Health Care Insurance Stories

Mine is only one of the millions of horror stories about access to medical care, even when you DO have coverage. Here is my first-hand experience with the current California/USA version of health care.

When I broke my back in a car accident in 2001, I was able to maintain health insurance for the next seven months only because my co-workers pooled their personal unused vacation time, and traded it for work time for me, so that my coverage wouldn't be dropped and I wouldn't lose my job.

Even then, the medical insurance coverage I had wasn't acceptable to any back care doctor closer than Daly City (I was living in San Jose). The plan office said it was not their job to locate a specialist for me, and that they didn't maintain a list of doctors they accepted as specialists in broken backs with spinal chord injuries. I had to make all the calls myself, while in a body cast, flat in bed.

It took me five months to find someone who would even begin to treat me under my plan. I was employed by a prominent San Jose Hospital at the time (…and they had no doctors on their staff who would accept their own hospital's medical plan to treat me). The Santa Clara County Hospital, Valley Medical Center, had doctors who would have treated me, but the medical insurance company plan I had would not have paid them or that hospital because they were not "in the plan."

I still struggle daily with excruciating back pain from the injury that healed so badly because it wasn't treated in a timely manner.

Less than a year later, I got breast cancer and had to have a double mastectomy. I had to keep working a minimum number of hours through all eleven surgeries and chemotherapy, or I would have lost my job and my coverage. The hospital's cancer surgeon that my oncologist worked with was not "in the plan.” We had to pay his fees out-of-pocket, which didn't count towards the maximum yearly "out-of-pocket" expenses (because the doctor wasn't in "the plan").

By June 2004 I was exhausted and nearly incapacitated. Beaten down by the years of struggling to stay alive, and without hope of recovering, I quit my job to focus full-time on getting well. I continued to spiral downward and have now been diagnosed with Fibromyalgia from stress and trauma. I now face little to no hope of ever having gainful employment again.

My COBRA has run out. Because of my many medical conditions, it is next to impossible to get medical coverage. When I looked for insurance companies who would cover me, they took one look at my health history, and wanted to charge me over a thousand dollars PER MONTH plus co-pays, deductibles, and exclusions for most of the conditions I have had for at least a year or forever. Even if I could work, I couldn't pay
for the insurance coverage.

When I try to explain this to my family and friends in Canada, they're just mortified and cannot believe it. They are shocked at the amount of money we have to spend on health care, that we still get incomplete coverage, and that we are tossed out of the hospitals before we're well enough to care for ourselves. It seems we only get to recover to the point that our insurance will cover before we're discharged, and not until we're really on the road to recovery.

Truly the way health care is set up here in the States is that you can get it only if you are extremely healthy, and don't really need it in the first place, or are extremely wealthy and cost is no object to you. It is time the USA steps up to the plate and joins the other developed nations who have managed to figure out how to provide compassionate, quality health care for all their citizens.

Respectfully submitted,

Lucille D. Proulx
San Jose, California

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