Missing a good HMO:
When the HMO "went," a child
was caught between health plans

By Erin DeHart


Urinary Reflux Disease
Blue Cross Blue Shield North Carolina

When a child is sick, the most important thing is health care. What if your child was sick, and then your health care plan suddenly changed? Would you be able to afford it?

North Carolina used to offer state employees an HMO. Now the state can no longer afford it.

This means that state employees are now paying more money out of their pockets for health care. Ashley Mills, of Greenville North Carolina is a working mother of two beautiful children: Sara six and Joe eleven.

Ashley is a state employee. She is a Field Service Assistant Manager with The North Carolina Department of Health and Human Resources. Ashley is not happy with the recent changes in her insurance plan. (Ashley is married. Her husband has his own insurance plan through his place of work.)


You see, the trouble with children is that they get sick. When they get sick, it can become very, very expensive.

Ashley's six-year-old is sick. Though, no one would ever be able to tell by looking.

Sara is a beautiful little girl. She has big blue eyes, blonde hair, and all she wants for Christmas is her two front teeth. When Sara was six months old she was diagnosed with
Urinary Reflux Disease: A birth defect that affects the bladder and kidneys.

This is a disorder that will sometimes correct itself.

So for the first four years of little Sara's life she had to be tested twice a year. Ashley's current insurance policy is with
Blue Cross and Blue Shield of North Carolina. With this policy there is a $350 deductible, and after that she has to pay 20 percent of the total bill. "Trust me, twenty percent of the total bill is a lot," Ashley said, "I had the HMO when the children were born, and it picked up everything except the co-pay. I liked that much."


When Sara was five years old, her doctors decided that she was not getting any better. Sara needed an operation. So that is what she got. An expensive procedure, and of course Ashley paid 20 percent, plus 20 percent of the Hospital stay and supplies. Sara made it through the surgery just fine. "Sara was a brave little patient." Ashley said. Sara said, "It hurt a lot."

It has been a year since Sara's surgery, and she is doing well.


There are going to be more tests in March to see if the operation was a success. If not then there may have to be a second procedure. The problem here is that Sara's surgeon is no longer covered by the HMO, so Ashley's new insurance plan will pay only what they think is fair. This means that if there is a second procedure, it will cost Ashley more money out of pocket.

For the mean time, Sara is a happy well-adjusted child, though she may be a little tougher than other six year olds. Every one hopes the surgery was a success both for Sara, and her mothers pocket book.


Erin DeHart is a junior at ECU. She is 22 years old, and is a communications major. Erin wants to one day be a household name. She is very excited about journalism, and writing in general. She cannot wait to graduate, and get into the real world. Erin has had no insurance problems to date.

 Copyright ©2004 Erin DeHart
All Rights Reserved
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