The Bottom Line
Today I received a fat envelope from Blue Cross/Blue Shield which I assumed was information about renewing the girls’ healthcare coverage with Child Health Plus (a New York State funded program for children 19 and under that’s amazing and wonderful – no copayments, no deductible, everything is covered as long as you stay in network). It costs me $90 a month for both girls. That’s it. There are several different insurance companies in NY that participate in Child Health Plus, but we chose BC/BS because all of Ana’s doctors at Columbia Presbyterian are covered under the plan – which is an HMO – and if you have any experience with HMOs, you know you only get to enjoy your delicious, delicious benefits if your provider is in network.
It wasn’t a renewal letter.
It was a letter stating that BC/BS would no longer be participating in Child Health Plus as of January 1, 2015 (my plan was supposed to be good until February 1st…) and helpfully providing a list of alternative insurance companies that I have the option of switching to within the next month. I have to make this switch within the brief window between 11/16/14 and 12/15/14. Thank you very much and have a good healthy life.
Warning: Everything beyond this sentence is pretty much a fist-shaking rant.
For most people the letter is likely a minor annoyance. They’ll call their kids’ doctor, see what plan they accept, and make the switch. I mean, I’m sure it’s a hassle but not anything to rant about on a blog or anything.
I imagine the corporate henchmen involved with this decision made that point. There were probably pie charts that showed how the Child Health Plus and Medicaid programs lose money. BC/BS has shareholders to keep happy, after all. The majority of people will switch to a different plan and be relatively unaffected because the benefits under Child Health Plus are equal no matter what insurance company you choose. It makes good business sense for BC/BS to drop out of this program (that helps very sick children survive while their families avoid financial ruin…) What the hell do we (yearning masses) think they are anyway? A charity? A government program? Hell no! The plans are all the same, so what’s the difference?
Well…the difference is the provider networks. And here’s where the conversation may have gotten uncomfortable in that board room. Maybe someone had a kid with something more serious than their local pediatrician could manage. Maybe it was autism, or severe food allergies, or diabetes or maybe even cancer. This person would’ve (hopefully) pointed out that the small percentage of children getting benefits under Child Health Plus absolutely had to go to a specialist in the BC/BS network because of a number of things including continuity of care, expertise, accessibility to new treatments and medications…
And the guy standing near line chart with the graph pointing down (illustrating that they were losing millions by treating these very sick or chronically ill children), may have shrugged and said, “Only a tiny fraction of families that will be affected. They’ll find other doctors, or another plan. It’s not our problem.” (THAT guy probably has four healthy, strapping sons all of whom volunteer for their local Republican congressman during election time).
Or maybe he had a pained expression on his face when he said, “I understand a few children may not have access to the doctors they need, but we have to think about the viability of this company. We owe it to our shareholders and those we serve who are not enrolled through Child Health Plus.”
Or maybe he pointed to the chart and shrieked like a monkey. That’s how I’d like to think it went down.
I have no idea how much money BC/BS made this year (and believe me, I searched), but I have to wonder if the program truly couldn’t be sustained by the millions of people paying ridiculously high premiums and using their insurance only minimally – kind of like I did for years upon years upon years – before Ana got sick.
This feeling of desperation and anger is something that KEEPS HAPPENING. Every single year I’m thrown into a frenzy of indecision regarding what healthcare plan to choose because I’m self-employed and it’s very, very expensive. Before we discovered that the girls were eligible for Child Health Plus, we had CDPHP which had excellent coverage (once we met our $10,000 deductible.) I paid that deductible two years in a row – the year Ana was diagnosed and the year she had her liver transplant. Columbia Presbyterian isn’t in CDPHP’s network in the Child Health Plus plan though (something I found out in January when Ana was in the midst of starting treatment for her recurrance).
So, even though CDPHP actually forced us to take Ana to Columbia Presbyterian for her liver transplant – refusing to cover it at Westchester Medical Center where she was initially being treated – they would not cover her hepatologist once we switched to Child Health Plus. Thus, I switched to BC/BS in February of this year (after experiencing an extra month of heart-stopping panic.)
But once I got the insurance carrier sorted out, things were awesome. This was the miraculous year that the deductible went away (thanks to Child Health Plus), and the bills finally stopped coming. I cannot understate the impact BC/BS’s letter has on my life right now. It will be the central focus of my brain until the issue of insurance is resolved.
Ana’s care depends on doctors that may only be accessible via BC/BS – an insurance plan that I can’t afford to pay for without Child Health Plus – but yet I may be forced to pay for anyway. If I can’t keep Child Health Plus and have to get BC/BS through another source, my premium goes up by a good $500 or $600/month – that’s on top of the $750 I already pay if you include my own insurance plus all those copayments and deductibles return. Ana’s meds cost thousands of dollars (even tens of thousands) each month. And then there are labs, specialist visits and tests. We’re not even talking about surgery and hospitalization.
The whole system is maddening. It’s a ball of yarn that I’m sitting here desperately trying to unravel. It’s crap. It sucks. It’s not good enough! We deserve better than this – all of us. Our children deserve better than this! I’m shoveling money out the door at a system that’s barely able to meet my needs and I have no idea how to fix it. Can it be fixed? I’m shouting into the void.