Head In The Clouds About
Insurance??
Posted by Ë11VËN
March 23, 2023
It’s not you. Insurance was hard for me too. It can be so unclear and confusing, especially when you need life-saving care. After my first surgery, I realized how important it was for folx within marginalized communities to have access to medical literacy to advocate and protect themselves navigating the healthcare system. This way we can all avoid the frustration and despair of canceled procedures, denial of services, or discrimination due to the absence of education, and ableist policies.
Even though it’s been an entire year since my procedure, I can still feel the headache of trying to register for insurance and then keep it active long enough to undergo a surgery I had been waiting for over two years for. Long story short, on top of all the preparation including but not limited to the mandated two-and-a-half-year waitlist, a mountain of paperwork, and several pre-operative clearance exams, my insurance was being shut off repeatedly. And only days away from my surgery date.
Unaware that there were four types of insurance programs, payment types, and varying qualifications, I kept hitting a wall with the application process. There is the Beveridge model, the Bismarck model, national health insurance, and the out-of-pocket model. More commonly known, as the federal and state marketplace.
To briefly explain the four types of health insurance models;
● The Bismarck Model is insurance that covers care for those who are unable to work or those who can’t afford to contribute (aging / retired citizens)
● The Beveridge model requires employment to enroll.
● National health insurance blends both the Beveridge and Bismarck models connecting the public to private insurance providers, while the government acts as the single-payer, making payments using tax dollars .
● The out of pocket model is where the patients themselves must pay for their own care.
Over the course of several chaotic months, where I called my insurance practically everyday, I finally got a hold of someone who took the time to explain and help me understand why it was being cut off. It turned out that my case was initially closed because of technical issues with the system during the recertification period. I was advised over the phone to reapply and was directed to the federal marketplace site. However, the representative failed to explain that if I applied with the federal marketplace while I have existing benefits with my state, the case will show up as a duplicate in the system, causing closure of one case and a consolidation of benefits. Unfortunately, because I was improperly informed my case kept being closed, over and over.
No matter how many times I reapplied, it just kept happening. Resulting in my original surgery date being postponed over six times. I remember feeling so lost, and hopeless. With dysphoria closing in, lack of access to my medications and deadlines approaching I was desperate for a miracle. I thought to myself in those moments, that if I feel crushed by these circumstances, then there has to be others, especially folx less able or fortunate, just silently suffering. I realized how crucial it is that people can comfortably and confidently find a way through the registration and recertification process well before a dire emergency, major surgery or procedure takes place. Most specifically understanding the details about eligibility requirements for any selected insurance company or procedure; such as what policies or benefits cover general medical needs and what requires alternative payment methods.
So what exactly is the difference between State vs Federal marketplace insurance plans and providers again? According to the U.S. Department of Health and Human Services, each state is allowed to structure its own health insurance exchange marketplace and determine how many and what type of health plans to offer. Noting that while not every state will be participating in the general health insurance marketplace. The Federal health insurance market will cover individuals who live in states that choose not to participate. In a nutshell, one unexpected outcome of applying with the federal marketplace is that it may be interrupted by existing state benefits and vice versa. Be sure to check that you don’t have any existing cases or benefits that would be interrupted before applying.
What does it take to qualify? To qualify and be eligible to enroll in Federal or State health coverage you must reside in the United States and be either a U.S. or national citizen. (or lawfully present). However, if you are an applicant who does not currently have U.S. citizenship there are alternative options and resources you can access such as;
● Withholding of Deportation, or Withholding of Removal, under the immigration laws or under the Convention against Torture
● Temporary Protected Status with Employment Authorization
● Special Immigrant Juvenile Status
● Victim of Trafficking Visa
● Adjustment to LPR Status
● Asylum
It’s confusing, but don’t worry! There are ways to navigate insurance to get the support you need!!
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