Thursday, September 3, 2009

To Health With It

I received another rejection letter from a health insurance carrier today. It reads, “Regretfully, the following applicant cannot be approved for coverage.

Applicant: Sean Bevins Reason: Autism”.

Sean has insurance now but anything associated with autism (doctor visits, therapies, medications) is not covered nor do the costs go toward our deductible. Worst of all, we don’t receive an R&C rate -- this is the reasonable and customary rate that insurance companies and doctors/clinics/ hospitals negotiate and put into contracts. This rate is substantially lower than the published rates at physicians’ offices and hospitals. So if a doctor visit costs $225 (and Sean’s visits do) we pay $225. If his autism was covered we would have an R&C rate, and we would pay that rate. Add to that, the $225 does not go toward our family deductible which is quite high. Each month we pay a premium and very little is covered. Our out-of-pocket costs and uncoverable expenses can be staggering. Speech therapy and occupational therapy (not covered) can run as much as $125 an hour. But for a child who struggles to communicate and/or has fine motor impairments these therapies are necessary.

It is strange to me to think we live in a country that allows insurance companies to discriminate against people, particularly children. My son didn’t elect to have autism. It is to no fault of his that he has this. It’s a difficult and trying neurological disorder that not only exhausts us physically and mentally but also financially. And yet it’s perfectly legal for him to be denied coverage because he is autistic. Clearly, we wouldn’t deny somebody coverage due to their gender, race or religion, but it’s acceptable to deny them due to a disability.

The next step is to apply for a state plan that pools together high risk candidates. This will most likely be very expensive and have a high deductible but at least he might have basic coverage for autism. We are keeping are fingers crossed that he will qualify.

It’s interesting to me to hear and read about the current healthcare debate. The people opposing it don’t want government in their healthcare. They say this loudly and with such certainty. And yet I am completely baffled by the irony. Currently, there are nearly 40 million people in this country who have health insurance through Medicare (a government run plan). The nearly 40 million people covered under this government plan are mostly those who are 65 and older. I am glad that I live in a country that takes care of it’s aging population. However, I would like to see more of an effort to reach out to everyone, at the very least the underprivileged and/or disabled and I cannot fathom why this is such a contentious debate.

Also, the idea of a public option is exactly as it sounds, an option. If someone doesn’t desire it he/she doesn’t have to choose it. But for those of us who don’t have options, a plan that doesn’t exclude somebody due to a pre-existing condition -- in our case, our son’s autism, might be an option for us to consider purchasing. Also, it could extend options to those who have no health care benefits through their employers or are self-employed. As health insurance costs rise, less employers are able to offer affordable and inclusive healthcare benefits.

I know many families that cannot provide proven therapies for their disabled children because insurance companies deny them coverage or exhaust them in the fight. For some of these diseases, disorders and illnesses valuable time is ticking away and the window is closing for their children’s success and well-being.

We live in a country that really has taken the care out of healthcare. There is little money to be made in preventive care -- my current policy not only denies coverage for Sean’s autism but it also doesn’t cover immunizations, breast exams or pap smears. It’s much more lucrative to treat cancer than it is to conduct physicals and well-being check-ups. I don’t think that bodes well for a civilized country. I understand that financial costs need to be weighed but at what price do we write off children, particularly those who face adversity in their young lives everyday.

Sometimes it‘s important to tune out the noise and the scare tactics. Let us not forget how critical the art of listening really is. Most times it’s the calmer, more rationale voice that makes the most sense. Take out the my and the me and replace it with the us and the we. Life is not an individual sport -- it’s a team effort.


Linda V said...

Well said!

Jen said...

Hi Katie,

It was so good to see Bob & Sean over the weekend. We were talking a bit about the health care debate, and Bob told us about your blog, which is really great! I'm passing it along to my dad. He blogs too (, about various subjects, lately about health care. I think he'll be interested in your story / your blog. Thanks for sharing!

Jen Miles.

Katie Donohue Bevins said...

Hi Jen, You and Dave are very generous and kind to offer up the beach house to Sean and Bob. They had a great time with you and your family. Thanks for reading the blog. I will definitely check out your Dad's blog -- especially on the topic of healthcare reform!! Best, Katie