My Journey As An American Consumer With A Pre-existing Condition
I haven't been posting here much for a little while now. And I must admit, if I have, it has been almost half hearted.
For the last few months, I have been tired. Really tired. 3 hour nap kinda tired. Along with the sleepiness, other symptoms have popped up that have led me to believe that I may have some sort of anemia. I started taking my B12's, and iron supplements more regularly, but they haven't really helped much.
So, I have to go to the doctor.
But I have been avoiding it. I am one of those 46 million Americans without health coverage. Without coverage, I can't afford those blood tests. Or treatment.
So I applied for coverage, not even considering the possibility of being denied by the insurance company.
I was denied.
Why? I knew why, I almost didn't even have to ask. But just to be sure, I asked anyway.
I spent a few days in the hospital in my early 20's for what some Hollywood P.R. Firms, or Marilyn Monroe's manager may call "exhaustion." I received treatment, and was sent on my way. For this, I was denied coverage.
I disclosed this on my application. Some people said, "why didn't you lie about it?" Well, I was afraid to lie. Had I lied, and been covered, and one day I decide to seek treatment for anything even remotely related to "exhaustion", the insurance company could find out my little fib, and choose not to cover my treatment anymore, or revoke my coverage completely. Leaving me with the bill.
Smart move on the part of the insurance company. I could wind up costing them money.
So after getting word of the denial, I decided to do a little reading on the interwebs. What I found upset me even more. According to the California Department of Insurance (I couldn't find the proper link for Ohio, but I can't imagine it is much different here) an insurance company will more than likely automatically deny coverage for someone with "major depression", while if you have "mild depression" they may accept you, but charge you a higher premium.
Other common liabilities *ahem* I mean, conditions that will get you automatically declined. If not, at the very least you'll get a higher premium.
*Cancer (under treatment)
*Heart Disease
*Obesity
*Ear infections (under treatment)
*Diabetes with complications
*Current infertility treatment
*Allergies (while testing is in process)
*Rheumatoid Arthritis
And how about these all encompassing, quite vague items that can really apply to anything. These too can get you denied coverage.
*Health problems for which you have not seen a doctor
*Health problems that a doctor cannot explain
*Health problems for which you have not completed treatment
The last time I had health insurance, I was maybe 19. I had it through my employer, and I was fully covered. For everything. After leaving that job, I haven't had coverage since. In that time, I had to utilize emergency rooms, and urgent care facilities. Urgent care is fantastic if all I have is a cold. It's cheap, and you get in, and get out. The only problem is not having prescription coverage. The emergency rooms are another story. I advise planning an emergency well in advance so you can take the day off work.
Truth be told, the possibility of anemia isn't the only thing I need a doctor for. Along with needing glasses for my failing vision, I have had stomach pains off and on for nearly 3 years now that have gone undiagnosed. I need to see a specialist, but cannot afford to. I have had doctors only shake their head at me after telling them I am not covered. They know how much I would be spending should I seek further treatment.
As a 28 year old American, the only debt I have is medical debt. Weird I know. I really should be drowning in credit card debt, or student loans. But I'm not. It's all debt I accumulated in the last 10 years because I can't afford to pay the cost of staying healthy.
Let's think of it this way. When I found out I was pregnant last summer, I had to get coverage. Medicaid will cover maternity costs as long as you meet the financial requirements. From what I understand, it doesn't matter what sort of pregnancy it is. High risk, cesarean, whatever. You will get coverage. *It's worth it to say, if you apply for regular insurance, and you, or your spouse are pregnant, you will more than likely be denied coverage.* In Ohio, "all pregnancy-related services" are covered through medicaid. They even retro-actively foot the bill for your pre-natal care prior to signing up for the program.
Sadly, before I had a chance to apply, I lost the pregnancy, leaving me to pay the pre-natal care, emergency room bills, and after care myself. Had I actually had my baby, and was covered through medicaid, it would have been cheaper. Go figure.
I filled out all the paper work needed for financial assistance after losing the pregnancy. But now 5 months later, I still have no word on if I am approved for assistance or not. All I know is the bills are still piling up, and I haven't so much as opened one. I don't want to open them. I can't afford them. I have to prioritize. What's more important? My electricity staying on, or my hospital bills.
The hubby and I are not poor. We work hard, and make money. We can afford to pay our way through life, with a little left over for a tasty I.P.A. at the end of the week. But the cost of health care simply isn't in my budget.
And it's the cost of unpaid health care that is stopping us from buying our first home.
I can't imagine what an American with a serious, chronic condition goes through...WAIT...my phone is ringing...HAHA what a coincidence...it's 9:02 a.m. on a weekday, that can only mean one thing. Someone want's me to pay up.
I never answer those.
Anyways. Talking about money woes, and health problems is sooooo tacky, isn't it? But I can't stop myself from doing it. The topic of affordable health care is all around us. And maybe, we need to hear these stories. Maybe we need to talk about our own. The stories are out there. Find them. Some are truly heartbreaking.
We are human beings who have a right to seek medical treatment. No matter what. We should be able to pay for it. I shouldn't ever have to worry about weather or not I can afford to pay for my medical care. I shouldn't have to ignore a health concern because I can't afford the cost of treatment. Nobody should.
And most of all, I should never, ever be at someone else's mercy. I shouldn't have to wait and see with fingers crossed if someone deems me one of the chosen few who can obtain affordable medical coverage. It is my body, and only I have a right to it.
We cannot be a strong nation until our bodies are strong first.
For the last few months, I have been tired. Really tired. 3 hour nap kinda tired. Along with the sleepiness, other symptoms have popped up that have led me to believe that I may have some sort of anemia. I started taking my B12's, and iron supplements more regularly, but they haven't really helped much.
So, I have to go to the doctor.
But I have been avoiding it. I am one of those 46 million Americans without health coverage. Without coverage, I can't afford those blood tests. Or treatment.
So I applied for coverage, not even considering the possibility of being denied by the insurance company.
I was denied.
Why? I knew why, I almost didn't even have to ask. But just to be sure, I asked anyway.
I spent a few days in the hospital in my early 20's for what some Hollywood P.R. Firms, or Marilyn Monroe's manager may call "exhaustion." I received treatment, and was sent on my way. For this, I was denied coverage.
I disclosed this on my application. Some people said, "why didn't you lie about it?" Well, I was afraid to lie. Had I lied, and been covered, and one day I decide to seek treatment for anything even remotely related to "exhaustion", the insurance company could find out my little fib, and choose not to cover my treatment anymore, or revoke my coverage completely. Leaving me with the bill.
Smart move on the part of the insurance company. I could wind up costing them money.
So after getting word of the denial, I decided to do a little reading on the interwebs. What I found upset me even more. According to the California Department of Insurance (I couldn't find the proper link for Ohio, but I can't imagine it is much different here) an insurance company will more than likely automatically deny coverage for someone with "major depression", while if you have "mild depression" they may accept you, but charge you a higher premium.
Other common liabilities *ahem* I mean, conditions that will get you automatically declined. If not, at the very least you'll get a higher premium.
*Cancer (under treatment)
*Heart Disease
*Obesity
*Ear infections (under treatment)
*Diabetes with complications
*Current infertility treatment
*Allergies (while testing is in process)
*Rheumatoid Arthritis
And how about these all encompassing, quite vague items that can really apply to anything. These too can get you denied coverage.
*Health problems for which you have not seen a doctor
*Health problems that a doctor cannot explain
*Health problems for which you have not completed treatment
The last time I had health insurance, I was maybe 19. I had it through my employer, and I was fully covered. For everything. After leaving that job, I haven't had coverage since. In that time, I had to utilize emergency rooms, and urgent care facilities. Urgent care is fantastic if all I have is a cold. It's cheap, and you get in, and get out. The only problem is not having prescription coverage. The emergency rooms are another story. I advise planning an emergency well in advance so you can take the day off work.
Truth be told, the possibility of anemia isn't the only thing I need a doctor for. Along with needing glasses for my failing vision, I have had stomach pains off and on for nearly 3 years now that have gone undiagnosed. I need to see a specialist, but cannot afford to. I have had doctors only shake their head at me after telling them I am not covered. They know how much I would be spending should I seek further treatment.
As a 28 year old American, the only debt I have is medical debt. Weird I know. I really should be drowning in credit card debt, or student loans. But I'm not. It's all debt I accumulated in the last 10 years because I can't afford to pay the cost of staying healthy.
Let's think of it this way. When I found out I was pregnant last summer, I had to get coverage. Medicaid will cover maternity costs as long as you meet the financial requirements. From what I understand, it doesn't matter what sort of pregnancy it is. High risk, cesarean, whatever. You will get coverage. *It's worth it to say, if you apply for regular insurance, and you, or your spouse are pregnant, you will more than likely be denied coverage.* In Ohio, "all pregnancy-related services" are covered through medicaid. They even retro-actively foot the bill for your pre-natal care prior to signing up for the program.
Sadly, before I had a chance to apply, I lost the pregnancy, leaving me to pay the pre-natal care, emergency room bills, and after care myself. Had I actually had my baby, and was covered through medicaid, it would have been cheaper. Go figure.
I filled out all the paper work needed for financial assistance after losing the pregnancy. But now 5 months later, I still have no word on if I am approved for assistance or not. All I know is the bills are still piling up, and I haven't so much as opened one. I don't want to open them. I can't afford them. I have to prioritize. What's more important? My electricity staying on, or my hospital bills.
The hubby and I are not poor. We work hard, and make money. We can afford to pay our way through life, with a little left over for a tasty I.P.A. at the end of the week. But the cost of health care simply isn't in my budget.
And it's the cost of unpaid health care that is stopping us from buying our first home.
I can't imagine what an American with a serious, chronic condition goes through...WAIT...my phone is ringing...HAHA what a coincidence...it's 9:02 a.m. on a weekday, that can only mean one thing. Someone want's me to pay up.
I never answer those.
Anyways. Talking about money woes, and health problems is sooooo tacky, isn't it? But I can't stop myself from doing it. The topic of affordable health care is all around us. And maybe, we need to hear these stories. Maybe we need to talk about our own. The stories are out there. Find them. Some are truly heartbreaking.
We are human beings who have a right to seek medical treatment. No matter what. We should be able to pay for it. I shouldn't ever have to worry about weather or not I can afford to pay for my medical care. I shouldn't have to ignore a health concern because I can't afford the cost of treatment. Nobody should.
And most of all, I should never, ever be at someone else's mercy. I shouldn't have to wait and see with fingers crossed if someone deems me one of the chosen few who can obtain affordable medical coverage. It is my body, and only I have a right to it.
We cannot be a strong nation until our bodies are strong first.
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12 comments:
As a European who automatically has public health insurance, all this sounds scary, to say the least.
I completely agree with you, each and every one should have access to affordable health insurance and medical care!
It's terrible to hear that some people can't seek medical treatment because they simply cannot afford it.
it is very scary. while i don't have any life threatening diseases, there are so many stories of uninsured americans filing for bankruptcy, losing their homes, and going without care that may save their lives, all because it is unaffordable.
there are many people here who are against public health care because they don't want to have to pay for the care of others. to them i say "eff you."
it is the middle class, hard working people who can't afford the expensive care, but make too much money to apply for public assistance.
i am not middle class, and it is something i used to strive to be. but now our middle class here is being bled dry, and taken advantage of.
something needs to change.
Have you tried cutting out gluten? I've been anemic on and off for 12 years, and am currently getting some testing done to see if it's Celliac Disease. (I'm also a few days away from being 30 and bone density scans show that I'm very close to having osteoporosis. Ridiculous!) It's at least something to try before you have to foot a gigantic medical bill. Or you could eat a lot of gluten and see if it brings on stomach pains.
I hear you on the health insurance. We, luckily, have medical insurance. I ended up switching from Kaiser when I got pregnant (by photo-shopping the date on our marriage license) because of a series of misdiagnoses. Getting caught would have probably meant that my husband and I would have been dropped, or fired, but it was worth it at the time. I have no doubt that I would have died under their care due to the course my pregnancy took.
Even with good health insurance, the system is frustrating. My daughter had to be seen by an orthopedic surgeon. She looked at her for 4 minutes, all while playing on her pager, charged us a $20 co-pay, and billed our insurance company $276. For 4 minutes and a "come back again in 3 months." If we didn't have health insurance, I would have flipped out in that office. These doctors shouldn't be allowed to practice. How can you come to a conclusion after 4 minutes of barely looking up from a pager?
Lots of luck in finding a doctor/clinic/health insurance that will pick you up. What I've learned in dealing with health insurance companies, is to keep calling when I get an answer I don't like. It took me 3 phone calls and a couple of threats to get my bone density scan completely covered. The worst they can do is say "no."
Move. To. Canada.
Seriously... haven't you watched Sicko? We have full health coverage in Canada.
There is something terribly wrong when a country as rich as the U.S. cannot afford to keep its citizens healthy and help them when they need medical care.
Scary situation indeed.
rachel #1, i'm pretty sure my grandma has a gluten allergy, and from what i understand, it is hereditary. it's sad that in order to ensure that we can receive adequate health care, we have to conceal some truths. we shouldn't have to. and i hear you on the doctors. i've had several who just give me the old heave ho after a few minutes.
rachel #2, moving to canada is something that the hubby and i have talked about. it is actually something that many of us americans say we're gonna do at some point or another. :) i did see sicko, and i teared up a bit during it. when we went to see it, was when i was having the worst stomach pains. i couldn't eat the popcorn we ordered. even water gave me pain. i became really sad because i knew that the more treatment i sought for this problem, the less of a chance i would have getting health insurance.
this was sad to read. i really feel for you. i understand the struggle though. i have a thyroid disease (graves disease) that i left untreated for 5 years due to not having health coverage. when i applied for public health coverage in the state of washington, i was denied, not due to having a thyroid disease that takes blood tests every month and expensive tests and treatments, but for being diagnosed with depression 9 years beforehand. i hadn't taken anti-depressants for years (not needing them), but thats what disqualified me. i still dont understand.
i even cracked my ankle when i didn't have health coverage, and i popped tylenol for 3 months straight, just because it was too expensive to go get xrays / doctor opinions etc.
my happy ending was i finally got a job that provided health coverage. by that time, my doctor told me i belonged in a case study due to the fact my graves disease went untreated for so long. apparently it had affected my heart badly enough that i was about a year away from having heart failure (at age 29). and ironically - that wasn't what i was originally denied health coverage for. tell me how that makes sense??
anyways, thats my short story. have you considered even moving to massachusetts? everyone that lives there is required to have health insurance, which also provides help to those who can't afford it. i dont live there so i dont know all the nuances to their system.
anyway - knowing your family history is good, to see if you can "fix" or even lessen your stomach problems.
i wish i had better advice for you.
Krista--
Sorry you are going through so much. I do advise you to make contact with the hospitals though and even pay $1 a month. This will keep it from going against your credit. Even with health insurance, we are up to our eyeballs in medical bills, thanks to Abby's medical condition. I truly fear for her if there is ever a lapse her medical insurance. They paid out over $151,000 in her second year of life. I'm sure unless it is mandatory, no one will touch her with a ten foot pole.
Best of luck! Also, some hospitals and doctors will write off at least part of the bill if you call their billing department and tell them you are uninsured.
My little family is pretty much uninsurable for now. We accept it as much as we can; our family practitioner has a reasonable office visit cost for self-pay patients but specialists other than the gasteoenterologist my husband sees every few years is out of our reach. If the public option makes it into law, at the top of our list is getting my daughter's eyes taken care of. She has mild strabisimus (crossed eyes) and we couldn't afford the out-of-pocket cost of outpatient surgery when she was younger so now she has 20/20 vision in each eye but limited ability to use them together.
Re glasses, one fairly inexpensive route is to get a local eye exam (e.g., my local Wal-Mart Optical charges $45 for a basic eye exam) and then use that prescription to order glasses online. Glassy Eyes has reviews of a lot of online glasses sites and current offers from some.
Because of your post, I've just realised that we probably didn't move to the US (when I was 12) for this reason and that now I probably wouldn't be able to get health insurance either. Such a huge, wealthy, powerful country should really be ashamed that it can't even take care of all of its own citizens. I don't know if you know about the history of the NHS (in the UK), but I think the US needs somethig like it. I don't mean they should use the same type of health care system, but that there should be the same sweeping change. Some of the adverts for the NHS from the 1940's are online and they properly convey what I'm talking about. (Here's the link: http://www.nationalarchives.gov.uk/films/1945to1951/filmpage_cyvgh.htm )There were many detractors from the idea (the system was very much like it is now in the US) at the time, including the medical establishment, but they pressed on anyway and even though it is probably one of the most complained about establishments, I doubt anyone would want to see it go.
To me it just makes sense that you would want your citizens to be healthy.
I'm in the same boat as you except I have Rheumatoid Arthritis. I lost my health care when I turned 19 and I'm almost 20 now. It sure is a scary thing to go through. Hopefully us Americans will pass a health care bill soon that includes a public option. I hope you can figure out what's up with your stomach and deal with the anemia.
AMEN!!!! It is scary. My sister in law and brother face that now. Neither are working and they have a daughter with severe medical issues. She has coverage and they don't. THey can't pay to go to the doctor because neither is working. My brother owns his own biz but when the weather is bad or the economy is bad he doesn't get jobs. It's sad to see them like this.I wish there was something I could do.
Wow-the stories. We have something to be hopeful about now, even though 4 years is a long time to wait. Given your reaction to Sicko, take a minute and head to michaelmoore.com and read his open letter to Republicans.
I was in a car accident 8 years ago. My husband is a school teacher and we had insurance through his work. My medical bills were high enough that I was going to hit the life time maximum within a year of the accident. Luckily the system switched carriers and I started all over again. I was very lucky.
One of the things we figured out was that given our premiums and what the school system pays in premiums even my very large medical bills don't make a dent in the money made by the insurance company. What a stacked deck!
I am a huge Michael Moore fan and I now can't stop repeating his comment. No one should ever be allowed to ask the question "How much can we make by making this poor bastard suffer."
Hope the gluten advice is making you feel better.
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