The View From Your Sickbed

A reader writes:

Our twins are preemies - born at 34 weeks. While there were no complications, it was cold-and-flu season when we brought them home. Their health was a very precarious affair. We were under strict orders to keep them in the house, to limit visitors, to always wash hands after coming back into the house, etc. When we went to the pediatrician, she scheduled us on on a Saturday afternoon when the office was empty in order to minimize potential contact with other sick children.

At our first visit, she recommended a vaccination for a common virus. This is a virus that everybody gets, and is generally mild. With preemies, however, it can be quite severe and commonly results in hospitalization and even death. It should have been done in the NICU, but it had been missed. She scheduled us for the following week. She had to order the vax since it was quite expensive (a total of about $16K.) Two days beforehand, she notified us that our insurance company had denied the coverage as too expensive.

We then proceeded to try to get the insurance company to cover the vax. Our doctor called. The NICU doctor called. We had conference calls with them and the insurance company. We worked up the chain of command at the insurance company. We had it done and paid out of pocket. What choice did we have? Finally, we pulled in a specialist and managed to get high enough up the chain to get it approved. By this point, it had become something of a crusade for the various doctors involved. Two weeks later, my company's health insurance premiums went up 30%.

Coincidence? Who knows. But when people talk about rationing under socialized medicine, I always think, "You know, we have rationing now, it just hasn't effected you. Yet." And mine was one of those highly-vaunted "gold-plated" private health insurance policies.