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Tuesday, August 24, 2010

Ella's insurance issues are fixed

Yesterday, we received Ella's insurance cards in the mail. I have been fighting to get her covered since the day before she was born last November.

My husband's job pays pretty well, but the benefits stink. It doesn't offer insurance for family members, just the employees, so the girls and I can't get on it. Our state offers a program called Cover Kids. For children a year old and older, the income range for free coverage is $21,000 to $55,000. I think this is wonderful because so many people fall into this income bracket and can get good health care coverage for their children. If your child is under a year old, the income bracket is $40,000 to $55,000. What I also like about this program is that it's mostly for people who are middle class, who work really hard and pay taxes, but find it difficult to get help when they need it because they make too much money, and if someone says anything about government assistance and them paying for our healthcare, I can pull out our tax return and show exactly how much we paid in taxes last year and the year before.

I hate talking about how much we make, but we do make over $40,000 a year. When I signed Ella up, I was nervous about being induced as I was doing it just a few hours before I was to go into the hospital. I looked at Brian's paycheck stub wrong and put down his take home pay instead of his gross pay. The insurance company would not do anything though until I received Ella's social security number, which took almost two months. So, I put her number in and at the end of January, I find out we didn't make enough money for her to be under Cover Kids. They said she was eligible for TennCare, our state's version of Medicaid.

So, I go and apply for TennCare. They told me then they thought I would probably not be eligible based on Brian's pay. A few weeks later, we get a letter, telling us exactly that. At this point, I'm wondering why we aren't eligible for either one. I decide to do some investigation and in mid-April, I figured out my mistake. I corrected it in the computer and waited for a response.

Nothing came. I called in May, and they told me that since they had just opened up re-enrollment that it would take a while to get back to me, but they would eventually. So, I waited and waited. I paid out of pocket for medical expenses. Ella became sick in July with the adenovirus and had an ear infection. It was only $85, but I knew something else might happen. My patience with the people at Cover Kids was running thin, and I thought I had waited long enough.

They checked their records and said I was supposed to be told to provide proof of income. In all of the phone calls I made, no one ever told me that. I never got a letter, nothing at all. So, I faxed a paycheck stub to them and waited. However, just about two weeks after the adenovirus, Ella was sick again, very sick. She had a very high fever of nearly 104, but her ears weren't infected. Her throat wasn't red either. Her doctor wanted blood work, a shot of massive antibiotics and a urine sample, which would require her to be catharized. He wanted to rule out sepsis.

I was worried to death about the costs, because he was sending us over to the hospital. I knew it would be a huge bill without insurance. However, I wasn't worried about her getting treatment, because it was a hospital, and they are required to treat, right? Nope, wrong. They demanded full payment up front and gave me a rough estimate of $400 to $700. It would have taken everything I had in liquid cash to pay that, and I would have had to go to two banks to get enough out of savings to cover it. We are building our savings back up after emptying it to buy a car in February, but it's slow going right now.

Well, I complained (my mom was there and was awful about it), and they allowed me to make a $150 down payment. Luckily, Ella just had a bad virus, and it had to run its course. I was not willing to risk this happening again, so I called Cover Kids the next day to find out what was going on. They said they had received the paycheck stub and was processing it. I would hear something in the next week. Well, the next week came and nothing. I called last week and was told that since it had been a month since I had enrolled her, I would have to re-enroll her. I was furious, but at least, she will have coverage starting September 1.

As anyone who has read this blog for any length of time knows, I am pro-universal heatlth care. Even after all of this hassle, I still feel that way. Tessa has been on Cover Kids for almost two years now, and all we have had to pay out in medical bills is co-pays and prescription costs. It is a wonderful program, and I have never had a problem getting them to cover something or pay. Brian, who is against universal health care, said all this trouble with Ella was why he was against it, but I reminded him of how well it has covered with Tessa. He had to admit I was right.

So, Ella's coverage starts next Wednesday, and we go Thursday for her nine month well baby visit. It's a little late, but that's ok. I am just so glad she has coverage.

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