...and the individual insurance market is a national disgrace.
From Sarah Wildman's excellent piece on the ordeal of getting her insurer, CareFirst, to pay for the pregnancy that was ostensibly covered under her plan:
Six weeks after I gave birth we received a bill for over $10,000 from Shady Grove Adventist Hospital in Maryland, for labor and delivery, pharmacy, supplies, room and board, and lab work. Our insurance had denied the claim. The hospital began calling us incessantly. CareFirst, the hospital reps insisted, told Shady Grove we had “maxed out our benefits.”
Why? For months we got nowhere in answering that question. Our calls to CareFirst went unreturned. Our lawyer’s letters went answered. One CareFirst rep we actually managed to reach explained we had maxed out because the benefit was “capped” at $3,000 per pregnancy. That means $3,000 for all pre-natal visits, tests and sonograms, labor and delivery, hospital stay and hospital care. In what mythical U.S. hospital is nine months of medical care paid for with $3,000? The study by the National Women’s Law Center found that (in 2006) a normal vaginal birth cost, on average, $7,488 in hospital charges alone. Using examples of riders similar to mine, NWLC found that women with uncomplicated vaginal births would pay between $6,780 and $9,682 out of pocket. C-sections came in around $13,000 nationally, and for them, the out of pocket costs ranged from $10,000 and up. I presented those numbers to CareFirst, and they freely admitted they knew their policy in no way came close to covering a pregnancy. “It’ s a crappy benefit,” one rep admitted to me.
Why didn’t we know that my coverage was capped at $3,000? Partly because of the lack of federal oversight of the individual market, coverage comes with layers of mind-boggling fine print. All of the upfront materials we read detailed how extensive the coverage would be. When we combed through the supplementary books, pamphlets and fliers during our battle, we finally saw one tiny table, stuck into an appendix, indicating that benefits for “maternity and related services” were limited to $3000. Our $3000 had been spent on anesthesiology, our midwife and obstetrician, leaving nothing left for the labor and delivery or hospital stay.
Speaking of which, one thing puzzles me about the health care debate: Where are the social conservative activists on all this? If you take them at their word, they want nothing more than to encourage married people to have babies. Where do they come down on the fact that it's almost impossible to get your insurer to pay for a pregnancy if you buy insurance on your own? After Googling around a bit, I can only tell you what they don't want covered.
I know social conservatives resent the accusation that they're easily manipulated. But, boy, if ever there were an example of false consciousness (or, at least, cheap dates), this would appear to be it.