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Just Because You Did Everything Right Doesn’t Mean Everything Is Going To Be Alright

August 6, 2019

It’s not my fault.

Did you know that line is used three times in the Star Wars movies? Three times by Han and once by Lando Calrissian.

What makes the lines so memorable is that despite everything those two do wrong, it really isn’t their fault. But, things turn out badly.

I left Microsoft in 2003 after nearly ten years. I decided to go back to school at BYU. I moved my large family from my home in Washington State to my adopted home of Utah.

Not surprisingly, Microsoft had good benefits. They were better than good. They were some of the very best I’d ever seen, health, dental, paternity leave, adoption credits, but mostly the health benefits.

Leaving a company with benefits is a hard. It’s scary to think about losing those health benefits. Back before the Affordable Care Act, pretty much your only option was hugely expensive private insurance, or slightly less expensive Consolidated Omnibus Budget Reconciliation Act, or C.O.B.R.A. coverage.

Basically C.O.B.R.A. let you keep your same level of coverage. You just have to pay the premiums yourself.

It was just as expensive as it sounds.

But, it let you keep coverage. And when you have ten kids at home to care for, you can’t not have coverage. One of my sons needed a specialzed operation. The operation was pretty expensive, on the order of $4,000.

But, we had C.O.B.R.A. And the operation was covered. It was specialized enough that the waiting period to get into the surgeon was a couple of months. In the middle of the waiting period we decided to move to Utah. School was starting and we couldn’t wait.

So, off to Utah we went. As a fulltime student at BYU, I was eligable for the student health insurance plan. And it would be a relief to stop paying the sky high C.O.B.R.A. premiums.

But, what about my son and his operation? We made a call to the school’s insurance provider and talked to a very polite young lady.

Yeah, my son needs an operation and I’m wondering if it will be covered under the school insurance?

Is it covered under your current insurance?


Then it won’t be a problem. It will be covered under the school’s insurance if it’s covered under your previous insurance.

Now, I ask you, could that have been any clearer? I didn’t think so either. So, even though we had the money, we dropped our C.O.B.R.A. coverage and signed up for the student health plan. We even made sure that we didn’t allow even a single day of “gap” between the two. We knew how important it was to maintain uninterrupted coverage.

And then we scheduled the operation.

Like before it was a couple of months out. Eventually the day arrived for him to go into surgury. We went to the hospital. We prepared my son, who was only 4 years old at the time.

We did everything right, wouldn’t you say? We are experienced parents. This wasn’t our first rodeo. We handed him off to the nurses and we went to wait. Just about the time he was scheduled to go into surgury we got a call from the nurse.

It our normal process to call the insurance company just to double check coverage prior to surgury.

Okay. . .

They said that this procedure is not covered.

Why not?

Well, in their view it’s cosmetic.

So, what do we do?

Well, the only option is to pay it yourself.

We had the money in the bank, although it was earmarked for school. So, we gave the nurse a credit card and our bank account became $4,000 smaller.

Of course, we appealed. After all, it wasn’t our fault.

The appeal was denied at every level, of course. It’s an insurance company we’re talking about. Finally, the appeal got to the highest level. We weren’t allowed to actually go into the council meeting with the insurance and school officials. The school had appointed an ombusman to represent us. He was actually very good at his job and clearly cared about our condition.

He came out of the meeting with a disappointed look on his face.

I explained that you guys called before cancelling your other insurance and were told this was covered. Everyone agrees that there was really nothing you could do.

It wasn’t our fault?

Right, clearly not your fault. And they were actually considering granting your appeal. It was really close.

So what happened?

Well, then the lawyer stood up to talk. . .

No, it wasn’t our fault. Yes, we did everything right. No, I don’t hate lawyers. But, even if you do everything right, it still sometimes doesn’t always come out alright.

Rodney M Bliss is an author, columnist and IT Consultant. His blog updates every weekday. He lives in Pleasant Grove, UT with his lovely wife, thirteen children and grandchildren.

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(c) 2019 Rodney M Bliss, all rights reserved

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