No, that mammogram is not covered: an insurance saga

Filed Under: Costs, Health plans, Patients

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Our friend who was  ordered to get a second mammogram, which was not covered by insurance, wrote to us again (if you missed it, here’s her first post.) Between insurance? You’ll learn a lot.

So, about my quest to find out the price of a second mammogram, because my insurance covers only $600 in testing in a   year, and I’ve expended my budget . …

I did not deliberately buy insurance that leaves me exposed.

When I was laid off last summer, I elected to take the expensive COBRA group coverage at  $1,094 per month. I didn’t want to shop for coverage that could leave gaps.

My employer was an entrepreneurial company insuring fewer than 10 people. It was Blue Cross/Blue Shield Horizon comprehensive, and  had a $2,500 deductible on certain categories of treatment. When I was an employee, the premium was fully covered.

I’d have been able to get two mammograms covered and not need to think about it.

Four months into my COBRA plan, which I was expecting to last the entire 18 months, through the end of

2013, I was advised that what was left of my employer’s company was dissolving completely and I should start shopping for my own plan.

I turned to an online insurance shopping marketplace. This was probably a mistake because it created a barrier between me and the insurance company, but I only realized that after the fact.

I applied for a major insurer’s EPO Plus plan, and thus began a series of  failed communications. I didn’t want to discontinue my COBRA until I got confirmation that the new policy had accepted my daughter and me, and at what rate.

My daughter has a history of sports injuries and I am youthful, but 55, the magic age at which all sorts of things can start to go wrong.

I was told I would not get accepted by the new policy until the old one was canceled. There could not be any overlap in coverage, even if I paid for both policies.

I had some misgivings, but instructed my employer to suspend my COBRA on Dec. 1, 2012. Through the first week of December I crossed my fingers that I had some kind of coverage, because no confirmation came.

After badgering the online insurance shopping marketplace by phone and by email, I finally got confirmation we were enrolled and at what price, which was the same amount quoted on the  website of $744.55 per month.

But I was cautioned not to cancel my existing insurance until I had received the full written prospectus for the new policy. WTF?!

Then came the wait. It took two months and several phone calls to receive the written policy terms. That’s when I saw in big letters. THIS POLICY HAS NO MAJOR MEDICAL and NO CHEMOTHERAPY.

Mind you, I wasn’t setting out to get cancer, but the idea that chemotherapy coverage was non-existent made me a little bit crazy. It got worse. I called again to learn that in fact I didn’t have the exact right description of coverage and I had coverage if I were to be hospitalized but yes, I had no chemotherapy. At this point, I wasn’t sure what coverage I had, but asked to upgrade my policy to make sure that if I ever got cancer I would be able to get treated by SOMEONE!

“You have to wait for the open enrollment period in November,” I was told because I didn’t request an upgrade within the first month of coverage. “But it took two months for the documents to arrive,” I blurted. “Why is that?” they asked me.

“HOW WOULD I KNOW?  YOU ARE THE ONES WHO SEND THE DOCUMENTS!!!”

I had expected to have a new full-time job by now with group health insurance. It’s true I have friends who have gone without health insurance for years. Everything is relative.

I’ve scheduled the second mammogram at the same place where I received the first one. They quoted me a self-pay price of about $365. but said that is not guaranteed.

Just breathe.