Another way to illustrate how serious ACL surgery is

Posted on June 17, 2013

5


This is not meant to be a political post. It’s meant to elucidate how serious ACL surgery is. This is the stuff your surgeon won’t tell you about.

I tore my ACL when I was 24 years old, I had surgery 7 months later briefly after turning 25, 18 months later (now) I’m 26 years old.

Due to ObamaCare I was able to be insured under my mom until I was 26 years old. This is one reason I had the surgery when I did: A year or two later may have been a poor decision to have the surgery because my mom’s insurance is unparalleled.

Now, 8 months into being 26 years old, I still can’t get health insurance. Why? My ACL history.

Let me correct that, I can be covered, but here’s how.

I rarely go to the doctor. Other than my ACL issue I’ve visited a physician maybe once in 6 years. So, I applied for a $4000 deductible plan, with a monthly premium of $90, and no coinsurance after the deductible. The plan is the “I’m fucked health wise but not financially.” The if I got cancer, I’d be covered plan. I was denied coverage, but because I had health insurance within the last 60 days I was, by law, eligible to be covered. The catch though is the plan I could be covered by is essentially up to the insurance company.

Here’s the new plan I was offered: $4000 deductible…$450 monthly premium…35% coinsurance on everything. So, yeah, I’m not going to pay for that.

Because that application was within 12 months of my surgery I figured I’d try again. Last week, 18 months post op., I applied for a $6000 deductible, $135 monthly, 0% coinsurance. Same idea. Need an amputation? Covered.

This time I was approved! I must have answered 100 questions on my application, and other than 4 or 5 about my ACL I answered “No, I don’t have an issue with that” for all others. So I felt good I would be approved, and I was.

Of course, there was a kicker. I was approved, but at a higher rate. I thought this might happen. I was thinking maybe an extra 100 bucks a month or something.

The insurance company I applied with puts each person into a tier. Tier 1 and you’re golden. You’re like an 18 year old. It seems healthy people under 30 or so are pretty much guaranteed Tier 1 or 2. The highest tier is 5. I’d assume for former cancer patients, diabetics, heart attack history, etc.

I was approved…at Tier 5.

Tier 5 changes my plan to: $6000 deductible and $421 monthly premium. I was also approved at some other plans. One was a lesser deductible at $650 a month, my favorite was another at $2400 a month.

My offered plans:

PLAN NAME

TIER

RATE

Access+ HMO

5

$2,406.00

Access+ Value HMO

5

$1,956.00

Shield Saver 4000

5

$518.00

Shield Saver 6000

5

$421.00

Shield Secure 2000

5

$612.00

Shield Secure 4000

5

$509.00

Shield Secure 6000

5

$450.00

Shield Secure Plus 2000

5

$721.00

Shield Secure Plus 4000

5

$584.00

Shield Secure Plus 6000

5

$509.00

Shield Spectrum PPO 5000#

5

$446.00

Shield Spectrum PPO 5500

5

$640.00

Shield Wise 2500

5

$568.00

Shield Wise 3500

5

$506.00

Shield Wise 4500

5

$459.00

I’m either denied health insurance or qualify as the riskiest candidate possible.

For all the people thinking ACL surgery is some run of the mill deal, that you get cut, wake up, and are off on your merry way, you might want to take note in how serious the insurance companies take it. They have obviously priced me out of the game. I even had a 10 minute conversation with one of the insurance nurses where I was asked over and over again, “So you have no complications now? You’ve been cleared a year? You’ve had no follow-ups since? Do you have any restrictions now?” None of which is an issue for me. Made no difference.

Here’s to praying til 2014.

Enter your email address to follow this blog and receive notifications of new posts by email.