Thursday, October 22, 2009

A serious post: Let's talk healthcare

I am having an angry day. I read this article this morning. It talks about women who are routinely denied health insurance. They are denied because they have been raped. There may be a PTSD issue, or in the case of the first woman, she took anti-HIV drugs for a month. Isn't that just a lovely kick when you are already down?

This issue is very near and dear to my heart. When I first got married, my husband was in the Marine Corps. I never worried about insurance. Everything was covered. I think the most I ever paid was $25 out of pocket to the civilian hospital where I birthed my second kid. Then my husband got out of the Marine Corps and we came back to MI.

We followed the rules. My husband got a job that didn't have group coverage so we bought private coverage. My older kid started having problems with UTIs. We treated one with 4 different antibiotics and it would not go away. We finally managed to kill it. The doctor reccomended having her tested for kidney reflux. We did, and it was negative. This was my first time using insurance outside of the military. I was young and uninformed. I didn't think about the $1000 deductable and I didn't understand what was covered and what we needed to pay out of pocket. Let's just say at the end, our side of the bill was over $4000.

The fun continued. A few years later, my husband was a driver at this point and we were covered under group coverage. After a run in with the flu, my older kid was really sick. I took her to the doctor and she ended up being hospitalized with dehydration and severe constipation. Despite insurance and following the rules, there is another few thousand dollars we were expected to pay.

The fun gets worse at this point. My daughter was 5 at the time of her hospitalization. The chronic constipation issue started. She also snored and gasped at night, and by 7 was showing sure signs of Asperger's syndrome. A sleep study to diagnose her with obstructive sleep apnea $$$. Tonsils out $$$ (after all, despite doing my homework and making sure everything was covered, I don't get to pick the pathologist, and things of that nature), and the most recent issue, the constipation problems that would not go away. My daughter had not seen a doctor for the constipation issues in well over a year. We were handling it at home. Her ped. referred us to a gastro. My husband had switched companies a few months before this, so we were on new insurance. "Best in the industry" and fully paid for by the company he worked for. When her blood test for celiac came back positive, I looked very very carefully through the plan. I had been burned so many times. I got the pre-approval and we did the biopsy to test her for Celiac disease. The bills started coming. I knew the $500 deductable was ours. Then there was the $2300 for the anesthisiologist (I cannot spell. Forgive me.) and the pathologist that were not covered. I appealed because again, I chose an in network hospital and doctor. I have no control over the rest.

The "best insurance in the industry" decided to deny the entire claim. Pre-existing condition. Almost $7000 we owe to these people. In the last 8 years we have racked up more than $20,000 in medical bills for one kid.

By the way, the Asperger's syndrome? She shows every sign but I refuse to have her officially diagnosed at this point. Can you blame me? I am trying not to make my kid completely uninsurable.

I am not the only person with this problem. From my mommy board:

One person keeps fewer diabetes supplies on hand for her child than she is comfortable with because of the cost.

One person had to pay for the treatment of cervical cancer out of pocket

One person's insurance wouldn't cover the cost of food for a feeding tube

One person knows of someone who suffered a heart attack and never went in because of lack of insurance.

Another person knows of a women who suffered a broken bone with no insurance and could not get it treated without paying upfront.

I firmly believe that those who do not believe we need some sort of healthcare reform have never had medical issues in which they had to deal with this. We followed all the rules. We made sure we stayed covered, yet the insurance company has paid less to these medical bills than we have paid into them. That is bull.

**Kid 1: Parts of speech, define humanities and art. Kid 2: Singular and plural nouns, introduction to theater, art and music. Me: Basic atomic structure**

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