Not Exactly a Health Insurance Horror Story

Sometimes I think I should never have opened up and shared my personal life with so many people. I'm very quiet and reserved, but when I write, everything has a way of rushing out of me, especially when I'm stressed. The last seven months have been incredibly stressful for my family, as many of you already know. My four-year-old daughter, Audrey, was diagnosed with T-cell acute lymphoblastic leukemia (ALL) on September 1, 2009. A couple of days ago, I wrote a St. Patrick's Day rant, in which I mentioned that I'm a little annoyed with our health insurance company. Actually I wrote, "I think I might have a pre-existing condition in my ass that they need to investigate" (and it still makes me laugh!).

Since then, a lot of my readers have expressed concern, and some of you have even offered to organize fundraisers for Audrey. Thank you; that's very kind, but at this time, it's not necessary.

What's it like, when a family member has cancer and the health insurance claims start piling up? Here's my own story...

What's it like? It's a nightmare! Maybe if you're insanely organized you'll be able to keep track of all the paperwork. But if you're not insanely organized-if, like me, you have a tendency to stuff papers into one big folder-you might have some problems. Almost every day, I get new papers for my collection, from either Audrey's hospital or our health insurance company.

Here's a direct quote from one of the letters from our hospital (I must have at least thirty of these, and that's not an exaggeration): "Your insurance company has informed us that they are having difficulty processing the claim for AUDREY. They may be doing a pre-existing condition investigation. Your insurance needs to verify whether or not there was another group health plan or policy in effect for AUDREY before your current policy came into effect. If there was prior coverage, your insurance company needs a copy of the Statement of Creditable Coverage from your prior health plan(s)."

I've sent them our statements of creditable coverage. Twice. I've sent them to our hospital. Twice. Our insurance company can do all the investigating they want. What they'll discover is this: from birth to age four, Audrey was a healthy, healthy child. Prior to her leukemia diagnosis, she'd had one ear infection and one other instance of fever, caused by seasonal allergies. That's it! Because we haven't been with our current health insurance company for over a year, every single claim, it seems, is suspect.

And then there are the letters from our health insurance company, requesting additional information for this and that-information that they should already have well documented. They need to know the "first date of illness/injury." (Duh! Can't they follow the trail of claims back to that fateful chest X-ray on August 31, 2009?) They need to know the "referring physician's name and address" and some sort of ID number. It's really confusing, because a lot of these letters say "Copy, No Action Required" at the top, even though action is required.

And then we get the forms that summarize the claims-what our insurance paid, how much money we saved by being one of their valuable customers, how much we owe. Some of these forms say we owe $0, which sounds really good. But then, when we read the fine print, we discover that, oops, our health insurance company didn't actually process the claim because they requested additional information and never got it!

Why can't they call me if it's so damn important? It's not like they have to shout their social security number and date of birth into some lousy voice-recognition program to get to the main menu, where the pleasant voice tells them "all customer service representatives are busy, but please stay on the line, your call is important to us; your estimated wait time is [switch to robot voice] twenty-three minutes" and then blasts them with madness-inducing piano music, every time they call me. Don't I wish!

That's why, just a few weeks ago, we got a bunch of bills that totaled $2000 for the chemo that was
delivered to our house in October and November. The memo on all of these bills stated "pre-existing condition," which is total b.s. So we had to call to try to figure out why the hell our insurance hadn't paid these people, and it was a big mess, and the third customer service representative I spoke to (from the company that sent the bill) actually made me cry. Now all the claims are being resubmitted to our insurance--properly, I hope. And our social worker and nurse practitioner are helping us with all the stinkin' forms requesting additional information.

So, add all this nonsense on top of the hard work of caring for two kids, one of whom has spent 22 days in the hospital in the last six months and goes to clinic for chemo treatments once a week, and you may start to wonder how we "keep it all together."

The Good News

Audrey's doing well. That's what keeps me going. She's been in remission since October, and she's about five weeks away from starting the final "Maintenance" phase of treatment (in Maintenance, which will continue until January 2012, she'll have chemo once a month rather than once a week; her hair will grow back; life will be a lot more "normal").

Audrey's oncologist is wonderful. Our hospital, Children's Mercy, is wonderful. They offer financial assistance, so we applied and were approved for a very generous discount for all the services Audrey receives there, at least through the end of this year. The good news is, we're not starving. We're not drowning in debt, like so many other families who've been hit with unexpected medical expenses. Our health insurance company has paid a LOT of money to our hospital and to the doctors who've cared for Audrey, and we have financial assistance to help us with most of Audrey's medical bills. I'm very, very grateful.

We've learned to pay attention to all the letters and forms, annoying as they are. If our health insurance company wants the same information, submitted over and over and over again, fine, we'll give it to them. I can't just ignore it all and assume they're going to pay everything they're supposed to pay. Sometimes we have to nudge them along. We can't expect special treatment just because we have a sick child. We should be glad we have health insurance, period. I am glad!

My Opinion on Health Insurance Reform

In case you're wondering, I do support the current health insurance reform bill. I've even written to my representative, Dennis Moore, about it-something I've never done before-because I'm concerned that, unless something changes, my daughter, as a cancer survivor, will have trouble getting affordable health insurance in the future. And what if, God forbid, my husband loses his job and we lose the coverage we have right now, while Audrey's still in the middle of treatment? It's terrifying to even consider.

I can't help but think of all the people in this country who don't have health insurance, who are one tumor or one car accident away from financial ruin. I believe the current health insurance reform bill is a step in the right direction. I'm not particularly attached to my private health insurance company, and I will continue to hope that I live to see the day when universal healthcare is a reality in America. The health insurance hassles I've personally experienced are minor compared to some of the true horror stories.

Until you or someone close to you has experienced a serious illness or injury, until you've opened a hospital bill for $50,000, you may not realize how insecure or inadequate your health insurance coverage is. The way I understand it, health insurance reform will put an end to a lot of the truly despicable practices that health insurance companies have been allowed to get away with, up to this point (for example, denying coverage because of pre-existing conditions or dropping coverage when you get sick). Go here to read a nice summary of the changes that we can expect within the first year if this health insurance reform bill passes.

Thank you for reading and thank you for caring.

Sources and Recommended Reading:

To learn more about the health insurance reform bill that will most likely be passed this weekend, check out the following sites:

http://www.whitehouse.gov/realitycheck/

http://www.whitehouse.gov/health-care-meeting/reform-means-you

I also found this article very informative (and disturbing): "Coverage Denied: How the Current Health Insurance System Leaves Millions Behind"

Recent articles on health care reform:
"Will Obamacare destroy the Democrats?"
"House Dems confident in overcoming abortion rift"

http://news.yahoo.com/s/ap/us_health_care_overhaul
http://blog.newsweek.com/blogs/thegaggle/archive/2010/03/19/will-obamacare-destroy-the-democrats.aspx
http://www.cnn.com/2010/POLITICS/03/16/health.care.immediate/index.html