[manasecret]

"Health Care Stories for America"

Megan
Altadena, CA
Blue Shield of California is denying me life-saving and life-prolonging treatments. I am 36 years old and have Blue Shield HMO health insurance coverage through my employer. In January 2009, I was diagnosed with metastatic (stage 4) breast cancer. When discovered, it had already spread to my bones, lungs, liver, and brain. My doctors prescribed a medication that targets and removes the cancer throughout the body like a "smart bomb"; however Blue Shield of California denied coverage of my doctors' recommended treatment. Blue Shield also denied a radiation procedure that would target and remove the two lesions in my brain. In both cases, Blue Shield denied the original requests and subsequent appeals I filed on the grounds that the treatments are not a medical necessity. I have learned that insurance companies will use "medical necessity" as an excuse to not cover treatment when it appears that the patient is "too sick" (read: not worth it). I am paying out-of-pocket for these life-saving and life-prolonging treatments, and intend to file an appeal to the State Dept. of Managed Care. A Seattle journalist who runs the website www.assertivepatient.com posted this article on my situation: http://www.assertivepatient.com/2009...r-outrage.html My friends have started a group on Facebook called "Megan's Circle" which will provide updates on my battle with Blue Shield, and collect donations to help defer the costs of the denied treatments. Megan Jones Altadena, CA

Michael
Bham, MI
In 1993 in Alabama, my wife and I were both employed by the same employer. The employer went bankrupt. When we looked into COBRA we found it was not available, because COBRA only regulates an existing insurance contract. In bankruptcy, the contract is suspended, hence no COBRA. Because of my unique medical history, I found it impossible to buy any health insurance for myself, at any price; my solution was to enroll as a UAB student solely to be able to qualify for the student health insurance. To cover my wife and two small children, I bought a family policy that covered them, but not me--although I was the policy holder and responsible for the premiums. THE MORAL OF THE STORY: employment-linked health insurance is a very bad idea. COBRA is more expensive even when it's available, and COBRA IS NOT ALWAYS AVAILABLE! In addition, it makes no sense at all from a public health standpoint to give to insurance companies the ability to cherry-pick their liabilities by excluding pre-existing conditions. As far as I'm concerned, the insurance industry has proven itself a poor steward steward of the public interest, and it does not deserve a place at the table for reform discussions. I support HR 676, and I think it's time to confront this issue instead of letting political fiction color the discussion.

James
Phoenix, AZ
I have been an entrepreneur for 40 years. I have started several small companies providing hundreds of jobs over the years, many of which were in industries which did not typically offer employees health insurance. Often this made it impossible to offer employer paid insurance and still remain competitive. I have watched people I care about risking their financial security and health because care was unavailable and, or unaffordable. As buyers of individual health coverage, my wife and I have had to navigate the insurance company rules regarding preexisting conditions. At time we had different members of the family insured by different carriers because we could not get new affordable coverage when companies raised rates on policy groups in an attempt to drive out the sick and to cherry pick only healthy people always simply for profits. Those healthy peoplewill eventually become the ones who need care and will be "uninsurable." What an appalling word to describe a whole group of our fellow human beings who have become insurance outcastes facing not only their illness but financial ruin simply becuse they were not included in the system. I am now sixty, 5 years away from Mdicare and uninsurable. My wife is fifty eight and after paying premiums for 40 years, we can no longer afford coverage. The concept of insurance; pooling revenue to weather individual hardship, is one of the miraculous components of our communal lives. It does not work unless all of us participate, pay our way, help those who can't and recognize that taking care of each other is a moral obligation. I find it incredible that those who are leading the charge against national health insurance are often closely aligned with the religious community. How can they wail about the elimination of a clump of fetal cells but stand by idly while there fellow humans suffer.

Three of many more stories.



The health care system is broken if stories like these can happen. Health care is a basic need, and I think that there should at least be a public option that anyone can get.