Too sick for comprehensive health insurance?
She's too sick to work full time but one woman battles full-time with her insurance company to pay for her medical bills.
NEW YORK (CNN) -- Forty-five-year-old Nancy Pessler is too sick to work full time. Instead, she has turned fighting her insurance company into a full-time job. Pessler, who lives in Cincinnati, Ohio, is one of so many Americans falling through the cracks in the health care debate.
She was diagnosed in 2003 with a rare disease known as "mixed connective tissue disease" which is combination of lupus, rheumatoid arthritis, and a few others all wrapped into one. Pessler wakes up every day feeling like she has the flu. "My immune system is in the tank," she told CNN. Because of this, she says, she's too fatigued to work full time. And that's why she finds herself in this predicament.
She's too sick to work full time, so she can't get full comprehensive health coverage from an employer. And she can't get an individual comprehensive health coverage either because of what insurance companies view as her "pre-existing condition." Pessler says she spends hours on the phone battling to get her bills paid, and she's going broke in the process. "First, you're on hold for about 20, 30 minutes. Then after you get off being on hold you get a representative ... they'll get back in touch with you or call another person or transfer you to another person ... it's quite an ordeal," says Pessler.
Pessler had COBRA, the government plan that allows former employees to continue to pay for their previous employer's insurance out of their own pocket, with the same benefits, for 18 months. Once it ran out, she says her insurance company, Anthem Insurance, only offered her a plan which didn't cover anything related to her "pre-existing condition." She says, "I feel the system has failed me ... I've paid into Social Security, Medicare, disability. It leaves me hopeless. I feel like there's no solution for my situation."
In fact, Pessler's current health insurance policy doesn't cover any of her routine doctor's visits - not even mammograms - because of her pre-existing condition. She pays close to $200 a visit when she needs to see a doctor, plus even more for medication. She showed CNN copies of some of her recent bills, including a $6,300 bill for two days at the Mayo Clinic and another $3,700 hospital evaluation. It even cost her about $400 to have a sinus infection treated.
On every insurance statement, the problem for Ms. Pessler is clear as day. It reads, "Denied, due to pre-existing condition." "It makes me angry at the insurance companies because I think they should be there to protect those of us who have health issues. It's almost borderline discrimination because they're segmenting a certain population, they're segmenting people like myself because we need the health benefits and when we need it most it's not there for us," Pessler told CNN.
Pessler says her plan only covers her for catastrophic care and even then, she still has a $5,000 deductible. What would that include? Pessler says she'd be covered if she gets cancer, or if she gets "hit by a bus."
She's preparing to sue Anthem Insurance to get the coverage she believes she's entitled to. The insurer told CNN via e-mail by the time Pessler tried to convert her COBRA coverage to her own individual coverage, which would've allowed her to continue with the same benefits, including coverage of her pre-existing condition, the deadline had already passed. Anthem say the deadline information was in Pessler's paperwork. Pessler says it was not. Also, Anthem says it suggested other coverage plans which Pessler told CNN were far more than she was already paying.
Anthem did not respond to CNN's questions about the role her "pre-existing condition" may have played in the plan she was offered. Pessler's response when asked what's wrong with the system? "It's not designed to insure those who are most (in need, those) who are ill. It's designed to protect the big companies and to protect the bottom-line profits of some of the insurance companies."
Health care has become so expensive for her that she's cut back on doctor's visits to save money and she's started cutting pills in half to save a buck. She says she's more than willing to pay for full comprehensive health coverage that would cover her disease and that she is not looking for a free ride. But until then, Pessler will continue to work odd jobs, part time, so she can work the phones from her living room full time as she fights for better health coverage.