I'm Just Sayin

Benefiting from the first phase of health-care reforms

September 22, 2010|By Shanon Raghavachary

Six months ago in Washington, there was a fierce battle over health-care reform and today is the day that several major insurance changes go into effect. As a mother of a young child with hydrocephalus, a lifelong, life-threatening medical condition, all I can say is "Hallelujah!"

Here are some of the key changes that will directly affect our family:

Coverage expansion for adult dependents until age 26: We hope and pray that Josh will go to college and get a good job, just as we expect for his sister, but we know that he could have major complications and surgeries in his future, which might mean he needs to stay home with us longer.

Children no longer denied coverage for pre-existing conditions: My husband has had the same employer and insurance coverage since Josh was born, but if he had changed jobs, a new insurance carrier could have denied Josh because of his hydrocephalus.


No lifetime limits on coverage: Josh had his first brain surgery at 8 months of age and another when he was 2. He has also had countless CT and sedated MRI scans, and a couple of other hospitalizations. All of these procedures and stays are very expensive and he will likely need many more throughout his life. Now we won't have to worry that at some time he would hit a dollar cap and the insurance would stop paying for his care.

Level charges for emergency services: On occasion, Josh has gone to the emergency room for things that aren't related to his medical condition, just as any other young boy may do. For the less critical situations, we take him to the closest hospital instead of making the trip down to Childrens Hospital Los Angeles. We shouldn't have to walk into the ER and ask if they are a participating provider when our son needs immediate treatment. Now insurers can't charge more for out-of-network hospitals.

Patient-friendly appeals process: We've appealed several claims over the years for various reasons. Now while our appeal is processed, the insurance company must keep paying for subsequent treatment and other claims.

These changes are a major step forward for people like us and our son who deal with serious and chronic medical conditions — but they don't go nearly far enough.

We are among the lucky ones who have good health insurance and can afford to pay the large co-payments and deductibles involved in our son's care. That isn't the case for more and more Americans who become uninsured every day.

Why should health care be a matter of privilege and not a right?

SHARON RAGHAVACHARY is on the steering committee for Crescenta Valley Community Assn. and a member of the Family Advisory Council for Childrens Hospital Los Angeles. She may be reached at

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