This Is Not Who We Are: Denying Coverage to a 4 Year-Old

Today I’m starting what will hopefully be a somewhat regular feature of the blog – “This Is Not Who We Are,” a chance for you to share some of the most preposterous situations you’ve encountered dealing with our broken system.  If you would like to be anonymous, please send me a message directly.  It’s important to remember that as much as health care is about money and entrenched interests and statistics, it’s also about individuals – in this case, a 4 year old with Type 1 Diabetes.

Type 1 diabetes is genetically determined (or, in rare cases, brought on by a virus), which is how a toddler can suddenly, through no agency of his own, be diagnosed a chronic condition that will stay with him the rest of his life.  His pancreas just doesn’t produce the insulin his body needs to break down sugars into food.  It’s treatable, but it’s also constant – there is no cure.

Because of the business practice of “pre-existing conditions,” there’s no immediate cure for his parents either, who find themselves boxed into a situation in which they can only control how much money they lose.  His mom, a reader of the blog, explains:

Because my husband and I work for small companies, we don't have insurance through work.  We were able to buy our own private insurance years ago (luckily). The downside is we chose a huge deductible plan to keep our premiums down, thinking we were a relatively healthy family based on our family history, activity level and that we’re both health care providers ourselves. Anyway, long story short - if you count our premiums and the deductible (which we hit with my son's prescriptions alone) we spend over $10,000 a year on him in medical costs. And our insurance company raises our premiums $50-60 a month every year. It adds up to practically a $700 increase every year!

I worry so much about the burden this places on him as he gets older. He basically can NEVER have a lapse in insurance coverage because he has a "pre-existing condition". (Don't even get me started on what I had to do to prove it wasn't pre-existing when he was diagnosed - at age 2 1/2!!! It was ridiculous!) It just worries me that when he gets older and has a job, changes jobs, health insurance is going to have to be his primary concern.

It’s a system that’s needlessly punitive, but also backwards.  The costs to treat type 1 diabetes may seem high, but it’s preventative medicine.  It’s also a fraction of what it would cost to treat the complications from not treating the diabetes, including heart disease, kidney disease, nerve damage, and eye damage.

Somehow, we’ve decided that it’s OK for a four year old to make all his decisions in life based not just on the disease he never asked for, but on what insurance company will even cover him and reap in the deductible.  But this is not who we are.

(Photo credit:  Manny Hernandez on Flickr.  The design is made from test strips and parts from an infusion pump.)