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Cover America: The plight of the uninsured... doctor

Consumer Reports News: October 03, 2008 02:32 PM

Dr. Kesani advises his patients not only on their health, but their health insurance. Get your coverage lined up before you see me for a diagnosis, he tells them. Otherwise the insurance companies will likely leverage the pre-existing condition to charge you outrageous premiums—or reject you outright.

Dr. Kesani knows this better than anyone…he has diabetes, and he's uninsured.

Running his own practice is a near-literal description of Dr. Kesani, who hustles back and forth between several hospitals in the Chicago area where he maintains offices as a kidney specialist.

He wasn't always uninsured. Dr. Kesani had a group plan at a former practice in North Dakota, where he was shocked by the diagnosis of diabetes at the age of 33.

When an opportunity arose to start his own practice in Chicago, he decided to make the move and kept his group insurance through COBRA for a year and half. When it expired he was told that in order to maintain the same policy his premiums would jump to $1700 a month—five times what he'd been paying. Then he tried to apply for an individual policy. He was flatly rejected by his health insurance company of ten years, and several others.

Dr. Kesani doesn't need to consult a(nother) physician to know how to properly manage diabetes—he maintains a healthy lifestyle, takes his medication, and gets exercise by playing soccer a few times a week. Having the professional training to keep this health issue in check is one thing, but accidents and emergencies are another thing entirely. Those are things that no one, not even a doctor, is immune to. When asked what he'd do if he got injured playing soccer, Dr. Kesani said he's already had to tough out a few knee problems. And, of course, it helps having friends in the medical field.

He's looked into other health insurance options, but so far none have been the golden ticket to coverage. Although he qualifies for the Illinois Comprehensive Health Insurance Program, the state's high-risk pool, Dr. Kesani hesitates to sign on to a policy that would set him back $450 a month with limited coverage. He's holding out to see if an insurance plan soon to be offered to doctors by the Illinois State Medical Association will come through for him, unsure if the group plans to exclude applicants—even though they're doctors—based on pre-existing conditions.

When Dr. Kesani says "health insurance companies only want to insure the healthy," it's not merely out of sympathy for those struggling to get coverage. It's empathy shaped by his own fight to obtain reasonably priced health insurance in a system of care so broken that even a doctor can't afford to be a patient.

Meagen Bohne, campaign organizer

Visit Cover America Tour to see more videos of the people we're talking to across America and to share your own health care story, and read more from our survey of Americans who can't depend on their health insurance.

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