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December 16th, 2008

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03:57 am - The Best Christmast Present Ever: Part III
(Continued from here)

Throughout all of it so far, Jim had still had a positive attitude, but this -- this brought him down. From laughing and making cancer jokes, he went to an "I'm fucked" kind of attitude that hurt all of us to witness. He just wasn't the kind of guy that you can picture getting down about anything, which made it doubly hard to see it.

Practically everyone in the company (and the PEO for that matter) was trying to find a way around this. I myself put in calls to many different agencies from the State Insurance Commissioner's office and the Governor's Commission on Healthcare Assistance to the Federal Department of Labor, plus many non-profits set up to help cancer patients with varying levels of assistance. The answer from the government agencies was all the same: "Yes, the insurance company can indeed do that. Sucks to be you."

This was from the people in the government agencies who I could get to understand the question in the first place. I got quoted state statutes that didn't apply and referred to agencies that were irrelevant. I was told it was a Federal issue, then a city or county issue, then, again ... "Sucks to be you."

Oh, and let's not forget Medicaid, the State medical insurance plan. Apparently, to get Medicaid, you must first be approved for Social Security disability. You can only get approved for Social Security disability if your disability will last for 12 months or longer or will end in death. And even if you COULD get Social Security disability, it takes months to be approved and more months to be approved for Medicaid. His treatment was only supposed to last around three or four months! At this rate, he'd be cured by the time Social Security could even turn him down.

That is, if he could even GET treatment without insurance.

"But," you cry, "what about COBRA? He could get COBRA coverage and stay on the old plan, right?"

For those of you unfamiliar with US employment law, "COBRA" (which stands for "Consolidated Omnibus Budget Reconciliation Act" and not, as many think, "Continuation Of Benefits Right Afterwards") is generally referring to some provisions in the law that allow employees who lose their jobs to take their medical insurance with them when they go. Under the provisions of COBRA, you can continue your old medical insurance (if you pay the full cost of it -- which every time I've seen it done it ends up being around $500.00 a month or more) for up to 18 months. It's supposed to allow people to continue to have medical coverage until they can get another job that provides it. COBRA also applies in cases of divorce (where one spouse can keep the other spouse's insurance), retirement, or other losses of insurance.

So, hey, no problem right? Jim can just get COBRA. Sure, it's expensive, but at least he'll be covered.

Well, see, here's the thing with COBRA. Yes, there's this law that if you lose your medical insurance in many cases, you can still buy into that employer's health plan (if you have enough money, which most people don't). However, that law only applies if your employer still offers a health plan. Since it would be the PEO offering the health plan, and not our company, and since, of course, our company would be cancelling their plan, there would be in effect no plan to continue.

So COBRA did not, unfortunately, apply. No help there.

The answers from the non-profits were more encouraging -- at least they could help with things like food and rent and transportation, but most of them can't or won't help with medical bills. There are a few non-profit organizations that help some with medical bills, but it still looked as though his quality of care would suffer and that at best he'd end up having to declare bankruptcy at the end of it all.

That's at best.

Best case scenario, this hard-working guy who's a friend to everyone is going to end up with barely adequate care and forced to declare bankruptcy at the end of it.

But the real kicker to the whole thing is this: the company we have medical insurance with now? Anthem Blue Cross/Blue Shield. The company we would have medical insurance with through the PEO? Again, Anthem Blue Cross/Blue Shield. So, in effect, the guy would be going from one insurance company to THE SAME EXACT insurance company with no break in coverage, but that insurance company would suddenly call his condition "pre-existing" and refuse to cover it because of the switch in employers.

And they are, by Federal labor law, allowed to do exactly that.

People wonder why I hate the medical system, and insurance companies in particular. This would be a reasonably decent example of why.

Well, as you can imagine, things looked pretty bleak.

(To be concluded...)

(10 comments | Leave a comment)


[User Picture]
Date:December 16th, 2008 02:36 pm (UTC)
Just wanted you to know that I was reading and sending you and Jim good mojo. You're the bomb for doing all this for him. I won't write more, because I don't want to drown your weblog in bile and nasty, nasty words.
[User Picture]
Date:December 16th, 2008 05:51 pm (UTC)
If the bile and nasty words are about Anthem Blue Cross/Blue Shield's corporate policies, go right ahead.
[User Picture]
Date:December 16th, 2008 05:41 pm (UTC)
I just don't EVEN have words for how completely screwed up this is. "Health" insurance- the Greatest SCAM ever thought up.
[User Picture]
Date:December 16th, 2008 05:51 pm (UTC)
Dude. Seriously.

The same EXACT fucking insurance company!

What. The. HELL?

Honestly, it boggles my mind.
Date:December 17th, 2008 02:55 am (UTC)
It should be a crime. Seriously.
[User Picture]
Date:December 17th, 2008 01:21 am (UTC)
Ugh. This is just disgusting! Poor Jim.
[User Picture]
Date:December 17th, 2008 03:05 am (UTC)
Personally, I'm voting that the mass turned out to be a) a pony embryo, and they removed it and finished growing it in a petri dish, and he is getting a pony for xmas, or b) a mayo smear.
[User Picture]
Date:December 17th, 2008 03:24 am (UTC)

Heh. Wouldn't that be nice.

Nope, it's small-cell lung cancer, big time.
[User Picture]
Date:December 17th, 2008 03:27 am (UTC)
This choose-your-own-adventure sucks!
[User Picture]
Date:December 17th, 2008 03:32 am (UTC)

I'll be sure to mention that next time I see him. He'd probably get a kick out of that.

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