When illness strikes
ELGIN — Covered by the same health insurance for more than 10 years, 61-year-old Maria never had been denied coverage.
Then last year, she received a notice from her doctor.
(Jonathan Miano/Staff Photographer)
PHOTO GALLERY
• Health care examined
• About this series
• Factbox: The underinsured
• Do-it-yourself medicine
• Photos: Health care examined
As the health care debate rages in Washington, we asked for your thoughts about this controversial issue. The response was overwhelming. Hundreds of you wrote, e-mailed or went online to share your feelings. This series addresses the issues you’re most passionate about.
• Sunday: When illness strikes
Even those with insurance aren’t protected from financial and emotional disaster.
• Monday: Don’t take my money
Many taxpayers don’t trust the government to fix the problem; nor do they want to bear the burden of those uninsured.
• Tuesday: Speaking of uninsured
Those who can’t afford health insurance want more options than disability or welfare.
• Wednesday: Fire the lawyers
Some are convinced tort reform could go far in fixing our health care woes.
• Thursday: Your suggestions
So how do you really feel? We look at more of your concerns.
• 25 million adults were underinsured in 2007, a 60 percent increase from 16 million underinsured in 2003
• You are underinsured if you spend more than 10 percent of your income on out-of-pocket medical expenses
• The amount is 5 percent for low-income families
More than health care reform needed
Cherilyn Murer, president and CEO of the Joliet-based Murer Group, a health care consulting company, said in addition to passing health care reform, Congress needs to get at the root of the problem. The amount of money it costs to provide some health care services is out of whack with what is charged, she said.
"We have to have greater transparency as to what things really cost and what are people being charged," Murer said.
Insurance companies also shouldn't be allowed to play a "gotcha" game when they deny claims based on technicalities, she added.
"People are frightened," Murer said of the need for comprehensive reform. "No one should go bankrupt because of medical bills in a country as wealthy as the United States. That's an absolute."
Women-specific pre-existing conditions
A few years ago, Aurora resident Terri Jacobsen left a career in nursing and health information systems to open her own in-home health care business, Comfort Keepers of Elgin.
As Jacobsen and her husband began to apply for business health insurance, however, they were in for a nasty surprise.
"The bill was $1,500 month as a small business owner," Jacobsen said.
"I had a pre-existing condition. Can you guess? Menopause!" she said.
The National Women's Law Center reports 7 in 10 American women are uninsured or underinsured, especially African American, Hispanic and Native American women.
Often women-specific treatments and procedures are not covered, including mammograms, obstetric care and cervical exams.
"The doctor told me she could no longer do a pap test because of my insurance company," said the Elgin woman who asked that her real name not be used.
Maria's carrier made changes in her policy, requiring that all pap smears be conducted by a gynecologist. Maria's doctor told her the company made the change because its computer system is coded that way.
After more than 10 years seeing the same doctor for her routine feminine care checkups, Maria had to make an appointment with a specialist.
"Now, I'm inconvenienced," she said, "and winding up paying more for exactly the same service."
In fact, by the time Maria had her new patient visit and exam with the gynecologist, she had spent more than 10 times what she paid when her general practitioner conducted the exam.
"It cost me a lot more because I had to pay the deductible plus a percentage of the bill, and the specialist charges much more than the general practitioner," she said.
Maria said she never received notice from her insurance company that her pap smear would not be covered if she had her regular doctor perform the test. She is frustrated and feels that, at any moment, her coverage could change, and she would be powerless.
Coverage denied
Maria is not alone in her struggles with ever-changing coverage and rising out-of-pocket health-care costs.
Kevin and Michelle Oliver ran into problems when it took two years for their small son to be diagnosed with epilepsy. Even though Kevin has insurance through his job, the medical bills have consumed them and thrown their lives into financial chaos.
The Fox Valley family moved out of their Plainfield house in March and put it up for sale. Offers have come in, but all have expired while the couple waits for the bank to process the paperwork, Michelle said.
The couple missed two car payments, and Kevin's car was repossessed. The lender, looking to collect the remaining due, along with fees and penalties that more than doubled the balance, froze their checking account.
Said Michelle, "We are trying to make ends meet like a lot of Americans today but are really struggling."
Like the Olivers, many readers who responded to The Courier-News recent survey on health care found out the hard way that they were without coverage or underinsured when they needed medical treatment.
A Carpentersville reader said at one point she was denied insurance because a doctor had diagnosed her as overweight.
Mark and Jenny Scherf of Joliet reported a bill for $1,400 when a back injury sent Mark to the emergency room. The couple was covered by private insurance, but the bill won't be paid by their insurance carrier because the back problems were considered a pre-existing condition.
An estimated 25 million adults were underinsured in 2007, according to a study by the New York-based Commonwealth Fund. The number jumped 60 percent from 16 million in 2003.
The group defines people as underinsured if they spent 10 percent of more of their income (or 5 percent if they were low-income) on out-of-pocket medical expenses or if they had deductibles that equaled 5 percent or more of their income.
Underinsured rising
Maria feels there is nothing preventing her insurance company from plunging her into the world of the underinsured — a group of Americans that is rapidly increasing, according to Commonwealth Fund Vice President Sara Collins.
Collins testified recently before a House subcommittee that more and more middle-class wage earners are becoming underinsured. The most rapid growth occurred among adults in households earning between $40,000 and $60,000 annually, she said in a copy of her testimony provided by the Commonwealth Fund (www.commonwealthfund.org).
Older adults like Maria, ages 50 to 64, are the most likely to be underinsured, Collins reported. From 2003 to 2007, that number rose from 11 percent to 18 percent, a 60 percent jump.
Collins urged Congress to act on health care reform. She spoke in favor of HR 3200, a health care reform bill that includes a public option. That bill would go a long way toward reforming the individual and small-group insurance markets that feature high premiums and high administrative costs. The plan would ensure coverage for people regardless of age, health or pre-existing conditions, according to Collins.
Maria said she is trying to do her part locally to push for health-care reform.
"I promised my doctor I would talk to an elected official about how insurance companies can do whatever they want, and we're stuck because this is our basic health," she said.
Solutions
Aurora reader Terri Jacobsen (see accompanying story) hopes the solution to health-care reform will come in the form of a public option.
"As a nurse, I'm quite aware of the fact that when people don't have health (insurance), we all pay for it anyhow," said Jacobsen, who owns Comfort Keepers in Elgin, a home healthcare business. "When people don't think they're paying for other people's health care, it's like an ostrich having his head in the ground."
Jacobsen points to the charity treatment hospitals provide for patients.
"People can't provide care for nothing," she said.
Jacobsen would like to see all Americans provided with basic health care, even if it is just for prevention. She's not alone.
The Elgin Area League of Women Voters, as a group, supports universal health care. And Elgin reader Robert Hollister said he wouldn't mind paying more in taxes to cover all Americans and supports a noncitizen pay-in plan.
"I don't want taxes to be raised for taxes' sake," Jacobsen said, "but if you're raising taxes to provide a minimum level of insurance to cover flu shots, mammograms and prostate checks for guys — if we did that as a country — I think that would be fabulous."
