Guaranteed Healthcare

While working as a social worker in Illinois, I had good coverage and never encountered a problem with any claims submitted for medical services. After moving to California with my husband, who was beginning graduate school, I discovered that my previous level of coverage is not available to everyone. I first started out with coverage through my husband's university, which was minimal; no preventative care was covered.

After finding a new job, I received coverage through my employer. It was during this time that I required a stereotactic breast biopsy to investigate concerns that arose from a mammogram. Fortunately the results were in my favor and no malignancy was found. I continued to receive my yearly mammograms which were recommended due to my mother's early death at 55 of breast cancer. However, my physician also ordered additional views for each mammogram as I was considered a higher risk for a malignancy.

Approximately one year later I began graduate school and obtained health coverage through a plan offered by the university. It was then I encountered a refusal to cover my mammogram because it was considered a diagnostic test rather than just a standard screening mammogram. How ironic that this "insurance" would not pay for something that was ordered to best insure my health. I fought this for seven months with the help of the medical staff, but in the end was forced to pay for the procedure myself.

While in school, I became pregnant. My husband and I decided I would become a stay-at-home parent which led to my decision to take a leave of absence from school. This required me to find insurance independent of the university. It was then I discovered that my pregnancy would not be covered by any plan other than the Major Risk Program of California. This program required extremely high monthly premiums. After miscarrying this pregnancy, I sought coverage through a self-insurance plan, however I was denied due to the rating of my medical conditions: in vitro fertilization, which was due to advanced maternal age; a miscarriage, again due to advanced maternal age; two previous abnormal pap smears for which I was then tested for the Human Papilloma Virus (negative result) and had two subsequent normal pap results; and the microcalcifications which the breast biopsy showed to be benign. Also listed were medications that had been prescribed for asthma in the past, a condition that had since resolved and was documented as such by my physician. I appealed the denial, but the decision was upheld, thus requiring me to continue paying the outlandish premiums for the Major Risk program.

My husband and I have since moved to Missouri and, being self-employed, we are again self-insured. I found my application process here to be rigorous, having to go through an agent and writing up a detailed history of all the "conditions" that prevented me from being covered in the past. Thankfully I was accepted, but we continue to pay high premiums because of my history. We also tend to pay for minor things out of pocket, thus keeping it out of the insurance files, for fear it will come back to haunt us. I am so fortunate that my medical conditions have been minor compared to others suffering from chronic or life-threatening illness.

Knowing the problems I faced, I cannot imagine the level of stress these individuals/families endure as they navigate the insurance system, or worse, find themselves without any coverage. It is negligent of our government to allow this system to continue. Families should not be so burdened by health care expenses that they lose their homes and savings. Such stress can only exacerbate health that is already compromised. Our government needs to focus efforts on restructuring the system rather than punishing citizens for their health issues.