I have been inspired to start this blog because of a few ongoing thorns in my side and because of being inspired to not sit still and take it. I thank Dave Lieber, the Yankee Cowboy for sending me a copy of his new book.
Now to the story: In March of 2007 my husband's health insurance lapsed. We could not afford COBRA. It is outrageously expensive. We started looking for alternatives. Since I am self-employed I was contacted by NASE (National Association of the Self-Employed). I asked about health insurance and a representative came to my home/office to discuss their plan. After he blew smoke up my shorts for about an hour we joined NASE (a requirement to get the insurance) and applied for coverage through Mega Life and Health. I should have done more checking into the program and into NASE.
I knew that I was going to be denied coverage because of a few health issues but needed two declination letters to get into a State plan.
In April and May 2007 our remodeling business really took off and my husband was extremely busy. It was quite warm here in Milwaukee during the week before Memorial day. We have been married for over 30 years and my husband has never been sick. When he arrived home on Wednesday he commented that his ankles were swollen. My thought was "big deal"...we all retain water when it's hot and he had been wearing steel toed shoes on the job site. Thursday morning he was fine. Thursday night when he came home the ankles were swollen again. No big deal, right? On Friday his ankles were a bit more swollen but he had a very rough week.
In the mail on Friday was a letter addressed to me from Mega Life & Health. It said what I thought it would about me. It also said, "All other policies have been issued." The key to this sentence is the wording, "have been issued". The letter was dated so my thought was that my husband's insurance went into effect on the date of the letter or earlier.
Going back to my husband's issues now. On Saturday morning my husband's ankles had not gone down to normal. In fact his legs were swollen up to his knees. He didn't feel well. You know how guys are about going to the doctor. I suggested (nagged) that we go to urgent care to get a diuretic. I had plans for the Memorial Day weekend and didn't want to have to babysit a sick hubby. He finally agreed to go to urgent care. He was examined and was told that he needed to go directly to the hospital. He was a bubble away from having a heart attack (at age 57). He was admitted to the hospital at about 3pm on Saturday.
The only information I had about our new policy was the letter I received on Friday the day before he was admitted. On Tuesday morning (Monday was Memorial Day) I called Mega Life & Health to see if I could get my husband's ID number. I told them about the letter, that we had not received his information and that my husband had been admitted on Saturday. I was put on hold for a very long time. Dave, if you are reading this it sure sounds like some of your AT&T stories. When the person returned to the line I was told that my husband's insurance did not go into effect until 12:01 am on that Sunday. This date means that we had no coverage for the hospital stay.
My husband's diagnosis was congestive heart failure. He has had a remarkable recovery but takes a handful of medications every morning and sees his Doctor every 2 - 3 months.
I complained about the effective date. I appealed. I sent a letter to Wisconsin's Insurance Commissioner. Nothing helped. Go back, read what my declination letter said..."all other policies HAVE BEEN issued." That letter was dated the Friday before the trip to the hospital. I'm not a dummy. I have a B.S. in English. "Have been" means present or past tense....it doesn't mean the policy is GOING to be issued at some time in the future.
Over $10,000 later all of the bills have been paid. In addition, you should note that if my husband would have had any other subsequent issues with his heart there would have been no coverage for the first year as this is now a pre-existing condition.
The coverage with Mega Life does not include office calls. If I would want to add this coverage it would be $23/month and only one office visit per quarter would be covered at 80% after our deductible. An office visit is $180 and my husband needs to be seen at least once every 2 - 3 months. Diagnostic testing is covered at 80% after the deductile which is $2500.
I finally received my husband's ID cards and policy about 2 weeks after he was home from the hospital. The cover letter was dated the same day as my declination letter. This date, imho is bogus. Where was this letter hovering for over two weeks? The US Postal service isn't that bad. I think they back dated the letter. I also think that there was some hanky panky going on in that office when I called to get my husband's policy information. The woman's tone of voice tipped me off. She was kind of sheepish as if she knew she was telling a story but really didn't like being the messanger.
Before doing business with NASE visit ripoff reports online. Before signing with Mega Life Google them. Their AM Best Rating isn't too good either. It's only a B. AM Best reports that their outlook is negative.
Saturday, November 1, 2008
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