Four-Year-Old Boy At The End Of His Insurance Rope

Main Category: Health Insurance / Medical Insurance
Article Date: 23 Oct 2008 - 1:00 PDT

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"My son Thomas, now 4 years old, was born with severe hemophilia, and a year later developed a resistance to treatment. Basically, Thomas needs treatments that can blow through a $1 million policy in as little as a few days or as long as a year. My employer provided health insurance, but because of the claims history, the insurance company has raised the rates and implemented a $1 million cap," reports Nathan Wilkes of Littleton, Colo.

When Nathan knew his son would soon reach that cap in benefits, he and his wife researched every possible way to handle the situation, including filing for divorce so that their children might qualify for Medicaid. Eventually they found coverage for Thomas through the state of Colorado's high-risk health insurance pool, CoverColorado, but even getting to that point was not easy for the family.

"CoverColorado could only be started once Thomas capped out on the other $1 million private plan. Because the law forbids you from having dual coverage, and because you have to be filed for CoverColorado by the 15th of the month for coverage to start the next month, there is always going to be a two to six week potential gap in coverage. For my family's sake and to meet the legal requirements to qualify for the high-risk CoverColorado coverage, we had to know exactly where we stood with Thomas' bills and treatments."

"We had to work with a lot of people that were bending a lot of rules to avoid uninsured expenses, but we still ended up having over $80,000 in uncompensated care expenses because when I would try to get the most up-to-date claims summaries and status of our cap total, UnitedHealthcare delayed providing me the detail I needed in order to know exactly where we stood in relation to the $1 million cap. It felt like another example of how the system, and for-profit insurance companies, screws with people at every possible turn," Nathan added.

But even the state high-risk plan has a $1 million cap, and Nathan has to find yet another way to obtain health coverage for his son.

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Eighty-two percent of Americans think the U.S. healthcare system should be fundamentally changed or completely rebuilt (Commonwealth Fund, Aug. 7, 2008). America's nurses know that only single-payer, improved and expanded Medicare for all will fix our broken system and the tragedy of our devastated families. HR 676, by U.S. Rep John Conyers, is the most comprehensive, cost effective way to achieve guaranteed healthcare for all.

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