My Health-Care Story: Just Don't Get Sick

By Frank Hoerster
Woodbridge

Your insurance is fine — until you get sick.

In 2003, my wife was diagnosed with lung cancer at 53. My first experience with our health insurer was the rejection of a claim because her biopsy “was not medically necessary.” When I called the doctor’s office about this, I was told, “Don’t worry, they always reject the first claim. We will just recode it and resubmit it.”

After my wife had been on a ventilator in intensive care for about three weeks, the insurance company tried to move her into a nursing home because our policy did not cover more than 90 days of “custodial care.” The nursing home cost $9,000 a month. Since my wife never lost her fever, the nursing home could not accept her. The insurer then sent a letter to the hospital saying it would no longer pay for her ICU care because the hospital was “delaying treatment,” even though she was receiving radiation therapy. It took the threat of a lawsuit against my employer to get the company-sponsored insurance to pay my wife’s bills.

My wife finally passed away at home in terrible pain. The only solace was the great care provided by Washington Capital Hospice.