Coverage without the hassles
The Soeth Family, Pittsford, NY
Posted September, 20 2011 by arianne
For the Soeth family, fighting with insurance companies had become a way of life. Their oldest daughter, Pam, has suffered from epilepsy since childhood.
She had always been covered under her mom’s plan, even when she went away to college. But, after her seizures became too frequent, she was forced to leave school. That’s when the insurance problems began.
Mark, Pam’s father, recalls, “As soon as she came out of college, we had to start fighting with the insurance company. They would say, ‘well, she is over 18 so she is no longer on our insurance,’ because she is a costly enrollee – Epilepsy medicines are very expensive… ambulances cost money…hospitals cost money.”
For four years the family struggled to keep Pam from being dropped by the insurance company – which happened often and without notice. Every time this happened, they would have to repeatedly send in medical records to prove their daughter’s disability in order to get her coverage reinstated.
“We would try and get medicine and we would find out she no longer had insurance. Then we would have to fight with them [to get her coverage back]. This would take 30 to 60 days. During that time we prayed that she didn’t have a seizure. And we paid for her medicine.”
At $1,300 per month, Pam’s medicine was breaking the family budget.
When the new health care reform law was passed, Mark heard that young people could get coverage under their parent’s plans until the age of 26. This meant that the insurance company could no longer try to deny Pam’s coverage based on her age. He simply showed the insurance company the statement from the federal government, and the family no longer had to worry about Pam losing her coverage.
For Mark, the relief he felt was long-overdue.
“If you have a daughter with a life-threatening disease, and she is without insurance for a period of time…we are happy to pay for the medications. But, if we do, it means we are not able to pay for something else…and you can go through your assets pretty fast.”