Complaint 3 of 8 in “Unable to Buy / Afford Coverage”

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  • Insurance Carrier: Kaiser Permanente
  • State: CA

Consumer Complaint:

My daughter was born on March 27th. She had a difficult delivery and aspirated myconeum resulting in a 5-day stay in a special care nursery and left fully recovered. She was covered under my family plan for the first month. After which, I needed to sign and return a document. I did so but did not realize that I would owe an additional $500 per month. The health provider then backcharged me for all the remaining months. The easiest way for me to resolve the issue is to cancel her health insurance and pay for her well baby visit. I want to be sure that later on if she contracts a lung illness the insurance company cannot deny coverage due to a pre-existing condition after which there was a lapse in coverage. I now have an affordable family plan; however, my insurance company will not backdate my coverage. So I owe about $2000 because I did not switch plans 4 months sooner. If I had done my homework with a newborn or before, I would have taken care of the problem and switched plans. Therefore I have no legal ground to stand on. Please help.

Insurance Expert Answer:

First congratulations on the birth of your daughter, and I hope she is doing well now.

Second, it seems as if you may owe the $2000 because you signed a form agreeing to pay for her health coverage. (BTW, $500 per month seems VERY expensive to add a child. It may be that your employer's plan has some very funny wrinkles -- or the plan had charged you a single rate and now charges a full \"family rate\", so ask the employer and Kaiser.)

Third, while I understand you'd like it so that \"if she contracts a lung illness the insurance company cannot deny coverage due to a pre-existing condition\" that's water under the bridge unless you can reinstitute the Kaiser plan. You would have had such assurance if there was no lapse in coverage -- until you arranged for new coverage but now there probably is none because you cancelled it. Thus any new insurance company will look at your daughter as a person with prior medical problems and a higher than average risk for which it charges much more. Insurance does not work on a buy it when you need it basis -- as if the weather report is for a hurricane and you take out a policy only for a few days until the storm blows over and then the insurance company collects premium for a week and pays the damages -- that's heads your win, tails the insurance company loses. (The insurance companies would like it if they only collected premium and never had to pay any losses.)

To be assured coverage you needed to pay to continue the coverage you had. Perhaps there are some plans out there that don't impose waiting periods or exclude pre-existing conditions, but I don't know of any such insurance company backed plans -- there are lots of low cost \"plans\" that are not insurance that purport to do what you want -- and don't, as you can see from the website.

I wish there were a solution, but given the lack of affordability of health insurance, the high costs of health care, and the administrative nightmares you read about, one day we will have a sensible national health care plan -- we sure need one.

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