Health Insurance

Recently, Louis and I came to the realization that our monthly expenses are way too high, causing tons of stress each month as we try to juggle all the bills that are due. Our biggest monthly expense is our health insurance premium with Kaiser. Neither one of us receives health benefits from work (I'm self-employed and his company of only 5 employees doesn't offer coverage), so we have Kaiser coverage through an individual/family plan. I'm starting to realize this is much more uncommon than I thought. I don't think I actually know anybody else in the same situation, since all my friends and family are either covered through work, through their spouses' work, have medi-cal, or are uninsured.

Anyway, here's our situation. Each month, the two of us pay about $500 a month for a $4000 deductible plan, which is the highest deductible Kaiser offers (basically, it's the worst coverage we could have and still have insurance). That means, in addition to our monthly rate, we pay out-of-pocket for all services including medical and dental. The out-of-pocket rates are super inflated, but we have to pay them until we reach our deductible plus an out-of-pocket max of an additional $4000. So, each year, we have to spend $8000 (plus our monthly rates) before Kaiser even begins to start covering anything. This is where it gets ridiculous.

When our little one is born next year, our monthly rate will shoot up to $800 per month, beginning 30 days after the birth. If I wanted to switch to better coverage, our monthly rate would be $1400 a month but we'd have to go through a medical exam first. If Kaiser wanted to, they could find something, anything, on our medical exam and deny us coverage altogether. Even though I'd love to have better coverage, that's not a risk I'm willing to take.

I called member services today to ask about expected costs associated with the rest of my "prenatal care" from Kaiser. I'm only planning on visiting a nurse-midwife a total of three times, and receiving one ultrasound, so the costs won't be terribly bad. However, when I asked about the expected cost for a prenatal panel (the labwork I just had done through my own lab account), she told me it would have cost me $674. OMG. I didn't know whether to laugh or cry. I just paid $73 for the same test.

Oh, and get this. I learned that Kaiser runs mandatory drug testing on all pregnant women who have labwork done, they don't even tell the women (much less ask for their consent), and they charge them for it!! If something shows up in the lab results, the women could potentially lose their coverage altogether. A-mazing.

Even though I plan to pay our midwife way above and beyond the standard rate for a home birth in our area, I still will up paying less than having a hospital birth.

The only good news about our situation is that if we have to end up in the hospital (I can guarantee it would only be for a serious life-threatening complication), it's good to know that we will reach our $8000 limit within a couple hours, so Kaiser should cover the rest.

The most ridiculous part of all this for me is that I don't even consider Kaiser "health" care. I mean, when I want to take care of my health, I see a chiropractor, an acupuncturist, an herbalist, a midwife, and/or a massage therapist, none of whom are covered by insurance. I think of my Kaiser coverage as more "disaster" care than health care. When/if the worst happens, I'm glad I have access to a close hospital (really, I am), but that's the only benefit I get from Kaiser. I wish I could feel that the amount of money spent each month is actually worth it, and not just our punishment for working jobs that aren't affiliated with a large corporation.