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Week of 9.24.09

In Your State: Insured and In Trouble

Many Americans who have health insurance think they're guaranteed medical care whenever they need it, but testimonials from around the country tell a different story.

Consumers Union has collected the personal health care stories of Americans whose coverage has fallen short—in some cases with dramatic consequences.

See stories using the map or the video player below, and send in your own stories.

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Viewer Comments

Commenter: Rhonda
I have a simple solution for Sophie's predicament. Congressman Cogburn refuses to pass any legislation that would require a public option and arrogantly suggests others step up to help people like Sophie. Given he's a medical doctor, how about he show some compassion and "step up". He claims to be a Christian so how about he put his own money where his mouth is. I won't be holding my breath while we wait.

Commenter: Mark
Ideology stands in the way of healthcare reform. Conservatives and Progressives approach the issue with different philosophies. Conservatives are afraid of a complete government takeover. There is a lot to be said for the benefits of free market forces, however, the number of uninsured Americans is an outrage. Progressives are naïve to believe that government will be more efficient than the private sector; however, their goal to cover all Americans is commendable.
We need a tightly regulated private system that covers 100% of Americans.

Commenter: dogs rule
All I can say is that something has to be done now.
This country the USA. is looking like a third world
country as far as health coverage for its citizens.
In other words we do not have any, unless you are rich and I mean rich enough to pay for the 7500.00
a year coverage minimal at best. We let people die, this is called population control it is a discrace.
We are suppose to be smart enough to figure out a system that can work. Other countries can, but all we do is bicker and then bicker some more and nothing gets done, while people suffer and die.
Is this suppose to be the American way? We can take the best of other countries and make a good system.
As far as government involement, well some one should learn how to stop wasting money. Like all the fraud that goes on in Medicare for example. Let me at the helm and I will fire the lot of them and
get people that at least have half a brain.
Think about it!!!

Commenter: Elaine
It is very sad that we have become a society of me me me, and not what I can i do for my neighbor. Health insurance is not a luxury, and no one should be denied...

Commenter: Stephanie Rimbach
M Husband and I have own a business for twenty five years and responsible for our own insurance. Six years ago crisis hit. My 13 year old son son was dx with type 1 diabetes and heart disease, my husband was dx with a genetic spin disease and I became ill with an immune disorder. My son now 20 goes in for heart surgery, my husband is doing his best to hold off on this forth spine surgery and as I am antibiotic resistance I continue to have problems and surgeries to remove infections. Today we pay 1,700.00 a month for health care and an average of a 1,000.00 co pays or deductions. My Son may not be able to finish college as at the age of 23 he will no longer be allowed on his parents insurance and there is not an insurance company who would cover him. He will have try to find on f the few companies who offer insurance. My husband and I have no choice to work, but will have to give everything up at some point to apply for medicaid as our bodies may call for early retirement and cost in 5 years for health care will not be in our reach. It is the children I am afraid for. My son and others who have over come and will not have health care after 18.

Commenter: Kris
We gave up our healthcare coverage roughly 4 years ago. We have 2 children. We have no major health issues fortunately for now. We are in our late 40s. We gave ours up when our coverage over a period of 4 years went from $200.00 per month up to over $700.00 per month. With very few visits. Currently if we were to even attempt to aquire coverage, we've estimated it to be close to $1000.00 a month. For us, this would be like having 2 house payments. We have learned that it is far less expensive to go with out. In fact, after an emergency visit involving our son at the local hospital. Our bill was less than the cost of 3 months worth of healthcare premiums that we would have had to pay. The hospital even went as far as to call us to tell us if we paid our bill off by a certain date, they would in fact knock 28 percent off the bill. Which we did. We also looked at our standard medical bills before we dropped our insurance and after. We found on average the medical bills themselves were less without insurance. We realized in the end that we had been paying for blue sky, and, the insurance companies we trusted were just tacking on costs and not really covering that much. Between premiums and co-pay charges we were essentially being fleeced. We said "no more" and dropped them. We have no intent on looking for healthcare insurance in the future. The reality is, that even with healthcare insurance, a catastrophic event most likely will lead to an impossible financial burden for the average working American family. So knowing this, makes private healthcare insurance of little value to us. We as a nation can no longer support a failing system such as the one we have now. When we watched the segment tonight about the couple in Oklahoma, we understood how they felt. And we saw how the private insurance companies have failed them and others. The fact that they had to limit their income to be able to have healthcare through Medicade (a government run institution) is sad. And, something that our politicians and insurance CEOs should be held accountable for. Can you imagine what it would be like to be forced into poverty just to be able to have healthcare for your children? It is easy for politians to ignore this when they already have a socialistic medical coverage plan in place for them, paid for by "The American People". And yet, for some reason, that same medical plan that they have, isn't good enough for the American People. We shouldn't be scared. We should be outraged.


Commenter: Bill
A few years ago, my wife was diagnosed with progressive liver failure caused by hepatitus. We believe she contracted it during a previous minor surgery at a local hospital. She was hospitalized for much of the next 20 months, most of the time in intensive care. At the onset we thought we were adequately covered with an insurance policy through her employer. To our shock and amazement, we went through our life savings of 365,000 dollars in just 45 days. But that was just the tip of the ice berg. Over the next year and a half, we lost our home, my business, and most of our belongings. All I was able to salvage were some of my tools that I needed to to work and pay medical and medicene bills, and to support our two young sons. My wife's liver functions continued to deteriorate until we were advised the she would need a liver transplant. It took nine months to get an appointment for the tissue matching. The first step in the transplant procedure. We would also be required to have $ 9,000 cash to put up in advance. The day I was to take my Wife from a hospital in Houston to a hospital in Dallas for the tissue matching, she started hemmoraging internally, which had happened several times before. Only this time, even though she received 21 units of blood and they were able to stop the bleeding, two days later she slipped into a coma. Her liver and kidneys failed and she died a week later. My beloved wife and Mother of my children was dead at 46 years of age.

The lessons to be learned from this is one must find the presence of mind to ask hard questions. For example, after the fact, I learned the the insurance company drug their feet in the hope that my Wife would die thus negating their responsibility. They suceeded. We were told that the reason for the delay was due to the fact that the transplant team in Dallas was booked up. Later, I found that the insurance co. had a special deal with that particular hospital and transplant team and that there were 4 transplant teams in Houston that could have preformed the surgery provided a donor liver was found. Approximately two months after my wife's death, a famous baseball player was diagnosed as needing a liver transplant. Three weeks later, he received a new liver. His surgery was done by the same surgical team that would have done my wife's surgery. In this space, I can't begin to convey all the difficulity, heartache, and trama my family suffered as a result of this experience. But in a nutshell, THE WEALTHY HAVE FULL ACCESS TO ALL THIS WONDERFUL MEDICAL TECHNOLOGY and THE WORKING JOE BLOW, GOES BANKRUPT AND/OR DIES. After it was all said and done, my wife was dead, the insurance was maxed out, I still owed 490,000 dollars and the insurance executives went laughing all the way to the bank. Now, I find myself caring for my 87 year Mother, who has Altzheimers, supplimenting the cost of her care, still working at 64 and living on 500 dollars a month. So much for the "Golden Years".
P. S. I have no health care insurance or benefits.

Commenter: reuven weiss
I Hhave good insurance with little premium for myself, my wife and our 17 year old son. But our dental insurance is poor because its limited. We can only go to dentists listed in the policy. The dentist said he prides himself that he can do a cleaning or filling in 10 minutes. He said he makes a million dollars a year from me and my fellow union workers. But he won't pay for a dental hygienist. He does cursory work and as a result I have 3 caps and lost one tooth. He would rather do a poor cleaning so he gets more serious dental problems to bill the insurance company. I can't afford to go to a private dentist who would have a hygienist because I have limited income as a ciy worker.

Commenter: Ron
I to lost my insurance and lost my job in the process. I collect unemployment now and that just barely covers the bills well oin fact it doesnt. That means no money for healthcare. I am diabetic and cant afford to go to the doctor or pay for the test i am required to have to help me along. Its been months since i had any medication or tests. This public option doesnt pass or i cant get help will in all likely hood kill me . Jobs are tough to find and since i have diabetes im sure the insurance wont accet me because its a precondition. There is no hope here and if the republicans get their way i dont see me getting any better.

Commenter: Greg Gordon
There are many sad stories about people needing more than what their insurance is willing to pay. However, just remember this: insurance is a gambling game. You buy insurance because you gamble that you will take more out of the system than you put in. No one is forcing you to take that gamble. Gambling on health care is not a universal right. The Democrat-controlled, veto-proof Congress and White House has had a chance to remove the gamble out of health care, and yet has not passed a bill to do so.

Commenter: Dami
From New Mexico... I went to College, worked hard and saved what I could to owe my own business one day. That day arrived, now as a small business owner for the last 6 years my income has been impacted by the downward economy. My husband illnesses and my recent chronic illness has hit us hard. In the last 4 years we have purchased health insurances and found that the monthly premium was over $800.00. Additionally, when we went to the doctor the insurance denied approval. We changed companies 4 times. We need a one-payer system.... or, if we have to comprise we need a public option. To lose weight I tried not eating but get sick, I can't afford a lap band, but I am working on myself every breathing minute. I read lots of information online about how better to manage our condition, but I haven't seen a doctor in over 6 year, though I am going blind, have pain in my chest, my blood sugar is up, my thyroids problems is worse and cholesterol management probably needs medication. There are lots of other symptoms I have that worry me. I see a nurse nearby and I pay her cash. But, I can't have tests done, no x-rays, or other new testing mechanisms have been preformed. I need Obama and congress to do the right thing. Their rewards will be heavenly if they do what's right. Feel free to share my story with anyone and any entity.

Commenter: Albert
I had to change my insurance policy due to a 30% rise in premiums in one year but stayed with the same company for coverage. At the time of renewal I was told that is was the same policy and just higher deductibles. Come to find out that this plan only covers me in New Jersey. I find this out after needing emergency care while on vacation in another state. Six weeks later the insurance company is denying all claims for emergency care because I didn't travel 350 miles back to New Jersey to receive emergency care. So now I will be burdened with all the bills that should have been covered. It will cost me more for this one bill then for an entire year of premiums for my whole family. It's never about the patient, it's about the profit.

Commenter: Joe Monroe
I speak as a provider of health care; in my case, as a Physician Assistant (PA), in dermatology. I also happen to have been in health care in one capacity or another for 49 years, 31 as a PA.
Moreover, I am very aware of the state of "health care" in this country, not only as a PA, but as a Medicare patient myself.
I should also state, as will become quite obvious, that I am unabashedly pro health care reform and have been so since before Medicare was passed into law.
I remember those debates quite well, from the early to mid-sixties, when the same lies and half truths were being told about Medicare that are being repeated now. If it weren't so serious and sad,it would actually be humorous.
Let me zero in on a recent case that illustrates the need for reform. A 44 year-old woman came to see me, having just obtained coverage through Medicaid. As often comes up in our patients, the problem was a lesion which the patient had noted several month's previously, on her leg. My examination confirmed the probability that the lesion was a malignant melanoma, and so I removed it surgically and sent it in for pathologic examination which, in turn, confirmed my impression. I should also mention that the woman also had a rock-hard nodule in her groin on that same side, which almost certainly represented spread of her cancer to the local lymph node, a very grave sign.
Having made the diagnosis, I then set about to refer her to a surgeon for further care, a difficult task for Medicaid patients, since many specialists are reluctant to get involved in such cases. I finally did get her seen on an urgent basis, and that's the last I've heard of her. Her cancer will almost certainly lead to her death, since early detection is key with this disease because chemo and radiation are of almost no help.
As if all this were not sad enough, it turns out that the woman knew, or at least stronly suspected, that this was her diagnosis, but she simply had no coverage from her part-time job,making a bit too much money to qualify for Medicaid until she became unemployed.
It also happens that this woman has two grade-school age children who will have no one to care for them once she's gone.
I could give you dozens of examples of this same kind of situation from just the last year alone. In our state (Oklahoma), very few dermatologists will even see Medicaid patients, let alone in a timely manner.
This is particularly ironic since the average US dermatologist make 350K per year, up dramatically over the past 10 years, in part because many are supplementing their pratice income with "cosmetic" procedures such as botox and "fillers" like collagen enhancement of lips. If a patient calls such a dermatology office to make an appoinment to have her botox injection, she will get in within hours. If a Medicaid patient calls to be seen for a lesion, they will either be told that the practice doesn't see such patients, or that it will be months (6 months is not at all unusual)before they can be seen.
In the Dallas area, I personally know of a dermatologist who sees 100 patients before noon, none of whom are Medicaid.
This is not to denigrate my profession since there are many selfless practitioners who give freely of their time and effort. Most, however, are after the dollar and make no secret of it. Alas, this is all true of the medical profession in general.

Commenter: Sally Burnell
I have employer provided health insurance, but when my doctor recommended a preventive colorectal cancer screening, I went ahead and scheduled the appointment, until I found out that I would have to pay the entire cost of it myself, $2000. I don't have that kind of money, so I cancelled the appointment and will go without this important preventive measure. If I got colorectal cancer, my insurance would cover me, but not for preventive screenings like this. My insurance also will not pay for imaging like X-rays and MRI's, nor will it pay for diagnostic testing, so I begin to wonder why I bother to have insurance at all when it doesn't really cover the things I need. Oh, I can pay my $20 co-pay to see my doctor, but if he orders any tests to find out what's wrong with me, I'm forced to refuse because I can't pay for them. In the richest country in the world, and when I have a full time career of 26 years and employer provided health insurance, this makes no sense at all. Something's gotta give, and the sooner, the better.

Commenter: Jenn
I have been diagnosed with Multiple Sclerosis for 9 years. Multiple Sclerosis is a horrible, chronic disease that effect the central nervous system. No choice that I made in my lifestyle contributed to my having this disease. After 14 years as a well paid computer executive I am now unable to work because of the MS. My husband and I do have insurance, but this luxury costs us $14k a year. With the existence of the pre-existing condition clause my husband feels unable to change jobs to fulfill his own career goals and I live in constant fear of him losing his job and us losing our current insurance. I am begging for change in insurance model so I can stop feeling so guilty for being a huge burden on my family.

Commenter: Billi from Wisconsin
I have a masters degree and am self-employed, so my husband, daughter and I are covered under my husband's employer's health plan. He has no options to choose from -- just one plan offered. We pay $300 per month out of his paychecks for the coverage and the deductible is $7000, with 80/20 coverage after the deductible is met. That means we have to spend $10,600 of our own money each year before our insurance pays a penny. Our family income is under $50,000. So, we do not go to the doctor. And if/when one of us ever does have a serious illness or accident, we can only hope it happens at the beginning of the year, because otherwise we will be paying $14,000 of deductible split between the end of one year and the renewal of the policy in the next. Health care is not a party issue; it is not a privilege; it is not a commodity to be used for profit. It is life and death. If we can all agree that every citizen deserves a free education, why can't we all agree that we all deserve reasonable access to health care?

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