My Health Insurance Headache

“All of that hard work paid off!  Congratulations!”

This is the kind of message I would’ve expected to receive when I graduated from law school, got a well-deserved promotion or finished my first marathon.

It isn’t the kind of message I thought I’d receive from my insurance agent informing me that I had just been approved for worldwide medical insurance for my upcoming trip.  Call me crazy, but the idea that it requires hard work in order to obtain private health insurance just seems…wrong.

I thought obtaining my Russian visa would be the hardest part of my trip preparation.  Nope, applying for worldwide medical insurance was.

I have been extremely fortunate that I have always been covered by group health insurance – first through my parents and then through my employers over the last ten years.  When I decided to leave my job to travel for a year, one of the biggest questions facing me was what to do about health insurance.  Of course, I have the option to continue with my recent employer’s plan for up to 18 months through COBRA, but that would cost me a whopping $529 per month.

Considering COBRA as a last resort, I began to explore other options, focusing on plans that would cover me both at home and abroad.  While I am not too concerned about paying for health care if something happens to me overseas (because we all know most care overseas is likely cheaper than in the United States), I wanted to make sure that I would be adequately covered when I return to the United States – that my family won’t have to go bankrupt paying for my care if I’m in a car accident that leaves me in a coma or I find out I have cancer or something horrible like that.

Option #1: International Medical Group (IMG)

Initially, my top choice was International Medical Group (IMG)’s Global Medical Insurance. I heard good things about IMG from other long-term travelers and I liked that they offered a plan that would cover me in the United States as well as overseas, the only caveat being that I have to spend 6 months out of every 12 abroad.  IMG’s price was also exactly right – about $100 a month for the Gold Plan with a $500 deductible.

However, I wasn’t crazy about the idea that I might be limited in my coverage once I came home. It also wasn’t clear to me whether IMG’s coverage would count as “creditable coverage” for HIPAA purposes in the United States (and thus offset limitations for coverage of pre-existing conditions). Despite that, I applied for coverage and was promptly denied due to my alleged “extensive medical history.” After some begging and pleading and pointing out that my medical history doesn’t include anything serious, I was able to convince them to offer me a plan with a more expensive premium and higher deductible – that also came with an exclusionary rider that would basically have prevented me from being covered for any issues I ever had previously. Far from ideal.

Option #2: HTH Worldwide

After more consideration, I looked closely at HTH Worldwide, which offers coverage that is more expensive than IMG but is also more comprehensive (for example, it waives the deductible for preventative care). HTH doesn’t have any requirement that I be out of the country for any period of time so I can rely on it indefinitely if I need to once I return to the United States.  I also learned that HTH can be considered “creditable coverage” in the US while IMG may not.

I decided to apply for HTH’s Global Citizen Health Plan with a $5,000 deductible to keep the premiums down to $179 per month.

Let the Hard Work Begin

Erin of EMF Insurance Agency (who I met through Meet, Plan, Go last fall) guided me through the process of applying for HTH’s coverage. Erin answered a lot of my questions as I completed the application and made sure that review of my application moved along quickly.

This is where the hard work came in.  HTH asked me to provide a detailed medical history for the last ten years, including doctors’ names and contact information.

Well, in the last ten years, I have seen doctors for a fallen arch and strained ligaments in my foot, a suspected case of appendicitis that turned out to be food poisoning, lower back & hip pain due to a sacroiliac joint problem, a sprained neck, a sprained wrist and wrist tendonitis, an inflamed nerve in my foot, costochondritis (inflamed chest cartilage), a pulled calf muscle, a pulled back muscle, occasional migraines, non-allergic rhinitis, gluten intolerance, a sprained ankle and, most recently, an emergency room visit for shortness of breath caused by a bad case of acid reflux.

As I started compiling this information (a massive project that took an entire day), I started to get worried about how it would appear to an underwriter.  It looks pretty extensive, although the vast majority of visits were for injuries suffered while running or playing tennis or volleyball – things that active, healthy people do, right?  Am I injury-prone?  Perhaps.  A serious health risk?   Absolutely not.  The big question was whether the underwriters would see it that way.

In an attempt to address possible issues from the beginning, Erin recommended that I write a letter of support pleading my case and that I ask my primary physician to write a note attesting to my current good health.  Unfortunately, those didn’t seem to do much good.

Within 24 hours, HTH responded and asked me to provide copies of ALL of my medical records for the last 4 years.  Luckily, I have lived in Chicago for the last decade so this was not as hard as it could have been.  Nonetheless, I spent about 7 hours over the next couple days making phone calls and trekking around the city to multiple facilities to obtain  the necessary records, as well as nearly $200 in copying fees.

A few days later, the email arrived in my inbox informing me that HTH approved my application.  This was a huge relief and really the last major hurdle I needed to clear before departing on my trip.  The hard work did indeed pay off, but why did it have to be so difficult?

Lessons Learned

• I have been extremely lucky to have never gone through this before.

• I am extremely lucky that I don’t have any more serious health conditions.  As I emphasized to HTH, I am generally a healthy (albeit injury-prone) person.  I can’t even imagine how difficult the process must be for someone with a chronic condition or history of serious illness or surgeries. This is a prime example of what is wrong with the health insurance system in the United States: sick people who need coverage the most likely can’t get it because no one will provide it or it is prohibitively expensive.

• It boggles my mind how antiquated the medical record system in the United States is.  Every single doctor I contacted had to ask a staff person to copy my paper records. With the advances we have in technology today, why on earth do doctors and hospitals not keep records electronically so they can be easily shared?  I would have saved so much time and money if every office could have simply e-mailed me an electronic version of my file.

• Finally, I wish I would have tracked my medical history from the time I went away to college.  If you aren’t already doing this, I highly recommend starting now. Keep track of doctors’ visits, prescriptions, diagnostic tests, etc.  Before you apply for insurance, request records from at least your primary physician. Reviewing those records will jog your memory about minor issues that may have slipped your mind and having them handy may be helpful if and when issues arise.

Have you ever applied for worldwide medical or other private health insurance?  What advice would you share with someone applying for the first time?

Photo: digital cat