium or because you committed fraud.Since the company went out of business and there is no COBRA, you qualify. If you opt to not take COBRA, you don’t qualify.