[Starla D.] Darling, who was pregnant when her insurance ran out, worked at Archway for eight years, and her father, Franklin J. Phillips, worked there for 24 years."When I heard that I was losing my insurance," she said, "I was scared. I remember that the bill for my son's delivery in 2005 was about $9,000, and I knew I would never be able to pay that by myself."
So Ms. Darling asked her midwife to induce labor two days before her health insurance expired.
"I was determined that we were getting this baby out, and it was going to be paid for," said Ms. Darling, who was interviewed at her home here as she cradled the infant in her arms.
As it turned out, the insurance company denied her claim, leaving Ms. Darling with more than $17,000 in medical bills.
I just had to highlight this anecdote because it shows so starkly how all of these issues are connected.
Also check out the coverage of the sit-in at a Chicago factory on Sunday, where workers demanded the wages they're owed. Shark-Fu has more...
Related:
Women Charged More for Identical Health Insurance
Saving on health care costs by crossing borders
New report: Unionized women workers earn more
Health care is a feminist issue
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Guh, this is so typical of so many insurance companies. I wonder what their reasoning was for denying her: maybe that inducing labor wasn't "medically necessary". I wonder if the same company also denies claims for contraceptive.
That poor woman. As if we can time our pregnancies just right to bypass job issues and economic recessions!
The Raising Women's Voices blog also had a post on this NYT article...although less about the individual woman's story and more about strategically framing the pressing need for health care reform in the midst of the economic recession.
http://raisingwomensvoices08.wordpress.com/2008/12/08/framing-health-care-reform-in-reference-to-economic-recession-and-unemployment/
It's always struck me as strange that delivery is insurable in the first place, considering how much it would seem to promote adverse selection. Since insurance is for protecting oneself from unexpected expenses, while pregnancy is done deliberately, it's like insuring cigars against fire and them filing a claim when you smoke them. Not that I wouldn't do exactly that if someone was willing to insure them against such a thing!
First, half of all pregnancies are not planned.
Second, children and reproduction are essential to society. We as a society should be doing everything we can to ensure access to pregnancy and birth care for all people. In the US medical system, that means covering it with insurance.
I suppose that argument would stand- accept that a having a baby is a medical procedure that requires you to be in a hospital or in the care of one or more medical professionals. That's expensive. And also I don't think insurance is only for "unexpected" health issues. It's just for health in general. I have allergies. I know I have them. If I went to a doctor and s/he prescribed me an allergy medicine, should that not be covered by insurance, since I already knew I had allergies? Or people who go to their doctors to ask about getting a new drug they just heard about...should that be covered? I mean, they want these medications, right? Want=can't cover by insurance, right?
And then, in your eyes, if insurers only covered accidental pregnancies, do they also cover abortions? Or, if you want to keep the baby, what do you have to do to prove that it was accidental and not planned?
And lastly, it's pretty disgusting to not cover it. There's just nothing else you can compare to having a baby (and I don't mean that poetically)- so it seems somewhat prejudice that insurers could deny what is wholly a woman's medical issue. A it's a rather big one at that.
It also helps to remember that health insurance companies act as intermediaries between the consumer and the health care providers for a broad range of services. And unlike the very narrow catastrophic coverage for things like cars, homes and businesses, health CARE (with care being the key word here) is a comprehensive service which includes prevention and treatment.
Home insurance companies, for example, do not typically pay for routine home maintenance or inspections, so the analogy is a poor one.
If insurance didn't cover birth, we would have a serious problem with a shrinking population.
I can't believe someone here would be so ignorant as to what health insurance actually does. The stuff covers viagra, why shouldn't it cover delivery?
I pay all my health and dental expenses out of pocket, figuring that my expected expense is lower this way, so I haven't dealt with it much.
Ok, so "health insurance" is used to mean any of a number of things from catastrophe insurance to, apparently most commonly, subscription-based health care. Thanks for clearing that up.
Alice,
Health insurance is not the same as car insurance or flood insurance. Health insurance is also to cover health care that is not considered an "unexpected expense."
For example, having a flat (ie, $30) co-pay for regular doctor visits is not a catastrophic situation. It is, if anything, preventative, or to ensure continued good health. Covering pregnancy, as well, is not a matter of unexpected expense, but, rather, a matter of routine health maintenance, which is very much within the scope of most health insurance.
If one were to have catastrophic insurance, your cigar analogy would work, but that is not the product most often referred to as "health insurance."
From an economic point of view, it's a much better investment for insurance companies to cover pregnancy than not. If parents were to have to fend for their own for delivery, then many working parents would look for deals or would try to figure things out on their own. This would necessarily lead to more complications stemming from delivery in the long-run, costing these same insurance companies a lot more than just covering routine delivery.
Does that clarify things a bit?
I just found a study done by Harvard that I read a few years back (It was published in Health Affairs, if anyone is curious). Over half of all bankruptcies are related to debt from medical bills. Of those, over 75% had medical insurance at least at the start of the illness and nearly 40% lost insurance coverage (likely because the illness prevented them for working, thus cutting off their insurance and income). Over half of all people who filed for bankruptcy due to medical bills owned a house and the same number had attended college. A lot of people who seem to be relatively well-off (middle class, good job, and benefits) are only one illness away from being destroyed by debt.
This study was done in 2001, well before the recession began. Now people are losing their jobs and the benefits that come with them, and many with jobs have a far smaller amount of income available to go towards these bills. Even before the recession, there has been a recent trend towards private-contract hiring (read: no benefits) in jobs that used to be typical salaried, full benefits positions. Be prepared for more employers to stop offering health insurance or reduce coverage.
I realize this isn't a direct response to the article in the post, but I think it's important to see just how easily people can become financially overwhelmed by just doing what it takes to stay alive.
The million dollar question is do the CEOs see their companies as more health care providers or insurers? Do they see their responsibilities the same way you see their responsibilities? Clearly there is a disconnect between how health care should work and how it does work. When is the last time you read your insurance policy? I get the feeling most people don't bother reading long contracts in detail unless they are lawyers (not to blame you personally for the ills of the world of course).
Under the "catastrophic care" model of insurance, they would be on the hook for any complications from a delivery gone bad, which could be in the hundreds of thousands of dollars.
So, assuming a mother/child who need intensive care after complications costs $250,000, and a "regular" delivery cost $10,000. If paying for 20 regular deliveries saves them the cost of one complicated delivery, they come out ahead.
And that's how catastophic insurance evolved in to something that covers preventative care.
The same logic shows how 100 vaccinations at $25 a pop saves them a hospitalization that cost $20,000, etc etc.