Underinsured and powerless: When health insurance fails

By Lisa Owad
Jan. 19, 2010
Medill News Service

Will Wilson, 56, thought he had good health insurance. The self-employed Chicago graphic designer paid $335 per month for a MEGA Life and Health Insurance policy. “It wasn’t cheap, but I figured it covered what I thought I’d need,” Wilson said. “It would have never crossed my mind had I not had a catastrophic medical condition, because for regular doctors’ visits, it was fine.”

In May 2002, Wilson tested positive for HIV. “The minute that happened, my whole world collapsed.”

Almost immediately, Wilson found that his policy did not cover his medical costs. “About three months down the road, the labs wanted payment,” Wilson said. His insurance company had denied payment. And since his policy only covered generic brand prescriptions, which were not available for HIV treatment, the insurance company denied payment for those as well. “They kept denying everything,” Wilson said

“At first I thought, ‘Wait a second, this is all covered,’” Wilson said. “Was this explained to me? Did I miss this somewhere down the line?”

A year later, Wilson’s medical debt forced him to abandon his policy. “Why am I paying for something I’m not getting anything back for?” he said.

Phil Hildebrand, the president and CEO of MEGA Life and Health Insurance Company, said that it was hard for people to find a balance between paying too much for their monthly premium and getting enough coverage. “Getting caught in the middle is a bad place to be,” Hildebrand said.

Wilson’s story is not an uncommon one. “If you’re buying insurance on your own, you’re kind of screwed,” said Kathleen Duffy, the events and communications organizer at Chicago’s Campaign for Better Health Care, “because you don’t have the purchasing power.”

There are an estimated 25 million adults like Will Wilson who are underinsured, according to a 2008 study released by the Commonwealth Fund, an organization that works to promote better health care. The study describes the underinsured as “people who have health coverage that does not adequately protect them from high medical expenses.”

Duffy defined being underinsured as having insurance that realistically couldn’t be used, like policies with a high deductible. “Who has $10,000 sitting around?”

Wilson started charging everything to his credit card. He traveled to Canada to buy prescriptions at one-third the local cost. Eventually he was forced to take a lower-paying job so that he could qualify for public assistance. “I’m not trying to make anyone responsible for my welfare, just give me a fair chance,” he said.

See this article at the Medill News Service

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