Health Insurance No Cure-All

* My wife and I were rudely awaken from our blissful beliefs about health insurance when the child she was carrying--our first--began growing abnormally large. My mother suspected twins; all of our friends suspected twins; I suspected twins, but each time my wife confronted her obstetrician, she was accused of overeating.

When I asked about a mid-term sonogram, the doctor told me to forget it since our insurance plan--a self-funded plan through St. John’s Regional Medical Center, where my wife is a critical-care RN--would certainly not pay for a third sonogram.

Twins were discovered but not until my wife’s water had burst just six months into the pregnancy. Through the heroic efforts of the staff at Ventura County Medical Center, she was kept pregnant an additional three weeks, which gave the twins an excellent chance for survival. Our twin boys, now almost 9 months old, are perfectly healthy.

Our insurance plan, however, was pronounced “dead on arrival” as soon as the hospitalization began, since the low-cost Preferred Provider Organization (PPO) to which St. John’s contracts out its employee health benefits does not provide for neonatal intensive care anywhere in the county.

Since then, our financial future has been in the hands of costly physicians, jargon-wielding claims representatives, case managers, utilization reviewers, insurance billers and the personnel administrators at St. John’s. At times, we have been promised higher rates of reimbursement and reductions in charges, only to find new bills and unexpected payments.

We are now coming to grips with the fact that we may never live to see home ownership, college for our kids, a secure retirement--in short, the American Dream. And we had insurance.

JEREMY BAGOTT

Oxnard

The Ventura County Edition of The Times welcomes the views of readers. Letters should be as brief as possible and are subject to condensation. They must include signature, valid mailing address and telephone number. Pseudonyms and initials will not be used. Send letters to: Ventura County Editor, Los Angeles Times, 5200 Valentine Road, Suite 140, Ventura 93003.