Date: December 5, 2016
President-elect of the United States
725 5th Avenue
New York, NY 10022
Dear President-elect Trump:
I am writing this letter to you in regards to the Affordable Care Act (“Obamacare”) and how it has affected the lives of my fiancée, Emily, and myself. I know one of your first tasks in office is to repeal and replace Obamacare but I would like to give you some additional insight into just how bad the insurance industry in general has become and how difficult it is to get reimbursed for medical care.
In April of 2016, a week after Emily and I returned from Disney World were we began the process of planning our dream wedding, Emily was involved in a serious motor vehicle accident where the vehicle she was driving rolled over after hitting a stone wall. I will spare you the details of the long night at the emergency room but thankfully Emily was physically ok except for a few cuts and bruises. While the CT scan didn’t show any brain injury the doctors said she likely had a mild concussion based on the way she was feeling and memory loss off the accident. It wasn’t until several days to weeks later that we would understand the full effect that the concussion would have on Emily.
Emily suffers from major depression and at the time before the accident had been symptom free for over 3 years. After the accident she began having depressive episodes and suffering from severe anxiety. When treatment from her local psychiatrist stopped making progress we began looking for alternative psychiatrists with experience in treating those with traumatic brain injuries. Thankfully we were able to find someone and Emily has been receiving treatment ever since, and although the process is slow, she is making progress to getting back to where she was pre-accident.
But of course good medical treatment comes at a cost. Since the accident we have been submitting the medical bills to the auto insurance company but they are only required to pay up to $50,000 for personal injury protection which covers medical and loss of wage claims. Due to Emily being taken out of work by her doctors that leaves a small percentage left for medical bills, which a good portion was used up by the ER visit the night of the accident. To complicate matters even more, since the doctor Emily is getting treatment from is not on the auto insurance companies “approved” list we need to regularly provide additional documentation justifying her treatment. We have provided all documentation requested ad nauseam and we were still denied the claim very early on in September. With that denial we filed for arbitration and have sent them all the documentation and bills regarding the treatment Emily has been receiving. Even with that, here we are in December and we have not received any reimbursement from the auto insurance company for any of Emily’s treatments.
When the $50,000 expires from the auto insurance policy we may file a claim with Emily’s insurance provided by her place of employment. Unfortunately due to the auto insurance company dragging their feet we have not been able to do so as we do not want to commit insurance fraud by submitting multiple claims for the same services as we do not know what the auto insurance company is going to pay. In retrospect we should have just filed the original claim for treatment with Emily’s insurance company but even then it is not very good coverage. They will pay only 40% for out of network providers and that is after some ridiculous several thousand-dollar deductible.
As a state government worker I have reasonably good health coverage, paying 80% for out of network providers, so since Emily and I are getting married in April of 2017 we explored the possibility of filing for a domestic partnership so she could get on my insurance early and possibly offset some of these expenses. Of course nothing comes easy and due to requirements my agency has for domestic partnerships we do not qualify so that option is off the table until we are married.
So where does that leave Emily and I? Prior to her accident we had money saved up to put towards our dream wedding at Disney and were very excited for our future together. While we are still excited about our future, financially we are not doing as well. Because Emily has been out of work since her accident, and we have received zero reimbursement from insurance, I have been solely paying all of Emily’s medical bills up to this point. Emily’s doctor has been very generous with us knowing our situation but even with that we have depleted our savings account, now have a huge amount of debt in the form of credit cards as well as a $50k unexpected loan, and since Emily still needs treatment there is no end in sight yet. Never in my life have I imagined having this much debt; at least not for something health related, that’s why we have insurance to help and protect us from financial hardships. It has gotten to the point where we are taking our old clothes and furniture to the consignment shop for a little extra cash. Sometimes it seems like we will be paying off these bills long after Emily is better instead of enjoying our lives and building a family together. We are both fighters though and somehow we will get through this and still figure out how to have our dream wedding.
While I know Obamacare doesn’t directly affect the auto insurance claims it does play a role. First, many mental health providers have stopped taking insurance because the insurance companies don’t want to pay for treatments. There is no parity in the system. They have no problem paying for a chronic physical ailment but when it comes to mental health they essentially look the other way. Next, if Emily had better coverage through her employer we could have used that avenue instead. But since we knew the out of provider coverage was sub par we naively thought that it would be better to submit as much to the auto insurance for a more substantial reimbursement and then we would only use Emily’s health care once that coverage expired. Unfortunately it looks like we made the wrong choice. Going through Emily’s health insurance may not have yielded any better results but in reality it shouldn’t matter if the system is designed to protect those needing services.
The whole insurance industry seems broken and is essentially working against us. Something is severely wrong when two hard working, honest people, through no fault of their own, have an accident and the system doesn’t protect them. The system doesn’t seem to be designed to help the people, it’s only helping the to line the pockets of the insurance companies. I don’t know if there is some provision that could be added to your new health care plan that would benefit Emily and myself at this point but I encourage you to make sure protections are put in place to prevent other people from falling into the same hole we have.
In closing, I hope I was able to show just how broken health care is and what a real impact it can have on and individuals life. If you would like to discuss or receive more details about Emily’s and my situation I am available for contact and I have included my contact information above. I also want to thank you for taking time to read my letter and as supporters of your candidacy, Emily and I look forward to you making America great again.
***** Please keep in mind Mr. President that almost all my husbands family has served this country. My father fought and died for this country when he willingly signed up for Vietnam because he knew he was facing the draft. He was in a nursing home at the age of 38 years old and died because of MS, Cancer because he was sprayed with agent orange. Our country wanted to deprive him of an American Flag over his coffin and definitely deprived him of a honorable military funeral. *****