I've debated telling this story for some time, but it is clear to me I need to do so now. The current HCR bill will make a huge positive difference to families like mine. But the reasons are personal.
For those who don't know, I have two sons with type-1 diabetes, a chronic disease that is life impacting and with no cure. Type-1 is not a 'lifestyle' disease. It's an autoimmune disorder. Their immune system destroyed their insulin producing cells in their pancreas and they will be forever dependent upon insulin injections, counting carbs and a shorter life-span with devastating consequences. You can watch the video in my sig line to get an idea of what their life is like.
We were fortunate enough to be insured by my employer when my oldest son was diagnosed. He nearly died because we did not know the symptoms and he was sick with the flu when his diagnosis became critical. He was in a coma for a week and we needed emergency transport from our local hospital to Boston Children's Hospital. There were two doctors on board that special ambulance ride and as we would soon find out, that ride cost more than 25 thousand dollars. My wife and I also spent that week in the hospital learning how our families life will change and what we need to do to provide the best chances for our son to live a healthy life. It was a week of learning, praying and crying, but we got through it and now we are on the other side acting as advocates for a cure for diabetes and for health care reform.
About 2 weeks after we got home, the bill came from the hospital for that ambulance ride saying the insurance didn't cover it. After I spent 40 hours on the phone between the hospital and the insurance company, both pointing fingers at the other, I learned that the ambulance ride was not an "emergency" and that our insurance did not cover rides in the ambulance that weren't emergencies. We had United Health at the time and after I hounded them as to why it was not an emergency and that we never asked for the ride, the hospital simply did it, they told us that the hospital did not file it that way. By this time I started logging every conversation with anyone at the hospital or the insurance company I talked to. 20 more hours on the phone and I learned from the Hospital's billing office that they did check the proper paper work to file it as an emergency. I took this information back to United and they again said they were looking at the form and it was not checked. Back to the Hospital, this time, I wised up. I asked the woman at the billing office if she could fax me the form and show me the codes that had to be specified for an emergency. She did and over the phone we reviewed it.
She said, "See check box 19 as emergent need?"
I said, "Yep."
She said. "It's checked, do you see that?"
I said, "Yes I do. Thank you very much."
I then called United and asked them to look up the filing for the ambulance ride. At first they hesitated but I said, "You've told me you are not allowed to contact the hospital on this issue, so if you show me what needs to be done, I will do it." They had mentioned earlier that they were not suppose to contact the hospital regarding how to file a claim. I didn't believe that then and after this phone call, I never believed a word any insurance person ever said again. So the woman at United brought up the form and I said, "Is there some code or check that needs to be made on the form for you to cover this."
She said, "Yes, there is an emergent need requirement."
I said, "What part of the form? Is there an item number?"
She said, "Yes, section 19".
I should mention at this point that this phone call was being recorded by them.
I said, "Well that's very interesting, because I have the form in front of me that the hospital sent you, and it clearly shows that the check box #19, emergent need, is clearly marked."
Several seconds of silence...
She said, "Ah, so you are correct. We'll see that the hospital gets paid. *click*"
And I never got another bill on this issue. But that took 80 hours of phone calls over a period of 2 months, meanwhile the bill was on the verge of being referred to a collection agency.
But from that point on we have lived with fear. Fear of the next bill that won't be covered. Fear that the insurance companies will wear us down on these types of billing issues. Fear now because both of my sons are now type-1. Fear that if there is ever a gap in our coverage, we will be uninsurable. I'm self employed now and I pay a very large price for our insurance, more than double what I'd pay if the House Bill was made into law. I could hire someone for what I pay the insurance company. What happens when my sons become adults and are no longer covered by my insurance but their employer doesn't offer coverage? They'll have pre-existing conditions that make them uninsurable. And let's not even mention the fact that because they have a chronic condition that requires a steady supply of drugs and equipment that would easily consume a young person's income, they would have to cut corners on their health in order to just survive. Nearly every time they get the flu, there's a good chance they may need to go to the hospital. How will they afford that without coverage?
I know the current HCR bill could be better. But for my family the bill means no longer living in fear of missing a payment, no longer living in fear of the next uncovered expense, no longer living in fear for the health of my children. If you see me get upset at posts that call the current HCR bill crap, this is why. It would radically improve our lives if it were to become law. More than 14,000 children a year are diagnosed with type-1. More than one in 500 children have it. I am fortunate enough to be able to afford a very expensive plan to minimize our costs and provide for my sons. There are many who can not. The need for reform is now. Please forgive me if I'm willing to settle for the House's Public Option. There are millions more like me who are anxious for it and willing to support it.