This person had a very serious auto-immune disease that was in remission because of the effectiveness of a very expensive medication.  For past ten years a miracle drug (that cost $1500 to $2000 a dose) had been administered every other month and had kept this individual healthy and functional.  She was able to work at her job, maintain her family and pay her bills until one day her medical insurance suddenly determined that they would no longer pay for the life sustaining medication.  Once the drug was discontinued, her illness quickly returned.  She because deathly ill and could no longer work.  As a consequence, she lost her job and her remaining medical insurance.

Her doctors fought hard to get the medication back into her medical regimen and finally, after months of countless attempts, managed to prevail.  Unfortunately, this woman developed an adverse reaction to the medication and is no longer able to tolerate it.  Her condition remains grave.

Medical insurance that is insufficient or non-existent is one of the major causes of bankruptcy and property foreclosure in this country.  I have cared for patients who have been hospitalized because they could not afford medication or devices to assist in regulating their medical condition.  These patients did not have insurance or their insurance had a very high deductible that required them to pay out-of-pocket.  A case that especially stands out in my memory was a young father who had diabetes but could not afford to pay for the tests strips for his glucometer that helped him to monitor his blood sugar.  As a consequence, he went into a diabetic coma and had to be admitted to intensive care and eventually, to my medical surgical unit.

Over the years, I have come in contact with the owners of small businesses that did not carry medical insurance because they considered it to be too costly.  Unfortunately, some of these individual quickly discovered that surgery and hospitalization consumed virtually all of their assets and left them destitute.

Many parents of special needs children, especially children with Downs Syndrome, have been refused insurance even though their children lacked the heart complications sometimes found in that population.  Children with complex medical issues are often not insurable unless the parents work for companies or corporations that provide wide medical coverage.

The situation is dire.  Unless changes are made in this nation’s health care system, many will continue to become critically ill or die because of lack of care.  However, there are avenues that can be pursued if health care is refused by an insurance company. 

• Know your rights under your insurance plan.  Read the fine print
• Know your rights under State and Federal law.  In some states you cannot be denied medical insurance because you develop a chronic illness.
• Challenge your insurance plan by filing a claim
• Once your file a claim, keep a written record of all communications
• Continue to pursue your claim regardless of how often you are denied your rights.  Persistence pays off
• Contact your Congressmen if you feel that your rights under federal law have been violated. 
• Contact a disability lawyer if all other avenues have closed for you.

Please remember that drug companies have programs available for those who are unable to pay for their medications.  Do not feel shy about contacting them.

Finally, join a support group for your particular medical condition.  Frequently, support groups can provide information as to how to gain access to treatment options and medications where other resources have failed.