Health

This Woman's Story Shows How Health Insurance is Ridiculously Complicated

May 19th 2017

By:
Almie Rose

Not only is health insurance in the United States expensive, but for one woman, using her coverage was like walking through a hedge maze with no end in sight — and all because she gave birth.

mother and baby

Amy Jay was pregnant with her second child when she and her husband realized his health insurance plan wasn't going to work for them any longer, given some health issues she'd faced during earlier pregnancies. After a long job search, her husband found a new job in Alabama, so the family moved there from North Carolina a week before Christmas.

"Because the new, amazing insurance with the new company wouldn't kick in until Feb. 1, we had to make sure we were signed up for COBRA, a continuation of coverage," Jay told ATTN:. "This meant that we had to pay over $1,500 to ensure that we would be covered during the transitional period, though the coverage would be through the old and inadequate plan."

Jay declined to provide the name of her insurer for fear of retaliation. However, she did provide ATTN: with copies of her hospital bills to review.

Their daughter wasn't due until Feb. 9, and if Jay went into labor before then, she would have to pay out of pocket because the new coverage hadn't kicked in yet. She said that she and her husband also reached out to their insurer to get permission to give birth at the hospital in Alabama without having to pay out of network costs.

"We were assured that, while it would be more expensive [if we gave birth before getting on the new plan], there would be an out-of-pocket maximum and that we could deal with the massive and inevitable bills through a reasonable payment plan."

Everything, it seemed, was in place. "My husband emailed a representative with the insurance company the Friday before Evie was born to confirm that we were all set up, our coverage was confirmed, and that Evie would be added to the plan once she was born," Jay said.

And of course, their baby was born before the due date, at 36 weeks gestation.

baby

Evie had complications as a result of her premature birth — including a collapsed lung — that required "intubation, sedation, tons of respiratory therapy, cardiology visits and testing, and around-the-clock care by incredible caring and attentive nurses and physicians," Jay explained. Evie had to stay in the neonatal intensive care unit (NICU).

baby

In the midst of all of this, Jay was having post-birth health complications of her own as a result of a C-section and severe postpartum infection. "Needless to say, we were exhausted out of our minds, and overwhelmed. We never heard anything from anyone with the insurance company or [my husband]’s old company, and therefore we assumed that everything was covered."

That's when the bill came.

hospital bill

The couple received a bill — not from their insurance company, but from the hospital — for $178,389.47. It turns out that their daughter was never added to the plan. "That paperwork, and the initiation of having it done, was, apparently, our responsibility. We received no reminder or warning, and because our first child was born under Tricare during my husband’s time Active Duty in the Army, we had no experience with this kind of thing."

We never learned in school anything about health insurance.

"We were totally uninformed. While my bill totaling around $8,000 was because the hospital was out-of-network, ALL of Evelyn’s bills — the NICU stay, the respiratory therapy, the cardiologists, etc. — were ALL billed directly to us."

father and baby

They then tried to add Evie to the plan, but couldn't, as they were told they missed a 30-day window ("that we didn’t know existed") so they appealed — and were denied.

"During the most tumultuous, terrifying, and physically and emotionally painful time of our lives, we were expected to have known to do something no one ever told us we had to do. And because we didn’t do it, we would be responsible for over $200,000 in medical bills. We applied for everything we were told to apply for that may provide relief — Medicaid, in particular — and we made just over $100 a month too much to qualify."

"For folks like us — middle class, young, and just trying to live the so-called 'American Dream' of stability and comfort — that amount of money would never be payable. After talking to everyone involved, as well as legal counsel, it was clear that our only real option would be bankruptcy."

In desperation, a friend of the Jay's set up a GoFundMe Account to assist the couple. While Jay is overwhelmed to see such kindness in donations from family, friends, and strangers, she believes she shouldn't have to rely on the kindness of others to pay her medical bills.

"Our situation is, unfortunately, not uncommon."

Not only have there been countless stories of people going bankrupt by health bills, but there's emerging research to show that Americans also think health insurance is too complicated, which leads to major issues. When open enrollment for Obamacare was launching in 2013, Forbes reported "research is mounting that shows consumers don’t understand health insurance, let alone key aspects of the landmark health law."

George Loewenstein, a professor of economics at Carnegie Mellon University, led a study for the Journal of Health Economics looking into this very issue. "It is strange, in my opinion, that the insurance market has evolved so, that so few individuals understand the fundamentals of the medical insurance plans they are insured under," Loewenstein said in a statement accompanying the study.

And because this is a massive lesson that isn't taught in school, this leads to stories like Amy Jay's.

"But at least we came home with our baby," Jay said. "Lots of folks face bills like this and have babies that didn't make it."