The individual health insurance market can be a scary place for Americans who turn to it for health coverage. If they’re accepted to a plan at all, patients often find that their coverage isn’t quite what they were promised, and limits and restrictions lead to high medical bills for covered services that aren’t really covered.
That’s how Sarah Wildman ended up with a $22,000 bill from the hospital where her daughter was born, despite having what she thought was good health insurance with a maternity rider.
Birthing our daughter was so expensive precisely because we were insured, on the individual market. Our insurer, CareFirst BlueCross BlueShield, sold us exactly the type of flawed policy-riddled with holes and exceptions-that the health care reform bills in Congress should try to do away with. The “maternity” coverage we purchased didn’t cover my labor, delivery, or hospital stay. It was a sham. And so we spent the first months of her life getting the kind of hospital bills and increasingly aggressive calls from hospital administrators that I once believed were only possible without insurance.
About 63 percent of Americans receive medical care through their employer and nearly 20 percent are uninsured. 16 percent receive some insurance through a federal program like Medicaid or Medicare. The rest of us-between 5 and 7 percent-pay for insurance out of pocket. That’s a small share of the total at any one time, yes. But it amounts to at least ten million people (the American Medical Association says it’s more like 27 million; that number would be even higher if premiums weren’t out of reach for many.) Over the course of our lives, roughly one in four Americans will buy their own health insurance. We’re the freelancers, the newly unemployed, the entrepreneurs, the people who are transitioning out of college or grad school or between jobs, or the ones who work for employers with fewer than 20 employees. Our numbers are growing. An estimated 14,000 Americans lose their job-based health insurance every day.
The individual insurance market is like that old joke about the food being terrible and the portions too small; it’s expensive, shoddy, and deeply unsatisfying. Those of us who buy into it are not protected by the federal and state laws that govern employer-based health care. In fact, there’s no one looking out for us at all.
Pregnancy on the individual health insurance market requires an additional rider that must be purchased before the pregnancy begins. Without this rider, the fetus becomes a pre-existing condition. Prenatal care, delivery, hospitalization, and any complications are not covered. Not a cent.
Wildman discovered that her maternity rider covered her daughter’s birth, but with a limit of $3,000. That is not a typo. Her story ended with the company covering 90% of the bills, but, she suspects, this is only because she happened to be writing a story about it.
We’ve written before about the problems with the individual insurance market—how everything from your health history to your credit score can affect premiums, and many seemingly necessary services have absurdly low caps or aren’t covered at all. Our sister publication, Consumer Reports, has studied the individual insurance market extensively, and doesn’t like what it sees. They call such plans the “Wild West of insurance,” and until the individual market is better regulated, their best advice is to research your options carefully and choose the most comprehensive plan you can afford.
Health Insurance Woes: My $22,000 Bill for Having a Baby [Double X] (Thanks to everyone who sent this in!)
Hazardous health plans [Consumer Reports Health]
Guide to Health-Care Reform [Consumer Reports Health]
Four Unexpected Situations Where Bad Credit Hurts
Blue Cross Blue Shield, Aetna: Sorry, Your Pregnancy Is A Pre-Existing Condition
Blue Cross of California Hates Pregnant Women and Sick People
Individual Insurance More Horrific Than Employer Plans