Monday, October 20

Why you should always keep asking

Aaaaaaaaaaaaaaaaaaaaaaaarrrrrrrrrrrrrgggggggggghhhhhhhhh!


Pardon me. I just needed to get that out of my system.


So, what with my depression and Tim's boil, days have been clipping on by without much notice. And suddenly, it's late October. Friday, I finally got Tim to sit down and check out the application for the Washington State Health Insurance Pool. (I had mentioned it in passing a couple of times, but always when we were out and about, nowhere near the computer. Which means we had completely forgotten long before coming back home.)


This is the pool you apply to once you've been rejected from "normal" individual plans. And apparently two or more MRSA outbreaks in the past five years has more than enough points on the scoring sheet (Who knew your health was being graded? Is there extra credit?) to reject him outright. Add the eczema and asthma, and I'm shocked they didn't just write "lol: nice try" on the top of the sheet.


This was way back in May, before we left for our honeymoon. We got back and read the rejection. Being normal people, we tossed it. Who the hell wants to keep something like that?


Fast forward to now. Turns out that Monday, the 20th, is the deadline for new insurance applications. And we find this out Friday.


Now: I understand that we procrastinated. So some of this is our fault. Although I swear that we were told the WSHIP application would come in the mail during the last month of coverage. Perhaps I made that up in my mind, as a comforting fantasy. Who knows.


But, the point is, we were in big trouble. Turns out you need a rejection letter with your application. And not just any rejection letter: One that is less than 90 days old. We obviously had neither.


So, first I have Tim call up his old work to verify that this is, in fact, the last month of coverage. No reminder was sent, and we had verified months ago that the coverage ended after just six months. But we were having trouble remembering exactly when the official "non-employee" coverage started.


Sure enough, this is the last month. And since we needed proof of coverage -- and didn't happen to have a Certificate of Coverage on us -- he had to ask them for a letter verifying the beginning and ending dates for his coverage, preferably on company letterhead. Oh and, uh, today if humanly possible.


Then, he called the insurance that rejected him to verify that it had been more than 90 days since being rejected. After three operators (and one accidental hang up), we were told it was back in May.


Then, Tim could finally call WSHIP itself. We outlined the problem: We were expecting an application in the mail; we procrastinated when it didn't come; we tossed the rejection letter. The operator's answer? Nope, you need the rejection letter. It's the one major eligibility requirement for the pool.


Okay, well Lifewise was sending us a copy of the old rejection letter. Would that work? Nope. Has to be within 90 days.


At this point, I asked for the phone. I reiterated that we didn't have a rejection letter and that Tim could not go without insurance for a month. I took blame and explained that I guess I had been wrong about being mailed an application. I apologized for the lateness of it all. Then I asked her if there was anything we could do.


Nope. We need a rejection letter.


I tried another tack: I understand we made our own bed here, but we really needed coverage and obviously today was the last day. Was there another way of doing this so we could proceed?


Nope.


I almost said okay and hung up and cried my eyes out. But I decided to be stubborn, because this is bureaucracy and there's almost always a loophole. (Plus, if there's anything my fellow Americans have taught me it's that denying reality over and over does often work out to one's advantage.)


So I said, Look, my husband has to have insurance. You're telling me that there is no way that we can get this application in and maybe get a rejection letter later? There's no way he can be insured in November? We are just S.O.L. for a whole month?


And wouldn't you know? Turns out we can fax our application in today to try and hold the Nov 1 start date. "But we need that rejection letter," the operator said. And we need to mail the original to them, since they need original copies of Tim's signature.


I reiterated what she had said -- we fax over the application today, apply for insurance again and as soon as we get the rejection we fax it over and we can still get it -- and thanked her profusely and hung up.


What I wanted to do, amidst the flood of relief and gratitude, was shout at her, "Why didn't you mention this the other two times I was practically begging you for a solution?!"


But that would have been pointless. And we are grateful that we can still get in.


However, it does highlight the important point that you should always keep asking -- even when it seems that they've told you point blank you have no alternatives. Especially in bureaucratic settings, there's almost always a loophole of some sort.


I've used this technique a few times. If you're politely stubborn enough, managers will often honor coupons, even if it wasn't intended for their store branch. Or if you're one day late on a sale, I know some people who have finagled an extension. If the shelf is empty of a certain sale item, be sure to ask if there's any in back. Many times, it's an issue of when they restock.


We also used it recently to stretch the meaning of "10 per person" to "10 per transaction" thanks to a cashier who was willing to humor us. But that is a story for another post...


Incidentally, you may be wondering what the big deal is -- one month of insurance can be inconvenient but not a huge deal for most. It's not really a big deal for medications. They're under $100 a month, which would be annoying but certainly possible for us to afford.


But with Tim's severe eczema, no insurance quickly spirals into major problems:


If Tim had been uninsured for a month, that would mean no light therapy. Each two-minute session costs nearly $200, three times a week. Our backup plan was lots of outside walks, but the main problem is that it's cold out, so not much skin would get direct sunlight.


Without the light therapy, his skin would rash up more easily. (Although people think of eczema as a rashy skin thing, it's actually called "the itch that rashes." Just because there's no rash, doesn't mean there's no itch. The itch is constant.) When it rashes up more easily, it's easier for MRSA to hide out. And also the rash breaks open more easily than regular skin, leading to more staph infection, MRSA or not.


That would mean doctor visits, which we couldn't afford. So, we would have to go to the low-income clinics or, more likely, we'd end up waiting until he couldn't take it anymore.


Then, we'd end up in Harborview ER (the local go-to place for the uninsured), wait for hours to be seen, only to have a doctor give him the expected meds. Often, this included more steroids, which are just soooo fun. Among other things, they kill your metabolism and can make you antsy, which a person with ADD just doesn't need.


Then we would have to fill out financial aid information to prove we needed the hospital to cover the cost. After that, we could go home... until it all happened again. Usually about a month later.


And this is how poor people end up in the ER, or even dead, from minor, treatable things.

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1 Comments:

Blogger Jennifer said...

Glad you found a way out. I hope it continues to work out for you.

October 21, 2008 at 6:09 PM

 

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