After you finishing reading this diary you will see that the public option is not an option, it is a must in any health care reform bill
My beautiful daughter was born in July of 2004. Due to breast surgery that I had 5 years prior, I was rendered unable to breast feed her. I tried with everything that I had to breast feed her, but apparently my milk ducts had been severed during my surery and the baby was not getting enough milk. The doctors in the hospital noted that I was not delivering enough milk to her and suggested that she start on the formula immediately. I was heartbroken, but not surprised as I knew that it was a possibility after my surgery.
After we went home from the hospital I noticed that my baby was crying all of the time and started to develop a servere rash all over her body including her anus. The pediatrician advised me to change to a soy formula as the baby could be allergic to milk protein. I quickly did this but was upset at the increased cost, but I am not destitute and I of course wanted the best for my baby, so of course I purchased the more expensive formula. However, the problem did not ameliorate itself. She became worse as the weeks went by.
At 4 weeks, my poor daughter did not sleep at all!!!!!!. All she did was cry the most gut-wrenching cry. She began to bleed from the rectum. There was bright red blood on the diaper, her stools, everything and it was horrific. I immediately took her to a specialist.... a pediatric gastroenterologist. See, I had "great" health insurance. Hell, I was covered by United Healthcare. They would never get in the way of the health of a baby....or would they?
The pediatric gastroentorologist informed me that she had colitis and that she was not only allergic to milk protein but to soy as well. She would be unable to digest any formula on the market. However, there was a formula for her that was available only from a pharmacy-company and you could not purchase retail. This formula cost(rougly)......$115 for 3 cans. Or approximately $115 every 8 days. I wasn't bothered much by the cost at the time because I had " great" insurance. Hell, I was covered by United Healthcare. They would never get in the way of the health of a baby...or would they?
Fortunatetly, I had means. Both my husband and I are attorneys so we didn't sweat the cost too much, at first. We would simply purchase the formula and as per the insurance company we would submit the prescription from the doctor along with the receipt. Soon thereafter I received a notice denying the claim indicating that the formula was not medically necessary. Not only did her pediatrician write a letter indicating the necessity of this, her gastroenterologist indicated that it could lead to further health conditions, if she did not have this formula. I then got another letter stating that as per my policy infant formulas were the equivalent of an "ace bandage" or a cane. What?? I had "great" health insurance, I was covered by United Healthc are, they would never get in the way of the health of a baby...or would they?
This was my duaghters life. She had a whole in her colon at 4 weeks and United Health care would not pay. But, I am a lawyer. I drafted the most beautiful appeal that you could imagine. I had medicine on my side. Guess what?!! i still lost. At this point, I had spent about $1,500 on the formula. A small price to pay for your child's health, and fortunately I was blessed and had the means, but I often thought about those similarly situated who could not afford that damned formula. Not fair.
I was so upset that I finally appealed to the New York State Insurance Department and made a complaint against United Healthcare. Shortly after filing my complaint, I received a letter fromt the New York State insurance department informing that the State of New YOrk mandates that insurance companies cover this formula if there is a doctor requesting it without question. What...??? All along this had been the responsibility of the carrier and they not only got between me and my doctor, they committed a fruad and violated a statute.!!! My daughter was about 3- 4 months old at this point and the only thing that saved her was the fact that I had money.
The insurance department instructed me to resubmit my bills and receipts for payment at once. A few days later I received a rejection for payment from United Healthcare for these bills.!!!!!!!!!! Why, because I didn't use the company authorized by United healthcare for the formula..... They are so lucky that I didn't get "Brooklyn" on them. I quickly called the contact from the insurance department who was annoyed to say the least. She told me to hold the line, she called someone at UNited Healthcare, and then promptly came back to me on the line and said, you will get reimbursement in 3 days. I got the check in 3 days.
I am writing all of this to say, that my daughter was in a serious life threatening situation and all that saved her was the fact that I could pay. How many children do you think died from this. Perhaps the diagnosis is sudden death syndrome, or perhaps the parent is blamed. But her condition would have led to death or at the least a serious medical issue.
Today, my daughter Nia is a rambuctious, articulate 5 year old who fortunately remembers none of this.
There must be a public option.