Why this small-business owner with medical insurance needs health care reform

by: LiberalLucy

Mon Aug 24, 2009 at 13:42:41 PM EDT

Hi, my name's Julielyn and I'm a small business owner. I'm lucky enough to be one of the millions of middle-class people who has insurance, but I don't just want health care reform, I desperately need it.

I recently quit a good-paying job with great benefits and started my own business. It is something that I'd been thinking about doing for a while, and despite the current economic climate, I knew that my business would be successful, it was the health insurance component that I was most worried about.

When I was a teen I was diagnosed with a particularly severe case of Crohn's Disease, and in the ten years that it took me to finally get in remission, I was hospitalized over 80 times, have had over 35 surgeries.

Thankfully through my dad's job in Detroit's Auto Industry, I had pretty good insurance, but the co-pays added up. At certain points, we were paying up to 25 different doctors and hospitals a month, and that was on top of raising two other children, a mortgage and all of the other living expenses. I still have no idea how my parents managed to keep us afloat.

Nowadays, the cost of staying in remission is a hefty one. I'm on several medications, and in order to stay alive, I had to have a major portion of my digestive track removed which means I now live with an ostomy. Because of this, I will live the rest of my life needing medical supplies just to stay functioning, and believe me, it's not cheap.

The hoops I've had to jump through to buy my own insurance have been, at the very least, ridiculous. Because of Michigan law, I had to show proof that I had continuous insurance coverage for at least eighteen months, and I either exhausted Cobra through my previous employer or could prove that they did not offer it. The paper trail for just those two things alone is an exhausting and infuriating one. 

Over three months ago I initiated the process, and it's still not completed. Now that I need to order my ostomy supplies, I have to find a provider that is in-network, and I have to make sure that provider uses the right procedure and billing codes, otherwise my purchase of the supplies could be invalidated (meaning it's not covered and it's not reimbursable and definitely does not apply to my deductible).

Of course, I also have to get a prescription from one of my doctors (I have over 15) that specifically covers every single item I need, and I have to make sure that I have all of the correct order codes for those items. All of this takes a lot of time, so if I run out of supplies in the meantime, I may have to go to an out-of-network supplier and pay cash out of my own pocket that doesn't apply to my deductible and isn't reimbursable. 

If you're exhausted or feeling dizzy just reading this, then imagine what it's like to be caught in it all. 

I'm a pretty smart girl, well-educated and someone who probably has a better insight into the process and industry than most. But more than I care to admit, I am driven to the point of tears and sheer frustration because it is the most-backasswards system I've ever encountered. 

So when I think about the working poor, those that haven't had the opportunity at a good education, a strong support system, or half the resources I've been blessed with trying to fight a similar battle, I have no idea how they do it. 

Chances are you or someone in your life has dealt with a one-time or ongoing health issue, whether it be a broken limb, cancer, diabetes, a heart attack, a sinus-infection, or any other condition. If you've had insurance, then you've been lucky enough to pull out the card, get the treatment you've needed. But you've probably had a co-pay, a prescription, or some other out-of-pocket expense.

If you were really lucky, it was a manageable cost. But what if you didn't have insurance, or if you had very little insurance? If you're living paycheck to paycheck, you really are only an emergency away from losing your house, your car, or going bankrupt. 

Nowadays if you live in Michigan, you probably know someone who's unemployed. In my own family, there are only two out of the five of us with a job right now. That's not including the multitude of aunts, uncles, and cousins who are also unemployed.  What are the unemployed supposed to do when they get sick, injured, or diagnosed with a life-threatening illness?

So yes, today and every other day I'll deal with my own frustration and figure out how to get by, because I realize that despite all of it, I'm still among the lucky few. At least I have something, even if it's a system designed to fail.

But to the right-wingers, the naysayers, the supposed 'business community' (not sure what that makes me), the chambers of commerce and everyone else living in a fantasy bubble that truly believes that our country doesn't need health care reform, I invite you to wake up and enter the real world, cause it's not working for the rest of us.

As a friend recently said - "It seems as if healthy people with health insurance are the only ones that think we don't need health care reform", ain't that the truth.