I have read stories like mine. Stories about people who have health problems – MAJOR ones – and can’t get help. People who actually have health insurance policies that they pay good money for, but the insurance company won’t cover necessary treatment.
For me, the reality is just setting in. I always assumed that surely these situations were few and far between, extremely rare, and that the corrupt insurance companies that behaved this way surely were forced out of business immediately. I was wrong.
I’ll start from the beginning of my story. I was a successful computer programmer for almost 5 years. My husband was a talented apparel buyer for the same company. Our 2 children attended a child care center where they were loved and very well cared for. We had it great.
Then I started getting calls. At first, it was only a few times a week. Then it was every day. My son was having major problems at school, crying inconsolably for hours. Screaming hysterically, and not a single person could calm him down. They would inform me that I had to come pick him up – he was putting the other children and teachers on edge.
I started noticing other things about my son. His arm flapping. The toe walking. His desire to be left alone constantly. One day while surfing the net, I came across the definition of autism. My stomach dropped. I think I cried for a week straight.
We realized this problem wasn’t going away. We still tried everything we could to make him comfortable at day care, but he couldn’t cope.
I put in my notice. I was gone more often than I was at work. My last day was in August of 2007.
Our health insurance had to go – temporarily. Our policy was (and still is) $250 a week – no, that’s not a typo. Insurance costs us over ten grand a year. Rediculous? Yes. But you have to do what you have to do. We tried to switch policies to a cheaper version, but our employer told us we had to keep the (expensive) one we had or drop it entirely. We couldn’t switch coverage types. We decided that we would have to pick it back up during open enrollment – usually in April.
We had no health problems in the meantime. We picked the insurance back up, and breathed a sigh of relief. Our effective date was June 1, 2008.
In October of 2008, I landed in the ER 3 times before the doctors realized I needed an appendectomy. During the appendectomy, the surgeon took pictures, and handed them over at the follow up with a recommendation for a hysterectomy. The gynecologist agreed, and a month later I had a hysterectomy.
Still reeling from the surgeries, I found a lump in my armpit. I had noticed it before, but for some reason a few months before it had seemed like maybe a bone or muscle in a weird place. It wasn’t.
After an ultrasound and an MRI, the radiologist’s report suggested a neural tumor. It’s size – 2.8 x 3.0 x 4.0 cm. Even my GP noticed its growth from appointment to appointment.
Finally we found a neurosurgeon to operate on it – brachial plexus surgeries are difficult, and there are very few surgeons who can do them. He wanted it out quickly, and the surgery was set for a little over a week out.
Then the scheduling department called me from the hospital. My insurance won’t cover the surgery until June.
Here I am, stuck with a rapidly growing tumor that is causing more pain daily, and they won’t budge. The hospital and doctor himself tried to change their mind. They refused, stating it was in the policy.
I’m sure it is. And they don’t want to pay out good money if they don’t have to legally. But should health insurance be about the bottom line? Or should they be looking out for us? Just because something has a leg to stand on legally, doesn’t make it right or ethical. Should medical treatment be about money, or about saving lives? Obviously, it can’t be about both.
As far as my case, the hospital couldn’t do my surgery without the insurance coverage. It’s unknown if the tumor is benign or malignant – no one can do a biopsy (or will). The scheduling employee informed me that she talked to my doctor, and “he said you would *probably* be okay until June”. It was not a very reassuring conversation. But I have no other choice.
Here I am, paying more than COBRA costs for insurance, and getting nothing… I can’t afford to do this out of pocket (especially with the cost of our insurance). Because assistance programs look at gross income, we don’t qualify. Heck, our gross income (pre-insurance numbers) looks great. Take over ten grand off, and it starts looking a little less ‘great’.
The point is, I am nothing but a number to them. To my kids, I am everything. If I don’t make it, the insurance company would save money. But my kids wouldn’t have a mom.
It’s my opinion that the health industry has proven it cannot be ‘for profit’ anymore. It doesn’t work. People are more than numbers, and we deserve better than this.