What Makes Them Sick?

Locals share their health care horror stories.

NAME: Caroline May
ADDRESS: Philadelphia

I have individual insurance through Independence Blue Cross/ Blue Shield, the best package available for an individual. It costs me $616.70 a month. There is only one drawback: My main health care problem is bipolar disorder, and when my claims started coming back, they said at the bottom, "lifetime maximum was reached." I called Blue Cross and it turns out that my lifetime maximum for psychiatric care is $2,500. My prescription drugs cost $600 a month. My psychiatrist visits [are] $95 for a 15-minute "med check." Why don't I switch my plan? Because the other two individual plans offer even less coverage for mental illness.

This problem is called the "parity" issue in mental-illness insurance coverage. Many states have laws (very problematic laws, but still something). If the plan offers coverage for prescriptions for medical illness, they must offer it for mental illness. This only applies (in states where it does apply [of which Pennsylvania isn't one]) to group plans, many mentally ill people work, but many also work part-time or not at all.

Universal health care would help the uninsured but it would also help the underinsured, especially if it contains parity laws regarding mental illness. Being unmedicated increases the risk of having an "episode." Having an episode causes high medical costs for hospitalization, and every time a bipolar person has an "episode," it causes the disease to get worse. A first-time psychotic episode can cause a person to act out in ways which might cause them to be arrested, but with medical attention and medication, that person would most likely go on to live a pretty normal life.

NAME: Dana Menkin, RN
ADDRESS: Germantown

My biggest frustration regarding our health care system is that there is no federal law mandating (in)fertility coverage from state to state. My partner and I have been trying for a year to conceive and thus far are unable. We have Keystone BC/BS, a supposed "big company," and they don't cover anything beyond [the oral fertility drug] Clomid. So that leaves her taking months and months of Clomid, and doing insemination after insemination without the hope of any other intervention; no injectable drugs, no IVF, nothing except "keep trying."

I am a critical care nurse on a bone-marrow-transplant floor [at a Philadelphia hospital]. I see the sickest of the sick every single day. I am constantly appalled at the things "covered" versus the things "denied." When are people going to learn that socialized medicine is only the enemy of those who are in health care for profit-making and self-interest?

National health care is absolutely the way to go. Anything less is irresponsible and ignorant on the part of legislatures and voters.

NAME: Carl Coleman
ADDRESS: Allentown

I had to get locally based AmeriHealth65 and their mental-health contractee, "Magellan." With a depression/neurosis disability, I haven't been able to get anywhere near competent mental-health care in two and a half years, and I'm one of the lucky ones! AmeriHealth65 has been giving my doctors and me an incredible run-around since January, on getting medically necessary "Protonix" medicine, originally claiming they "lost the records" proving I need it. Had my previous psychologist been allowed to continue with me, I'd probably be back to work. I have to be overtly suicidal or homicidal to get hospitalization. If I just feel "out of it" and unsafe to self and others, no dice.

NAME: Francis DiDonato
ADDRESS: Mayfair

Last fall, I was being treated with an ear infection by my primary physician. After about a week of taking antibiotics, my pain level went from uncomfortable to unbearable to the point where I was not sleeping at all, but writhing in pain all night. I ended up going to the ER at 4:30 a.m. The ER was empty and [a] doctor came in and told me I had an ear infection (which I already knew) and sent me home without addressing any concerns for the amount of pain I was experiencing.

Ironically, I had to go to my first day of hospital assignment for nursing school that very day. After school, I came home and went right to bed. I couldn't do anything but lie there in pain. Finally, my mother called my primary MD again, and he said I had to go back to the ER right away. The second time around, I was treated much better and was given painkillers which did so much to make me feel comfortable. I couldn't help but wonder why I couldn't have received that care the day before, which would have saved me an added day of pain and another trip to the ER.

Well a month later, I received the bills for my ER visits. My insurance paid $669.16, which left me responsible for $1,080 in hospital bills. Soon after this, the first doctor I saw sent me his own bill for $325, leaving my total costs at $1,405, which doesn't include prescription costs.

Needless to say, I was shocked. My visit to the ER involved no tests, X-rays or bloodwork of any kind. And my first visit involved being in the presence of a doctor for less than five minutes and not being treated for what I came to the hospital for.

I immediately contacted the hospital for an itemized bill so I could determine what could cost so much. I have yet to receive that. I also submitted written disputes for the bills, and after six months, I have not heard a response. However, I do continue to receive bills and phone calls from the hospital's third-party bill collectors in Iowa, but I refuse to pay.

I am not surprised that the insurance company did not pay my bills in total. The real bad guy here is [the] hospital. They are attempting to make a profit by charging individuals above and beyond the actual cost of care. Not only that, but it is impossible to talk to someone at the hospital involved with billing who can explain to me what costs almost $1,800.

NAME: Dawn G. Crist & Michael Harkins
ADDRESS: Center City

I am a self-employed jazz pianist/composer/arranger.Therefore, we have always used my husband's health insurance. He landed his dream job in April 2006, which is as a staff artist at Marvel Comics in NYC. He even works from home.

However, [as a lone option for employees], Marvel uses Excellus Blue Cross/Blue Shield, located in Rochester, N.Y. As lucrative and satisfying as his job has been, we still do not have health insurance. Why? I have no idea! From the very beginning of Michael's employment with Marvel, BCBS promised to send him his cards.Our address was given to them, by both Michael and Marvel's human resources. No insurance cards ever came, and they would not even disclose our numbers.Both Michael and Marvel human resources called and called, and promises were made, over and over. We finally got the Better Business Bureau to roust Excellus into finally sending our cards.The BBB representative even dealt with a higher-echelon manager, hoping to get the ball rolling.This guy would not send us our cards?!

Finally, I called the Rochester BCBS and asked about my husband's insurance numbers. The bimbo to whom I was speaking told me that they had no record of him working for Marvel or registered for their insurance plan.I hit the roof!This was also after several months of calling these people every day, almost, to no avail. It is now over a year and we still have no insurance. This makes NO sense, and we are now at a loss as to what to do. We've looked for insurance that we can pay for ourselves, but the costs are too high.This is the most idiotic thing we have ever encountered. These insurance companies are a bunch of shysters! At least we got payroll to stop taking out for insurance, but still ...

NAME: Katie L. Thompson
ADDRESS: Via E-mail

I broke my arm back in February by falling down the steps at [a local music venue] and went from having no previous debt to being about $30,000 in debt. I got whisked away from my life and job because I had no one to take care of me in Philly and ended up back in Virginia for three months at my parents' place. I had surgery in Virginia so now there's a metal rod in my arm. There's way more to it than that, but due to this weird series of events, I am now both jobless and homeless. I've been living in my car for [several] weeks now and I was almost out of money until someone loaned me some. I've filled out a shitload of paperwork but I'm tired of it now and I just can't even look at the bills anymore. I can't pay them. I'm living in my fucking car right now! I sleep in the suburbs and am on the computer every day looking for both a job and place to live, but it's hard, you know? I am determined to make it in Philadelphia, but it's seriously a really cruel place.