My Health Insurance Nightmare: A Personal Look at the Need for Health Care Reform

When I left the corporate world, I was very excited about becoming self-employed and opening my own business. The only fear I had, the only trepidation, was gambling with my future by not having health insurance. I was venturing into the world of the self-employed, and one of the ways I cut costs was by dropping my health insurance coverage. I told myself I would pick it up again once the business was self-sufficient and I could afford it.

One year rolled into the next, and I still hadn't bothered to get health insurance. By the third year of being self-employed, I began to look at the rates. I was floored. As an individual, to get any type of coverage that wasn't completely useless, it was going to cost me more per month than my mortgage payment!

So I didn't get health insurance. I figured: I'm young, I'm healthy, I have time.

Later that same week, getting out of my car, I accidentally whacked my shin against the side of the door. There was no mark. No bruise. No pain. I went to sleep that night and woke with my bed sheets wet around my leg. Thinking perhaps the dog had decided my bed was the garden, I changed the sheet, only to be awakened again a few hours later with wet sheets.

My leg was swelling, and through a very small fissure in the skin, most likely caused by whacking my leg against the side of the car door, lymph fluid was leaking out of my leg, enough to soak the sheets.

About two weeks later the leaking fluid turned into a rash that quickly become necrotic, and before I knew it, I had a full-blown case of bacterial cellulitis. I merely thought I'd banged my leg on the car and suffered a rash, so I didn't hesitate to go to a minor emergency clinic and get it looked at.

They referred me to a general practice clinic, and before I knew it, I had two diagnoses: 1. bacterial gram-positive cellulitis and 2. SLE, better known as lupus.

As if that weren't bad enough, these diagnoses meant one really important thing: I was uninsurable.

Don't get me wrong, for $300-500 per month, limiting me to five doctor's visits per year and capping me at $10,000 per year, with no prescription coverage, I can get insurance. Woo hoo! However, even with that, there's a 12-month pre-existing condition limitation on it.

When you have lupus, everything is pre-existing.

My bout with bacterial cellulitis lasted over a year, with two hospital stays, racking up a bill of nearly six figures. During this time, I couldn't work at my normal pace; my income dropped, expenses went up, and money got tight. Through the hospital district in our county, I applied for assistance from their medically needy health insurance reimbursement program. I was informed my income and assets were too high to qualify.

I was too rich to get help and too poor to afford to pay cash for my medical expenses.

The solutions: deferred billing, monthly payments for the hospital, and simply not going to the doctor. The last choice is the hardest option of all, but sadly sometimes necessary.

Now that I'm feeling healthier, I see a doctor regularly. Actually, I'm seeing a PA, because he is about $40 per visit cheaper than a doctor.

Unfortunately, the lupus is not under control, and without health insurance, I've had a hard time finding specialists who will see me. You see, there is a continuity-of-care requirement for doctors that won't allow them to drop me as a patient if they have already started providing care, and you'd be amazed how many doctors won't take on a cash-pay patient.

I can't say I really blame them; we are sitting around like we're waiting for a time bomb to explode but not knowing when it will. At any moment, my health could take a turn for the worse, and a couple of those bad turns could bankrupt a family fast.

It's a scary place to be.

Health insurance, even in the best of situations, is a gamble. You place your bet in monthly premiums and roll the dice, hoping you never need to use it. When you do need to use it, you hope it's there for you and is good enough to pay for all you require. When it's used for something big, you hope the insurance companies don't find a reason to drop you or raise your premiums so high they may as well drop you.

Still, even with all that, I sit here wishing I could even qualify for the gamble. I have no answer, no solutions, only a lot of questions, but the one thing I know for sure is: Health insurance needs to change. It isn't right that only the rich deserve to have quality of life and only the poor deserve to have the government pay for their medical care. Honest, decent people like me -- and many other small families who are stuck in the middle -- deserve the same benefits too.