Medical Insurance & it’s flaws

At the beginning of this year I was told I would need a full hysterectomy due to my endometriosis. After extensive research, an entirely new diet plan, and a second opinion I realized this was not the case and there were other options. Unfortunately those options cost A LOT of money and most surgeries associated with chronic illness's aren't considered to be "essential" or "necessary". My debilitating, life shattering pain is considered to be an ELECTIVE surgery, because it's apparently a choice of how much pain a women should have to deal with!

I own an esthetics business and while there are perks to that, the one major downside is that I have to find and pay for my own health insurance. The premiums for PPO health insurance plans are incredibly high ($600-$1000) so thankfully there are options through Covered California to apply for premium tax assistance credit. This essentially lowers your premium to $400-$600 depending on the plan. I was enrolled in the 80 Gold PPO program through Blue Shield because that was the highest plan available that I could afford however this was getting expensive due to the fact that I was in a different doctors office every other week and a lot of them did not accept my insurance.

After learning I would be needing my third surgery I spent multiple 8-hour days researching every insurance plan available and figuring out which one would best suit my needs. I ended up sticking with Blue Shield due to the fact that my OBGYN (who has been helping me since the beginning with pain management) was not accepting the other plans I had looked into. I changed my plan & upgraded to the highest/most expensive plan on the market ($1040) thinking they would cover my ($30K) surgery and it would be worth it. More expensive = better coverage right? WRONG!

Because my plan was a PPO it was not accepted amongst any excision specialist. Now this is due to a flaw in the health care system. I found out that insurance companies classify excision surgery in the same category as lesser procedures meaning less money for the doctors. Excision surgery requires an extensive amount of training and there are less than 100 excision specialists worldwide. 176 million women suffer from endometriosis and there aren't even 100 doctors who can treat us. This makes them high in demand meaning they can refuse to accept insurance and charge through the roof because they know we will pay it. However where does that leave us (the patients)?

I have a very severe case of Endo and it is accompanied by PCOS (polycystic ovary syndrome) and Interstitial Cystitis. Big words. Ok so now were looking at 3 diseases that need to be treated and all have different treatment plans. Because of this my surgery also requires a Urologist, and a Nephrologist on top of the Anesthesiologist and the Endometriosis Specialist. All of these doctors need to get paid and there are also costs involved with the Hospital of choice, which of course is also out of network. Mind you I’ve already had 2 (failed) surgeries with little improvement so I can’t just go to any surgeon, I have to go to a specialist.

Something needs to change. Paying $12,480 a year on a plan that doesn't help cover the costs of a chronically ill person is just insane. Insurance works great for people who aren't chronically ill and won't be using their plan much but for the rest of us, it's pretty much a joke.