So a few years ago I got stuck with no health insurance as I had a fellowship that had for its history accepted professors (with health insurance) not fresh off the boat PhDs as was the case with me. Since I was at a Large State school it was nearly impossible for me to get insurance and finally I ended up paying 400 a month and getting a whole lot of headache. In many ways my ordeal was a fluke following a change of policy and this fellowship now provides insurance to its postdocs.

Increasingly, however, it seems like a number of postdoctoral fellowships shirk from their duties and don’t provide a drop of health insurance. Given the academic job market, many academics don’t have any choice but to accept these positions and if they don’t come with insurance, well then these folks are shelling out thousands upon thousands of dollars for basic, really lousy, coverage. Given that universities for the most part have decent, even in some cases kick ass insurance, with a large pool of people, shutting postdocs out of their pool is.. gross and just plain wrong.

One of my fellow friends, currently on the market and currently screwed by her last postdoc wrote up a short document (aka Academic Labor Hall of Shame) and I thought I would post it here as it gets to the heart of the issues and starts shaming some of these shameful universities. If you know of other postdoctoral positions that don’t offer insurance, please please leave a comment. We will include it in the hall of shame.

Academic Labor Hall of Shame

Universities like to promote themselves as bastions of enlightenment, but their treatment of temporary and hidden employees is often anything but enlightened. Or progressive. Or fair.

1. Postdoctoral fellows and researchers:

There is a growing trend towards classing postdocs as “not employees”. I learned this recently when I was laid off from postdoctoral position at the University of Pennsylvania. I planned to extend my health insurance through COBRA, which is currently federally subsidized for workers who lost their jobs during the financial crisis. I was shocked when Penn initially claimed that I was not eligible for the subsidy (made available through the American Recovery and Reinvestment Act of 2009, the so-called “stimulus act”). Their reason was that postdocs were not classed by Penn as employees. I appealed this with the Office of General Counsel and after a few weeks was told that I was indeed eligible, as Penn had found “an inconsistency in [their] policy for certain categories of post docs between tax treatment and the availability of COBRA/ARRA”. This means that while I am in fact eligible for this subsidy, postdocs paid through many other classes of grants are still not.

If you want to see an example of this process of sorting some postdocs into “not employee” status, here is another one:
Postdocs on training grants or on individual fellowships (roughly 25% of VUMC postdocs) receive a stipend and are specifically excluded from the employee classification. They do not pay FICA and do not receive employee benefits. Their health insurance is provided and purchased separately. [by whom?]

Even if Vanderbilt does in this case make provisions for these postdocs to receive health insurance, there is abundant evidence that some postdocs are outright excluded, as in this example at Stanford:
Stanford makes no provision for fellows to purchase health insurance, and the Institute will not provide medical insurance or other benefits. External fellows must bring their own medical coverage with them or purchase an individual plan during their stay in California.

This is also quite apparent when you look into the outfits that profit from selling health insurance to postdocs (because their universities don’t provide them any):

http://www.garnett-powers.com/npa/

Also, take a look at the policy they and you’ll note that it stinks: it excludes such luxuries as preventive care, birth control, and chemotherapy. I’m not making this up:

http://www.garnett-powers.com/npa/summary.pdf

Bill Moyers has obtained this health insurance document outlining how to react to the movie Sicko. Pretty fascinating read.

I have not heard of them until last week but I like their name, Frog Design, and they have an issue dedicated to Health Care including an intriguing article The Paradox of Choice
A capitalist case for universal health care. For those just into tech, they also have a piece by OLPC.

This is just one problem with a profit logic ruling our health care. It is good to see this investigation start but it feels a little like a kitten fighting a 100 pound gorilla. A little to little and too late.

Nine Secrets Health Insurers Don’t Want You to Know.
Update: Link is now working…

Two nights ago I was having dinner with a colleague who recounted a truly horrible experience he had with the modern-day American health care “system.” While in Montana over the summer, he got bit by a bat and well, as a result, he and his entire family had to get rabies shots. These shots are hard to get and priceeeeeeeeeeeeeeeeeeey. The final bill was $ 20,000 and his NYU based health insurance, United Health Care is claiming they are not responsible!### Like getting bit by a bat and the possibility of rabies are not bad enough. Isn’t the point of health insurance to take care of the unexpected??

Someone also pointed me to The Daily Kos’ wrangle with BCBS of California and well, they picked the wrong guy to mess with given there are so many many many many eyeballs tuned to his blog, everyday (just check out the number of comments). I wonder if the public relations director will contact him as they did with me after I blogged about my trials and tribulations. I certainly don’t have the audience and readers he does, so I am always surprised they ever contacted me in the first place.

The Daily Kos also provided a link for a site that I was thinking of creating if my problems with BCBS were not solved (glad to see someone else has) called Sick of Blue Cross. I personally like the name I came up with a little better Blue Cross No Shield but the important thing is that a site like that exists and it is very good site, design and content wise. There should be a site created for every health insurance company and they should federate and pool resources to gain more visiblity.

While I am not hopeful that the health insurance industry will change within, I think mounting and steady consumer pressure can do a lot to force the industry to change their awful ways. And while I think the bad publicity is a key part to putting pressure on the health insurance to change, I actually think that the power of the consumers also can come from elsewhere, and this elsewhere is overwhelming the administrative channels within and outside of the health insurance. The gist is if they send us a lot of (useless) paperwork, send them A LOT of paperwork back.

On the Daily Kos, a lot of people noted that things got moving when they complained to the Department of Banking and Insurance. While my own complaint to that department did not produce any immediate fruit, it did get the ball moving for the appeal process, which eventually panned out for me. That is, I learned a lot and started to get decent customer service. Doors opened.

Now, it took me weeks to find out that I could complain to the Department of Banking and Insurance and I am sure many find themselves in that situation of walking in a no man’s land of confusion and frustration. If more and more people know that you can file a complaint to these Departments (and why are doctor’s offices not relaying this information??!!), they and the health insurance companies will get inundated with that which they love to inflict on us, paperwork.

This may slow things down for you but at a certain point, state governments will get the message that something is deeply wrong. So, people MUST use these channels and overwhelm these agencies with complaints, faxes, emails as this is a powerful and very material message that something is deeply wrong and broken and must be fixed.

Also, send faxes and letters to various departments in your health insurance company (appeals, customer service, medical director’s office, public relations office…) get people’s email’s and send them emails. Inundate them with a barrage of administrative paperwork. If they are not being helpful, send a fax or two a day concerning your case until you get clear answers. While individual faxes won’t make much of a difference, imagine if there are 300 a day coming in or 3000…. This can work with the numbers are there and I have a feeling that the numbers Are There.

So spread the word for housebreaking your health insurance and push the paperwork back on them.

Don’t you just love leaked corporate memos?

I do.

They are a window into that which we KNOW exists, yet we are not privvy to very often. Because corporations like to keep their dark, dirty secrets well hidden. Memos give us access to what I call in High Academic Jargonese “Corporate Psychological Interiority,” or to put in simpler language: memos allow us to see corporations crapping in their pants. Gross, but pleasant to see from time to time.

I just got word of leaked memos from the Insurance Company I love to hate: Blue Cross Blue Shield.

The four pages are chock full of interesting stuff, so take a read for yourself. Here, I will only highlight two things:

* Horizon BlueCross/BlueShield is picked out early in the film in a collage of stories citing bad
treatment of members.

And well, as most readers here know, I concur. Well at least
Blue Cross Blue Shield of New Jersey/Horizon can be proud for being one of the worst.

In their concluding talking point sections, they say:

2) The Blues recognize the need for improvement of both the coverage and delivery of healthcare.
But the divisive tone set forth by Michael Moore and his movie “Sicko” is not helpful. Positive
change to our healthcare system can be best achieved through shared responsibility, not
recrimination. To ensure Americans have access to the best healthcare that is both timely,
efficient, and of high quality, requires the collective contribution of all stakeholders –
consumers, providers, employers and the government.

Try NOT being angry at a 4,000 dollar bill or worse, an 80,000 dollar bill, or even worse a death.

It is near to impossible to stop the rumblings of anger. We are human beings, after all. We are born with the capacity to think and feel, passionately and deeply.

And some of the best change comes from the fire that is anger and I hope that enough Americans are finally feeling the fire.

1. Being at debconf.

2. Having your blog entry slamming Blue Cross Blue Shield of NJ be on the first page of a google search using both the terms Blue Cross Blue Shield New Jersey as well as Blue Cross Blue Shield Horizon.

I promise to write about something else very soon, but I have to post this given what I have just written. Ms Oprah is seeking Healthcare Insurance Company Experiences

Tell us about an experience you had with your healthcare insurance company. Please write in only if you are willing to appear on national television.

I am sure my story is babycakes compared to the scary stuff that is actually happening out in the so-called “Land of the Free.” Like people being denied some cancer treatment, them dying, and then some of the head honchos feasting on their major organs, but hey, I submitted anyway.

Are you having trouble with your health insurance? Are they stalling on paying a bill? Denying a claim? Not telling you what the heck is going on?? Well you can and should take action to eliminate some of the mystery and move forward, and possibly win fight against the health insurance company.

Thanks to my unpleasant ordeals with BCBS of NJ, I have compiled some handy resources and tips to get you started. Good luck and I welcome any other tips that you think should be here. Please email them to me at biella(at)gmail(dot)com

Can’t get a straight answer when dealing with health insurance representatives on the phone? Are different representatives providing different and contradictory information? Does talking to the representatives leave you with a pounding headache? Then the following may be helpful:

1. Ideally you should tape record all conversations. If this is not possible, get the name or employee number of the person you are talking to and write down what they told you along with the time and date. If they have agreed to something, make sure they send it to you in writing. This sort of documentation may come in handy later when you are trying to contest or prove something.

Is your insurance company flip flopping on a claim? For example telling you that the claim is still being “reviewed” but sending you statements that indicate it has not been paid and never will be? What action can you take to inch things forward? The following may help:

1. Most states have a Department of Banking and Insurance and they are there to help you. Many (perhaps all) provide a service for filing a complaint against your health insurance company and other insurance and banking companies too.

When I used the service in NJ , I got assigned an investigator and their service was prompt and helpful. It was my experience that even though they were not able to resolve my issue, the insurance company started to make firm decision on many claims and this alone has been helpful. Before this, it was impossible to get a clear answer from them as to the state of all sorts of claims.

They said “NO,” & you think they should say “YES, YES, YES, YES!!!!” In other words, appealing a denial:

1. This site has some great information on how to avoid a denial and what you can do to fight one.

2. Included on their site is the Health Insurance Laws and Benefits Tool which will provide specific information about your rights in different states. For example, you will want to know if there is an external or independent grievance system to appeal your plan’s decisions. In the case of NJ, which is the state I am fighting, the tool provided the following helpful information:

Does New Jersey require an external or independent grievance system to appeal your health plan’s unfavorable decisions?

Yes, for all health plans.

On what grounds can you file your external grievance?
Investigational treatment appeal, medical necessity.

What is the status of the external grievance panel’s decision?
Binding.

External grievance systems allow you to take a dispute with your health plan to a doctor or review board unaffiliated with your health plan. Thus, both you and your health plan receive an impartial ruling on its decision to deny coverage of services or treatment. Additionally, you can file a complaint against your health insurer with your state’s department of insurance.

Additional Helpful Information and Resources

1. The message boards on lawyers.com are a great place to hit for information. I have found folks there helpful.
2. You many want to blog about your experience as you may get an unexpected response directly from your insurance company. I think there are pro’s and cons to blogging about your experience but it does provide a public face to your ordeal and allows you to chronicle exactly what has transpired.
3. If your cases is particularly shocking, do not hesitate to hit the local media.
4. If your claim has been denied by an external review panel, you may not have much luck suing but if there is no external review panel, you can and should also try Small Claims Court or other legal action. Further, even if your claim was denied by an external review board, you may have other options for suing, for example, due to their bad faith handling of a claim. And on that note, here is a great legal resource covering the topic.