Health insurance; a necessary evil

We live in Deerfield Township, a fast-growing suburban community of 33,000 people about 26 miles north of Cincinnati.  In combination with the adjacent City of Mason, which has about the same population, we comprise the largest population center in our county. I was elected to our town council in 2005, then re-elected last year.  It's a challenging assignment--managing police and fire service, road and waterways, development and zoning, parks and recreation.  It's supposed to be a part time, board level job, but the first 5 years has been more like 3/4 to full time hard work.  A benefit of being on the Board is eligibility for health insurance.  It's been great for us.  Having insurance through the town has permitted me to be self-employed and to pursue other consulting jobs that don't offer health insurance.

Still, health insurance is a pain in the butt.  I won't get too high on my soap box, but health insurance reform is so badly needed; and not the kind of reform offered by the current Congress.  True reform would lower government-instituted barriers to competition to help lower the cost and reduce the need for insurance that covers every possible expense.  That would allow us to carry insurance that covers just the most expensive, unplanned costs, and every day medical costs could be covered out of pocket because the cost would be more reasonable.  Unfortunately, that's not how things are, and (at least for now) we have to carry insurance that covers just about everything because everything medical costs so much.

So, "why the rant?" you ask.  Because today, we're signing up for next year's health insurance.  Despite choosing one of the best "consumer driven" care plans, our insurance runs nearly $1 million per year.  And even though it's truly comprehensive coverage, I still can't get someone to tell me specifically whether or not Tommy will be covered under our insurance for the things he'll need like physical, occupational and speech therapy.  I have a masters degree in business and have run very large organizations, and even I can't tell for sure from reading our insurance plan.

The people in the know say he'll be a covered person on our plan.....HOWEVER....if he has what's called a pre-existing condition, and doesn't have insurance now, he may not be covered for certain costs.  When I went on to explain that he's in Ethiopia and we know he's got something wrong, but that we've got VERY little in the way of documentation, all I get is silence and wonder.  Differing opinions tell me he may not be covered for rehab services if he's been diagnosed there by a doctor.  I guess the distinguishing factor is...."diagnosed."  Unclear what they'll want to see, or whether we'll be able to procure it.  Sure makes it difficult to plan our finances for next year.