Declined. Again.


Obviously, I’m frustrated.

First, because I have to spend HOURS on the phone trying to figure this drama out.  Second, because after spending all that time on the phone, the answer remains, “No.”

Under Obamacare, I was able to get medical coverage for the first time since 1992 that I could actually use.  2013, I had skin cancer in my shin, and they covered the cost of that surgery for $8,xxx and my out of pocket payment was $860.  $860 for surgery that saved my leg, if not my life.  Life changing.

I worked a Corporate job with excellent benefits from 1979 thru 2015, however, the coverage I paid for was not always usable by me due to my birth defects.  Rather than play the denial game, I simply lived beneath my means, and paid out of pocket for anything I needed.

I don’t drive a Cadillac or fancy sports car, so I don’t need a fancy medical plan.  However, the simple existence of my birth defects becoming public knowledge in 1992 when my medical records went digital meant that I routinely was denied medical care, and “No.” became the standard response for actually using the insurance that I paid for with each job.

With my departure from Corporate America in 2015, the battle for medical coverage reached new heights as I fought for coverage under COBRA for $644 per month.  And, as Aetna, my new insurer under my employer, decided that “No.” was now its favorite word.

In June 2016, I was finally approved for long term disability (LTD), and a 2-year waiting period to qualify for Medicare was also started.  Seriously.  I’m disabled, but there is zero insurance coverage?  Mind-blowing.

So, I paid my COBRA through December 31, 2017, with the knowledge that the benefits would be exhausted as of February 2018.  I tried to select a policy to cover me for my medical needs, but was told that I could not choose it until I was approved for Medicare, which happened mid-year, AFTER the open enrollment period.

There was no counseling for Medicare coverage, and I had to wing it on my own.  I contacted AARP who sent me to United Health Care (UHC), and they promised to cover me for a Medicare Supplement plan for about $150 a month.  I gave verbal approval to complete the forms they would send me, and they took $150 out of my Social Security Disability Insurance (SSDI) check each month, before I saw a penny.

However, no forms were signed.  Why?  Because, when I got to the question, “If you have COPD, please see question 7.”.  In its pre-qualification forms, UHC then informed me that I did not qualify for a Medicare Supplement as I was under 65 and had COPD.

Did you know that there are two (2) sets of rules for folks to qualify for Medicare?  No?  Well, let me tell you.  The protections that apply for workers who retire at age 65 or above are very different than the guidelines (not protections, but “guidelines”) which apply to disabled people under 65 or their specific age of authorized retirement.

Working since I was 13, I have paid into Social Security EVERY year for 42 years (excluding the year that my employer absconded with my tax and SS payments in 1975).

SSDI Earnings Record life long

It makes me crazy to have paid into my benefits for all these years, dealt with the denial of coverage for many of those years, finally gotten the necessary coverage my payments should have yielded under Obamacare, only to go back to this whack-a-mole game of trying to obtain the disappearing benefits – even when one is required to pay yet again for necessary coverage !

As you can see from my crazy paycheck history, my income changed all the time based on health, what type of job I was working, family issues for changing jobs and relocating, etc., etc., etc.  But every single year – regardless of what was going on it my life – I paid into the program(s) meant to help me if I became disabled or achieved retirement age.

So, it’s maddening to be declared unable to work, and then find out that in addition to the changes that were made to Social Security and Medicare over the years, there was an additional change that prevents someone who is not indigent and not yet of retirement age, to qualify for the necessary medical coverage they need when disabled.

Medigap insurers

Having worked my way through their websites (useless !  one cannot enroll on a website – WTF !?!???) I am at my whits end.

I can see a great policy – if only I were allowed to exercise the right to buy into this supplemental insurance !

Medigap F

Starting with the thought that my premium might be between $21 and $74 each month, imagine my surprise to chase this ever-evading insurance company ball all the way to the point where my costs would be $455.99 per month – if only I didn’t actually NEED my insurance due to my pre-existing condition, COPD.  So, having wasted time attending seminars, combing the website, consulting the professionals, and having spent three (3) hours on hold this morning, going through the phone tree with various companies, I once again confirmed – there will be NO INSURANCE COVERAGE for me due to my pre-existing condition.

It doesn’t matter that I never smoked.

It doesn’t matter that I’ve not been hospitalized since childhood.

It doesn’t matter that I’m not on oxygen.

It just matters that I have a lung disease which MIGHT cost them some money, so I get zero insurance coverage except for what remains of the original Medicare coverage which has been cannibalized within my lifetime to deprive me of benefits originally paid for when I first signed up for coverage in 1974, when I was a child of 13, starting my first job and trying to survive while my parents marriage imploded.

So, with all this under my belt, I’m going away to get my monthly haircut.  I’m out of energy and any semblance of patience for today, so I will be at this keyboard again tomorrow trying to find an insurance company to throw my money at in the hope that any worst-case medical expenses not covered by original Medicare will be picked up by them.  Medicare Allies says they can help.  Let’s hope they are being truthful in my case:

Medicare Allies 2019

Medicare open enrollment is frustrating.

So needlessly exhausting.

We need socialized medicine that doesn’t deny one coverage due to birth defects.  If we are going to insist on keeping these children alive by repairing their birth defects, then we need to have a medical insurance program that ensures that they maintain quality of life without being driven into poverty through covering their medical needs – if they are able to work, or were fortunate enough to be able to work and buy their way into benefits at some point during their lifetime.

Actions have consequences.  If we are going to insist on life at all costs, then we also need to insist on QUALITY of life by allowing those people who have birth defects to protect their assets against raiding.  The stress from trying to juggle all the bills involved in remaining healthy is exhausting, and no one is well enough, in my humble opinion, to want to sign up for this medical denial of coverage dance once a year during open enrollment, or every time they have to use the actual benefits they’ve paid for.




4 thoughts on “Declined. Again.

  1. I am so sorry to hear about this long journey and battle. Is there an appeal process? I know it is tiring and exhausting and I can’t say anything to make this mess sounds better or easier. All I can say is that I hear you, it sucks and feels so wrong that it is people who are sick who have to keep fighting the system.

    Liked by 1 person

    1. No idea, Drug Opinions. I missed the deadline due to frustration with the process, combined with the timing for being audited by my supplemental insurance company to see if they can prove I’m a fraud and deny me my matching salary benefits.

      The resulting attitude problem, and my back pain from my August car accident, collided at the end of the week when I had to see my pulmonologist for signing off on the audit paperwork during our ongoing Winter rainstorms. So, I’ve missed the arbitrary deadline (a self-fulfilling failure to succeed), and I’ll start with the elder and disabled services counselors next week to see what happens next, or if I’m on hold until October 2020 when open enrollment reopens for 2021.

      Thanks for you patience while I whine.

      Liked by 1 person

  2. Welcome (again) to life as an ‘under age’ Medicare user. Those of us with disabilities are treated differently and are denied coverage for some fairly stupid reasons (as you’ve found out). Even though we paid for this contingency throughout our lives. I had an elderly (she’s 78) friend look at me oddly when I mentioned that ‘under 65’ ‘retirees’ (aka disabled or forced retirement) are subject to a whole set of rules that those who are of ‘legal age’ aren’t. And the endless and useless red tape!! Oh don’t get me started! I saw two elderly parents through their journey and at that time it was simple. You retired and you weren’t expected to pay very much, because the government (much more sensible) realized those people didn’t have very much. My father’s cancer and treatment cost them (parents) about $80 a month, which was a stretch, but not costly. Today? I spend that much in a single month IF I go to a specialist or get some necessary meds (like insulin). I would encourage you to find a local office (possibly through whatever they call Workforce Services now) where you can sit down with someone face to face and hash it all out. I know that’s problematic given the factors you face every day. But it might solve the problem or at least give you a little peace of mind that the issue is solved as well as it can be. I have an insurance agent who deals with the mess for me and I’m grateful. She’s tried contacting me this year, presumably to renew UHC (which is what I’m forced to use), and even with her help, I’ve still been chagrined to find the holes in what should be fair coverage. This year I didn’t have a single test that wasn’t free, and my specialist visits are limited to my endocrine doctor (diabetes) and my podiatrist (for foot care). The rest? Phooey on that. Here’s to a resolution and some peace in your coming year!! And thanks so much for the great Thanksgiving card! So cheerful! 😀

    Liked by 1 person

  3. Yes, I’ll get my butt in gear next week (we have our final show this Friday, so that’s taking all my time and patience), and we’ll see what Sourcewise suggests. I know you get it, and I’m sorry you’re dealing with this run around, too.

    Today, during our Better Breathers Club, I asked for the “Death with Dignity” law to be reviewed for those of us considering euthanasia (as that’s another runaround game of Whack-A-Mole, too), and I was surprised to have other attendees agree with me that we’d like more info on how to comply with the law when the time comes.

    Glad you liked the card. Take care of you


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