The Major Pitfalls of Obtaining Your Own Health Insurance

Posted on September 25, 2014 Updated on September 25, 2014

I try to stay positive on this site, but my recent health care fiasco left me struggling to take deep breaths to calm down, attempting not to scream as a result of my frustration.

I recently transitioned from working full time for an employer to becoming my own boss. It’s had its ups and downs for sure. The work, at least initially, can be sporadic, so it’s difficult to determine specifically how much you’ll actually make monthly much less annually. The first year of self-employment is not as steady as the second year, I’m told. I certainly hope so.

I found that I make too much money to qualify for Medi-Cal, which is not a bad problem to have. Yet, because there is still three months remaining in the year, and having just started my freelance practice, I cannot accurately predict how much I stand to make. So, I’ve been searching for a health plan that fits my wallet, and I wanted to be reasonably conservative.

Going cheap definitely has its pitfalls. I was asked how often I go to the doctor, but the plan that was the most attractive in terms of cost only gave me the option (and hope) to visit one up to two times within one calendar year. The insurance plans that are most affordable to healthy young adults include incredibly high deductibles. In other words, you basically don’t really have insurance. Often times you are required to pay $2,000 or more out of pocket within the year before your benefit finally kicks in. Say What?!

If I go to the OBGYN and the visit costs $300, then I have to pay the full bill, when the check-up is something that nearly every reputable society on Earth considers a necessity. If I need to see my therapist, it’s another $100 an hour. And while most prescription drugs are covered, not all of them are.

I was once on Pristiq and that anti-depressant worked wonders for me. But it wasn’t covered under my last employer’s health insurance so I had to downgrade to Effexor, which didn’t work that well. Pristiq (out of pocket) costs more than $287 for a 30-day supply! It is one of the most expensive psychotropic drugs on the market and one that is the newer, more improved version of Effexor. Pristiq comes in two levels, 50 mg or 100 mg, the latter being the maximum dosage that worked best for me. I had to go on Effexor 75 mg, which is the lowest Effexor dose and much lower than Pristiq. As a result I found that Effexor just wasn’t as effective.

Luckily, I have been able to gradually get off Effexor and am medication free. But, what about those folks that really need Pristiq but it isn’t covered by their insurance? With mental health, suicide and depression awareness on the rise, I would have hoped by now that the U.S. health care system would get it together, especially after all the “work” in D.C. on Obamacare. But the U.S. continues to foster an unfriendly environment for mental health patients as well as those who need to seek treatment for a variety of ailments. The fact that there is such a high deductible for the “affordable” health care plans is ridiculous.

Everyone has had highly frustrating customer service run-ins, but nothing tops having to deal with health care “professionals.” First of all, if you try calling Covered California be prepared to wait on the phone for approximately 45 minutes or longer just to talk to a real person. They ought to at the very least put on KROQ or hell, why not let us listen to a Kevin Hart comedy skit while we’re friggin’ waiting for almost an hour.

I had to summon the HealthNet supervisor after I learned my subscriber number didn’t match the name they had on file. In fact, even after I paid for my insurance, they had my account linked to an old employer I worked for more than 10 years ago!

Huh? As I recall, I didn’t even sign up for health insurance at that time because it wasn’t mandated, as it is today. I had just recently picked out the insurance plan from Covered California that didn’t have a deductible and paid the first monthly bill of more than $250 a month. I then waited and waited for my insurance card to come in the mail. It never arrived. I called HealthNet and they couldn’t locate my check, or even my name in the computer system. It wasn’t until I demanded to speak to the supervisor that suddenly they claimed to miraculously find the correct profile with the correct spelling of my name.

The Bottom Line:

Purchasing your own health care as a self-employed individual can be a real nightmare. Make sure you are on top of everything when you sign up. I wrote down all the names of the people I spoke to as well as any and all claim numbers. If you need to go see a doctor, you deserve to see one as soon as possible, especially if you already paid for it. It isn’t your fault if there are incompetent idiots working at these healthcare companies, losing your checks and screwing up your file in their system. These are people’s lives at stake! Some of us really rely on good health care to improve the quality of our life. Something in America needs to change and it must start with our healthcare. Maybe its time to revisit how Europe does it. France in 2014 is reported to have the best health care in the world. Come on U.S. get with the program! And the next time I talk to a moron who can’t find my file, loses the check that was supposed to pay for my health insurance, and etc. Then, be aware I will record our conversation and post it here for all 51,000 plus readers to hear!