The 10,000.00 baby

This is a post I wrote a while ago but never published.  I wanted to wait until there was an outcome.  As of this week there is one, and I don’t mind saying, it was not what I expected.  It was good.


I’ll be the first person to admit it’s something I should have know.  As a responsible adult I should have done more research.  It was an assumption.  Something I had no reason to question.  Before Obamacare, pregnancy, was a preexisting condition.  It boggles the mind how an insurance company could label something like pregnancy preexisting, but yes, it is.  Maybe it’s the word that bothers me, preexisting, that sounds wrong.  I mean, yes, if you get pregnant, after conception, something has come into existence.  It was not there before and not long after that, at some point, it becomes a baby, but it’s not like a history of back problems or asthma. You don’t get a re occurrence of pregnancy unless you are seriously catholic or want a reality show.  The whole notion is slightly absurd.  That being said, I should have known, but I didn’t, and because of that we got seriously conned.

My son was born January 14th 2012.  It will always one of the happiest days of my life.  A day that nothing can tarnish, not even the fact that insurance, so far, hasn’t covered one cent.*

In the Spring of 2011 I was in my last year of graduate school and my wife Nicole was teaching theater at Hunter College High School.  It was a great job that provided her with a nice salary and reasonably good benefits (I was covered through grad school).  We knew the job was not permanent, as she was working for someone who was, ironically, on maternity leave, but the contract was good and it could lead to more work in the future.  For an actor this kind of work can be great.  It’s usually sporadic so there is no serious commitment, but it pays well, and if it comes up often you can make enough money to survive.  Nicole is a natural teacher.  Students love her, she understands the nature of learning, and she is a born nurturer.  So it was all perfect. The plan at the time was she would finish out her contract, which I think was 9 months(more irony), and go back to auditioning.

It was while she was working there that she got pregnant.  I would say we got pregnant, but I take issue with that expression.  I always have.  At no time in this process was I ever with child.  I did none of the work to fight off nausea, sleep with an extra 6 inches strapped to my stomach, or have someone banging around in my tummy trying to get out.  I understand the desire to make it a “we” situation, for some people that’s a means of sharing the experience.  Of course, I helped as much as I could, was as supportive husband as I could be, but I did not have a baby. My wife did.  She did all the work, and because she breast fed, for much of the first year of his life, things continued that trend.  I will not saw we breast fed for the aforementioned reasons.

We decided (We did do that together) that she would not go back to work full time, that I would be the one to provide for us for a while and that we would not rely on daycare but raise our child in our home until such time we felt it was time, and honestly, we could afford it.  Both of us agreed that there was just something about being the main part of a child’s young life that was appealing to us as parents, and that even if we could afford daycare, we wouldn’t do it.

In addition to working at the high school school Nicole was teaching dance to kids at a studio close to our house in Jersey City.  It was amazing how she would come home from teaching all day just to go back out and teach some more someplace else.  She has always been someone who thrives on being busy and constructive, taking on tasks, and loving them.  She says yes a lot.  This time it was too much.  She was exhausted.  Any one who tells you teaching is easy has never done it, it’s hard, right up there with being a mother(Forced irony).  As the schedule caught up with her she began to realize she had bitten off more than she could chew, she was tired all the time, coming home and collapsing.  One of the jobs needed to go.  At first we thought it would be the studio, it made sense, it didn’t pay quite as well, and there was no chance it would lead to anything career wise.

Then, one night, Nicole took a pregnancy test.  Plus sign.  Smiley face.  Circle.  Go time.

We were very happy, but, in a tight spot.  I was just finishing grad school and she was just finishing her contract at Hunter, which meant we were both going to be loosing our insurance.  What does one do in this situation?  What makes sense? One looks into private insurance to cover the family.  We have been lucky enough in our time to have a little savings, it’s not a ton, we’re not millionaires, not even close, but it’s enough that if we don’t touch it much, it might help us out later.  Or now as it seems.

I tapped our savings to pay for the insurance and in the meantime graduated from school.  Nicole finished her stint of at Hunter, but not before we had started seeing a doctor on her insurance.  The idea was that we would stay covered with this insurance until I found work, then I would take whatever plan they offered and keep a continuing stream of coverage.   That however did not happen.  You might have heard the job market has not been so good and in the Spring of 2011 when I graduated it was dismal.

I graduated on May 18th of 2011 and in November of that year I found work, in between, after Nicole’s contract was up, in June I believe, we signed up for and were approved to use Horizon Blue Cross of New Jersey.  There was a lengthy application process and a number of phone calls that went into deciding on this particular plan.  Budget and (Not rich/unemployed) the plan must cover pregnancy, first and foremost we wanted to keep Nicole and the preexisting condition (Didn’t know that) in her womb healthy and safe.  We started by going though an organization called ehealthinsurance.  Basically what they do is help you narrow down your search in finding a good policy, it’s much the same idea that Obama is working toward with his system for Obamacare, but this all private, all business.  Once you narrow it down, you apply and a representative calls you to take you through the process and explain things to you.  I wish I had a script of that conversation.  It was a very long time ago and I remember parts of it, but not the whole thing.  One thing I am sure of is that we talked about my wife being pregnant and that we would be switching insurance because her job was ending.  After that conversation our application is sent over to Horizon and a similar conversation takes place.  I’m condensing this a bit so I get to the point in a reasonable amount of time, which right now looks like it’s not happening.

The point was now we were covered.  Now we could go about our pregnancy and breath a sigh of relief.  So we went about our life.  The pregnancy proceeded as they should.  It was a pretty wonderful time.  On January 14th 2012 Max Atticus Beerman was born.  What a day.  Everything was beautiful.

We came home from the hospital and three days later received a bill for over 20,000 dollars.  All of the color disappeared from our faces at that moment.  One of the things I remember most is the strange irrationality of that period.  For instance Nicole was convinced that if this bill could not be paid, which it couldn’t, that someone would come and take our son.  That this was about paying for a thing, and now that we had that thing, we had to give it back if it could not be paid for.  Part of me wants to laugh at ideas like that, but I have to say, I felt some of it too.  It’s a strange thing, but helping to bring someone into the world that all of the sudden is the most important thing you’ve ever seen, changes your reactions.  Even though I knew this irrationality to be crazy, it was still having a profound effect on both of us because the fact is, they were taking him from us.  We were not with him w were living in a place of fear that was about loosing control of our lives.  We did everything you are supposed to do in such situations.  Called the insurance, didn’t pay the bill, waiting for the next billing cycle worked within the system to find a solution, but nothing changed.  I’m not sure how long it took or how many hoops we had to jump though before someone finally revealed to us that we were not going to be covered.  That the birth of my son was not covered by insurance because he was a preexisting condition.

One of the many letters we received with explanations sent me back to the book that came with are policy.  It is the size of a small phone book and full of the information you need to make use of such a policy.  If you’ve had insurance you know what I’m talking about.  The letter had a code, that pointed me to a a page, of a subsection of a chapter, or some such thing, and on that page it noted that pregnancy was considered a preexisting condition and would not be covered.

We contacted the hospital and explained our situation and  because the end result would be paying out of pocket they reduced our bill to 5000.00.  The rational being that they charge the insurance company extraordinary amounts of money, much higher than the actual cost.  This drives the cost of insurance up and means the hospital must negotiate with the insurance company for the actual cost.  Normally if you have insurance you pay your deductible, which for us was supposed to be 500.00 and the insurance company would pay the hospital about 10% of that charge or something close to that.

*So here I am now.  After Nicole Beerman wrote a letter.  She wrote an amazing letter.  The kind the other letters in the mail box look at and back away from, because they know, that letter, that one is badass.  This letter documented in great detail what I just described, and the results, including Nicole’s battle with postpartum depression.  She cc’d our congressmen, senators, local representatives of all kinds, and The President.  The week we got a letter from Horizon saying that, 17 months later, the birth of our son was being covered.  The hospital will be providing us with a refund.

It’s exhausting living in a world where the bureaucracy makes you feel helpless, like you have no choices, and nothing you do matters.  That your fate is sealed.  If you feel that way, take my word for it, fight.  Fight for what you know to be true and right.  Don’t give up.  Now that this is done we just have to get through this traffic ticket.  The one where neither me or Nicole was driving the car.  I’m not sure which will be more difficult, insurance or the court system.


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