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Being a woman ended her health coverage

When Gina Presson came to me for her doctor's appointment three months ago, she was thrilled to finally have health insurance. Until five years ago this hadn't been an issue, but after a divorce she was taken off her husband's policy.

Gina has a full-time job as a producer at a local TV station but is an independent contractor and has been unable to afford individual insurance. Her sister, a physician, finally encouraged her to buy a policy this April because of her increasing risk as she reached age 50. This meant that she couldn't afford her son's college tuition, or books, and she had to borrow money from family to pay her taxes on her home.

Gina came to see me after dealing with hives on her skin, which had been infrequent for years but had become persistent for the past two months. Sometimes she even has swelling on her face. I could tell that she needed to have lab testing. I sent her for testing and gave her new medicines to help control the hives. However, before she could get this done she received a letter from her insurance carrier that her medical bills related to any gynecologic issues were being denied.

This happened because she now recalls that in a regular check-up shortly after she obtained insurance, her physician saw something suspicious. He asked for an ultrasound, which was inconclusive. She had developed irregular uterine bleeding that her doctor said was normal for her age. Her physician performed a simple procedure which helped to stop the bleeding and also tested for cancer.

The results were reassuring — no evidence of malignancy. Gina had two episodes of uterine bleeding over the past three years, which were likely related to peri-menopausal hormonal changes. Her insurance company cited this as evidence of a pre-existing condition that she did not disclose. Although they had previously approved the surgery, they then denied coverage and asked her to sign a waiver admitting this was a pre-existing condition, and accepting exclusion to her policy for all gynecological procedures for two years, which she refused.

Her policy has now been terminated and she has nearly $30,000 in medical bills from her procedure in May — more than she earns in a year. She is also unable to have the lab testing done, which I feel is critical in light of her symptoms.

Since when did being a woman and being peri-menopausal become a pre-existing condition? This sort of insanity will stop on Jan. 1, 2014. The Affordable Care Act will make it illegal for a person to be denied health insurance due to a pre-existing condition, so that merely being a woman will no longer be a "pre-existing condition."

Having access to quality care is essential for a healthy nation. Our current system is a disease management system — not a health care system. Most physician organizations see the ACA as a huge step forward in creating the kind of system where doctors and patients work together to create better health. Opponents of full implementation of the ACA have little to offer in the way of solutions.

Gov. Mitt Romney is running for president on a platform of repealing the ACA. That would mean that my 5-year-old daughter with asthma could be denied insurance. That would mean that my friend with breast cancer could have her insurance policy taken away for no reason other than developing a life-threatening disease.

It would mean that my colleague with an illness treated with monthly infusions of immune globulin would meet her lifetime cap as determined by the insurance companies and would fall sick with an otherwise avoidable infection. It would mean that I will pay more for an insurance policy simply because I am a woman. It would mean that insurance companies would collect our premiums and use much of it for marketing and CEO retreats while spending the least amount possible on the care of their beneficiaries.

And mostly, it would mean that Gina, who works hard every day and already collects food stamps, would likely have to file for bankruptcy because of a medical condition. She would be unable to receive the kind of care we all deserve.

Is this the America you want to live in?

Dr. Mona V. Mangat is an allergist and immunologist in St. Petersburg at Bay Area Allergy & Asthma. She wrote this exclusively for the Tampa Bay Times.

Being a woman ended her health coverage 10/03/12 [Last modified: Wednesday, October 3, 2012 9:41pm]

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