Saturday, October 31, 2009

The Health Care System REALLY Does NOT work...how it home personally again this week.



I thought it was bad when my sister lost her health insurance back in 2005, through no fault of her own. The non-profit foundation that she ran decided to close and she was suddenly unemployed and without insurance. This may sound like a common story these days but, there was another element involved: my sister was in treatment for Breast Cancer. She'd already completed horrendous chemotherapy that caused her to feel like her bones were breaking each time she moved, the nausea, not to mention the hair loss. She was finishing her radiation that left horrible burns on her breast. She was now told she had to take medication for the next 10 years, or she would die.

Said medication cost $899 per month, without insurance. My sister could not obtain health insurance anywhere because....drumroll...she had cancer and the insurance companies, in their underwriting wisdom didn't want to take that risk.

As a result, my sister moved back to Israel, where she lived in her 20s, in order to get health insurance. She didn't really want to move back but, she had no choice. As a newly unemployed non-profit executive director without insurance, she didn't have any options in the U.S.

So, some of you who know me know that October 30th marked the 1 year anniversary of my neck surgery. I was in a car accident in December 2007 and as a result, had to have cervical disc replacement surgery. I tried everyting in 2008 to avoid surgery: physical therapy, rest, more rest, acupuncture, massage, epidural injections....I did avoid all of the pain pills and muscle relaxers that the doctors wanted to give me. I didn't want to mask the pain, I wanted to be pain-free.

Finally, the head of neuro-trauma at Scripps informed me that surgery was "semi-urgent," meaning that if I were hit again or fell or did something to tweak my neck, I would have serious spinal cord damage. So, what were the options? Surgery.

So, after a year or almost non-stop pain, I am the proud owner of a bionic disc at C5-6. I am finally pain free and have remained so a full year. I quit my corporate job in January and pursued my dream of teaching full-time. It is better than I could have imagined.

One issue, however, is health insurance. I'm paying $450 per month to continue my old insurance through COBRA. This is only a temporary fix because you can only participate for 18 months. As a full-time yoga and pilates instructor, I must say that $450 a month is really tough. So, I finally decided to pursue some health insurance as an individual.

I received my first declination letter from Anthem Blue Cross. Like my sister's case, this is rather ironic as well. Apparently, they declined me because I had disc replacement surgery. Of course, there is no consideration put into the fact that it FIXED my neck, that I've been pain free for a year, that I haven't had to have any treatment for my neck since the surgery. No, that would be too logical.

They turned me down because, "Once there is a disc replacement surgery, we will not insure you." Ever. So, am I supposed to take out the healthy artificial disc to get insurance? How will I get coverage?

Something really needs to be done. These two examples are within one family. How many millions of stories are there out there? The insurance companies won't underwrite you and give you insurance if you've, gasp, actually had to use your insurance in the past. Go figure.

4 comments:

  1. so true and how frustrating!!!! thanx for sharing xo

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  2. Unbelievable, but totally believable. This is the whole reason for health reform. Why doesn't everybody get this!

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  3. yup I know what you are going through....that is why I will always have to depend on my husbands (soon to be ex-husband) insurance which he has agreed or I have to get a corporate job to get insurance. I wanted to be self-employed but I have had not only the neck surgery last year, but back surgery this year and two shoulder surgeries in the past....my husband has thyroid cancer and hep C...he will also always have to work a corporate job----healthcare reform would be wonderful!!!

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  4. This makes me sad, and mad, to read! I too was denied health insurance because.....get ready...I got a prescription for a face cream from my dermotologist 2 years ago. I used my insurance coverage, so no one will insure me now. It's unreal! I am against government insurance programs, but there has to be an answer for this. I can't believe your sisters story. That is ridiculous!!! but I know it is the story of so many. UGH!

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