THE BLOG
10/17/2008 11:47 am ET Updated Nov 17, 2011

Simple and Complete Health Insurance for Everyone

The presidential election has given people the opportunity to talk about issues that matter to them. The economy and taxes are high on our list right now. But I for one hope that the discussion around health care reform continues.

In the last year, my friends and family have tackled all sorts of medical issues. Thyroid cancer. Breast cancer. They were fortunate to have health care and insurance to help them face their conditions. They pulled through.

I continually wonder about all the people in this country who don't have insurance, worry about losing their health insurance or can't get insurance because of a "pre-existing" condition. And I wonder about our compassion when we can deny the needs of so many in our communities.

Anne_H_S shared this story about autism and why health care is so important to her.

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By Anne_H_S

One of my biggest issues is health care. Did you know that in today's insurance world a child with a diagnosis of a developmental disorder such as autism can legally be denied health insurance in the State of Illinois where I live?

The same is true for many pre-existing medical conditions and this applies not only to private insurance but employer sponsored plans as well. This means that if my husband ever changes jobs my son, who has an unspecified developmental delay, can be left without health coverage for his regular well child visits and immunizations - not to mention the two sessions per week of occupational and physical therapy that insurance currently covers.

But we consider ourselves extremely fortunate when compared to my sister who, along with my brother-in-law, is self-employed. They pay for private insurance for themselves and their two young children. Because the premiums are so expensive she can only afford to carry catastrophic insurance on herself and her husband which means she does not get regular check-ups or preventative care. Next year she will turn 40 and I know she won't be able to afford mammograms, despite the fact that our grandmother died from the disease.

Even with my "fabulous" insurance, I spend a significant portion of my time dealing with the insurance company's repeated attempts to deny claims for my son's medical needs. About every six months they send a notice asking us to confirm that we have no other benefits. If we fail to return this form they stop paying for anything until they get it. It's just a convenient way to hold off on paying bills.

Last year we were slapped with $10,000 in hospital bills because our pediatrician used the wrong billing codes for my son's treatment, even after their customer service representative pre-authorized the treatment. I spent an entire year fighting this out with the insurer and the hospital, finally ending up owing nothing and receiving a check for $29.00 from the hospital. I wish they could also reimburse me for my time!

My point is that insurance should not be this complicated. Insurers should not employ more people to work on denying claims than they do people to provide helpful service. Doctors should not have to employ an army of billing clerks to deal with insurance company paperwork and some should not have to stop taking it entirely to serve only clients who can afford their service without insurance.

There has to be a better way - but I don't believe either of the candidates have a real plan to make insurance simple, affordable and accessible for all children in America. They may provide access for some who do not currently have it - which is a good start - but what I think they really need to look at is the amount of time average Americans and doctors practices in this country are spending dealing with insurance company run arounds.

And they need to make it illegal to deny coverage to children (or anyone for that matter) with pre-existing conditions who can afford to pay. That is simply wrong.

Tell us about your experiences with health care and the issues you want addressed during the election on Tokoni.