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Monday, January 25, 2010

Why we need reform

Whether it is an obsession with town halls, vote counting, or negotiations, much of the focus during this health reform debate has not been on the actual human reasons why reform is so important.

Let's get us back to reality, at least for a quick second.

Joshua Lemacks should be considered a miracle. Born with a severe heart defect, he is now a thriving six-year-old without a trace (except a scar) of his past struggles. Thanks to numerous successful surgeries, Joshua survived his ordeal.

Wait! This seems like a health care success story, right? Not quite.

Seeking the best care for their sick child, the Lemacks, who live in Virginia, decided on a surgeon in Philadelphia. And their insurer approved their choice. However, the joy they felt coming out of successful surgeries was short-lived. Not long after they returned home, they received an unexpected bill.

According to Jordan Rau of Kaiser Health News,

...what the relieved parents didn't realize was that their financial life would be drastically impaired. They ended up with $70,000 in doctors' bills that their insurer, Anthem Blue Cross and Blue Shield of Virginia, refused to pay-even though it had approved the couple's choice of surgeons. After the second surgery, they were responsible for $15,000 more. Debt collectors have been calling ever since.

The Lemacks were billed because they had to go out-of-network to save the life of their son. The House health reform bill attempts to ease the unexpected costs of out-of-network care by allowing portions of out-of-network costs to be included in an out-of-pocket cap. Furthermore, according to Jordan Rau,

...the pending legislation would require insurers to have enough specialists to ensure patients could get care within their insurers' networks.

The reform legislation represents a step in the right direction to help prevent these sorts of injustices: No one should go into debt because they or their children become sick.