Health Insurance Woes

I spent the better part of yesterday on the phone trying to figure out what we’re going to do to get Annie some health insurance. While we were up North, Annie was on my policy through work, but that ended several months ago. Since we got down here, we haven’t had the extra income to buy her insurance, and her nanny job doesn’t provide it. Then, suddenly, we found out we’re pregnant, and it’s now a huge priority. Obviously, hindsight is 20-20, so before any of you start in on chastising me for taking care of this early, believe me, I know now, but I still need to solve this problem.

Our first attempt was to apply for the Oregon Health Plan. We were already applying for food stamps, and you apply for both through the Oregon Department of Human Services. It took a few weeks due to all the various bits and pieces of information we had to get in to them, but to make a long story short, yesterday I called our agent at DHS up, and she told me that with Annie’s new job, we’re making $300 a month too much to get OHP or food stamps. There’s nothing we can do about this - these income cutoffs are set in stone, and they don’t care about the fact that it’s still not enough to live on or get insurance with.

While losing the food stamps is a crushing blow to our budget, it had to go on the back burner. My top priority had to be finding Annie some insurance. I’ve still got the personal insurance I had when I was working here in Portland, so my first thought was that I could just cancel my insurance policy and get one for Annie with the same money.

Strike One. Personal policies in Oregon have a pre-existing condition clause, meant to protect the insurance companies from giving insurance to people with costly conditions. Pregnancy is on the list. I called Kaiser (my insurance provider) to confirm there was no way around this. The only possibility is if you’re on a group policy (such as through work) then the pre-existing condition clause doesn’t apply. I called Blue Shield in Washington, where I had insurance for myself and Annie when I was working in Seattle. Same problem up there, and even if there wasn’t, it would be a Washington policy, so she couldn’t get treated in Oregon. Finally, I called eHeathInsurance.com, who confirmed the problem would exist with any Oregon insurance provider. They told me the only option would be state-funded programs like OHP, and gave me a few phone numbers.

Just to be sure, I called Annie and confirmed that there’s no way she could get back on her Dad’s insurance policy (she stopped qualifying when she turned 24 and got married), and that there’s no way to get insurance through her work (she actually works for the family, not for the nanny agency, and the family obviously doesn’t have an insurance plan for her).

Next, I called the Oregon State Insurance Hotline (503-947-7984), who told me that all Oregon insurance plans will have the same problem, and that we should apply for the Oregon Medical Insurance Pool (800-848-7280) — oddly, there was no mention of OHP here — but there was a problem. Due to the pre-existing condition, there would be a six-month waiting period before the insurance kicks in. The six months would start on December 1st, and the insurance would kick in on June 1st. This not only means that any doctor visits and checkups before the birth are not covered, it also means that if Annie goes into labor a week early, we’re still uncovered. I took the information, and kept looking.

At this point, I felt like I had pretty much exhausted my resources, so I called our agent at DHS back and explained the situation to her. I explained that we couldn’t get a personal insurance policy for Annie because of the pre-existing condition clause (she didn’t believe me at first), and that we couldn’t qualify for state assistance because we made to much, or would have to wait six months. I asked her if there was anything we could do, even if it meant having Annie take a pay cut to get us below the income limit. She told me that I shouldn’t even mention that to her (against the rules, I guess) and apologized for not being able to help us.

By this point, I had been on the phone for several hours straight, having spent most of that time on hold, and my phone batteries were dead, so I was actually sitting on the floor next to the outlet, so that I could talk while my phone was plugged in. I called Rose to ask her a few questions, since I knew that she had gone through this, too. She was dismayed, because pregnancy isn’t a pre-existing condition in Washington (although I’m starting to wonder about that, after my conversation with Blue Shield - maybe Rose just wasn’t applying for an individual plan, or was only looking at state assistance?). While I was talking to Rose, I got another call, and it was our DHS agent again.

Turns out she had felt so bad about not being able to help us, that she looked further, and found a possible solution. It wouldn’t cover me (that’s fine), but it would cover Annie and the baby. It would only cover her while she’s pregnant, and once the baby is born she’s off the policy (again, fine, because after the baby is born we can get her personal insurance). Finally, the policy should last a year, which would more than cover the pregnancy (not sure how it lasts a year, but ends after the pregnancy). She barely knew anything about it, other than that we qualify. It’s called the OPP, which is a part or division of the OHP, but she doesn’t know what it stands for, or what the policy details are. She also didn’t know where I could find more information online, but she’s mailing me a packet. After thanking her for going the extra mile, I started looking things up, but I couldn’t find any references to OPP except in some Oregon state budget guidelines, and some rulebooks for OHP that explain that to qualify for OPP, a woman must be pregnant. (Oregon Pregnancy Plan?)

Anyways, this isn’t over until we get the information packet and the confirmation from DHS that Annie’s covered, but it’s still a weight off my mind. With any luck, this will give Annie the coverage she needs to see doctors and get checkups, and maybe even go through with her plan to use a midwife. We’ll know in about a week.

Obviously, in the long term, the best possible solution is for me to get a full-time job that offers a great benefits package that I can put Annie on. But since I don’t have one right now, I’ve got to plan for the worst-case scenario, so that we’re not caught with our pants down (well, any more than we already have been).

However, it looks like I’ll still be canceling my insurance policy so that we’ll have money to eat. Looks like we’ll be mooching off friends and family until I’ve got a job.