Friday, October 14, 2011

Health Insurance Nightmare

By Debra Heater

Debra Heater, left, with friend
I am the mother of three girls. A year ago I had a health care and insurance nightmare. Most of my experience with health insurance has been with employer-based group insurance plans that are generally affordable and easy to use ... if nothing unusual happens. In August of 2010, I experienced an unusually painful headache, probably the worst in my life. After seeing my doctor she dispatched me immediately to the ER for further evaluation. After a cat scan and a spinal tap, I was diagnosed with viral meningitis and sent home. That evening, the ER doctor phoned and told me that another test indicated that I had bacterial meningitis, not viral. I was admitted to the ER again, hooked up to IV antibiotics and put in isolation. My entire family was treated, including my 2 and 5-year old daughters. At 11 pm my husband was in the ER with our 5 year old. My admitting physician recognized her name and treated her for meningitis immediately – spinal tap and IV antibiotics. Thankfully, she did not have meningitis and was able to return home. After three days in the hospital, I too finally made it back home .

Why am I telling you this? I spent several months explaining, appealing, arguing, researching, and obtaining records for my insurance company to review and pay our claims. Unfortunately, there is nothing unusual about this. It’s the norm. What wasn't unusual was how utterly confused and muddled the communication and paper process was between the insurance company, hospital and my multiple providers. There was zero continuity. Not only did it take me several months to recover physically, but also too, many more months to recover emotionally from the stress of dealing with tens of thousands of dollars in medical bills and hours and hours of trying to get my insurance company to pay for tests that were needed in an emergent situation..

We need transparency in coverage and most importantly – my doctors should be able to run the tests needed to diagnose and treat me and my family.

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