The Incision

NEWS & VIEWS

Our healthcare system adds insult to injury — and injury to insult.

The Incision

SHUTTERSTOCK

A COBRA Story

By Tara Terpstra

A quick note from A bdul: I spend a lot of my time deconstructing the healthcare system at a 30,000 foot level, where I can see the full workings of a system uilt s eci c ll to ene t t e cor or tions that control it. But sometimes, it’s from the ground that you can really appreciate just how cruel it is. O ne of our editors, Tara, recently had to contend with the CO BR A system — extending employer-sponsored coverage after employment ends — for her mother after her father unexpectedly passed away. Her story captures all the ways the system’s hidden complexity punishes A mericans.

We lost my father earlier this year after a two-month battle with cancer. It forced us to navigate through the aspects of my mother’s life that were now oin to di er drastically. ne of those was health insurance, which my father had carried through his employer for both of them.

Mom wasn’t old enough to qualify for Medicare, makes too much to qualify for Medicaid, and is self-employed and therefore not eligible for any employersponsored coverage of her own. The first circ mstance we co ld do nothin about. The second didn’t help us in her current situation. The third could be remedied by seeking out a job with employer-sponsored coverage. But therein lies another set of considerations for someone who’s nearing retirement age, not to mention potential waiting periods depending on the employment terms. That left us with two possible avenues, buying an individual plan from the health insurance marketplace or co era e. he most a orda le plan on the marketplace was over $600 per month — for what amounted to catastrophic co era e. ct al ins rance co era e wouldn’t start until she’d hit an absurd deductible, in this case over $7,000 per year. So we shelved the idea of a marketplace plan with the hopes that co ld e a ia le option. is illo ical from the mp. Your employer-sponsored coverage has to end, and there’s approximately a month where you’re forced to wait in limbo for the enrollment paperwork o tlinin yo r enefits and plan price to be mailed to you. During this period you do not technically have any insurance (though it’s usually backdated upon enrollment), so you’re praying that you don’t need to see a doctor or, God forbid, get into an accident or have an urgent medical issue. The paperwor too a o t fi e or six wee s in Mom’s case. U ltimately, though, om wo ld e eli i le for for 36 months and the premium would still cost less than the garbage plan we found on the marketplace. We were relieved, and planned to move forward with si nin p for once the paperwork arrived. ne wo ld thin that the enrollment process would be fairly straightforward, but rather than your original insurer, it’s typically administered by an outside entity. nce we recei ed the paperwor the fun began. We had set up automatic payments to avoid any late fees or possible termination. We thought we’d done the right thing. But then we received a notice that a bill of a negligible amount was due, with the scary language that failure to pay by a certain date would result in plan termination. Many phone calls and emails later, we learned that plan administrators had changed their backend system shortly after the enrollment was completed. Somehow in the changeover they managed to delete the automatic payments that had been set up, and we started receiving notices of nonpayment again. In our discussions with the customer service representatives, they admitted that they didn’t know how to use the new system — while also making us feel like it was somehow our fault. But, l c y for s, eca se of I re lations, they could initiate reinstatement of the plan. How generous. I can’t even imagine how many people they did this to, how many plans were unknowin ly canceled. h, and then we fo nd out months after enrolling and paying premiums for a medical plan … that my mom didn’t actually have coverage. hen she called her dentist s o ce a o t an appointment, they notified her as a courtesy that their system was showing that she had active dental and vision coverage, but not medical. Several frantic phone calls on the Friday before a long weekend later, we found that my father’s employer had never submitted their paperwork.

To add injury to insult, mom developed a kidney stone and had several visits to the emergency room and a short hospitalization (thankfully, she is st fine . he emer ency room couldn’t turn her away, but her doctor’s o ce ref sed to sched le any follow p visits since, on paper, she didn’t have any insurance.

Throughout this entire process, I questioned why, in the U nited States, we even need to go through all of this just to have the ability to see a doctor or go to the hospital when we need care? We’re dreading having to navigate the system all over again in three years when her co era e r ns o t, not to mention what the a orda le premiums will look like as she’ll be three years older and healthcare costs only grow.

If o r system is the old standard of healthcare, we need to rethink our standards. It’s awful enough to have to deal with the insurance bureaucracy and worry about how you’re going to see a doctor. It’s worse to have to do it while grieving the loss of your loved one.

O riginally published O ct. 27 in The Incision. Get more at abdulelsayed. substack.com.