If you’ve been blithely ignoring the lifetime maximum benefits line in your health insurance summary, here’s a scary, cautionary tale:
What happens when your ailing son is about to exhaust a lifetime of health insurance benefits before his third birthday? Kelly Whaley came dangerously close to finding out.
Whaley, 34, and her husband Scottie, both public schoolteachers, had plenty to worry about when their son, Jackson, was born in 2008 with a cleft palate and Pierre Robin syndrome, meaning he had an underdeveloped jaw, a serious condition that makes it difficult to breathe. Jackson didn’t take a breath of air until 20 minutes after birth and suffered damage to his brain stem, which has limited his development. He spent most of his first four years of life on a ventilator under near-constant care at home in Johnson City, Tenn.
But at least Jackson had health insurance from Scottie’s job.
So they thought. The Whaleys’ Blue Cross Blue Shield of Tennessee plan included a $1 million lifetime cap on benefits. Jackson reached that limit in April 2011 and Blue Cross cut him off, two months before his third birthday.
After that, the family’s debts racked up quickly, as they continued paying for Jackson’s home-nursing care and other treatments. Things got so bad, their lawyer advised Kelly and Scottie to divorce and take separate homes so she, Jackson, and their twin baby daughters would be deemed poor enough to qualify for Medicaid.
Have you ever come close to maxing our your health insurance benefits? Tell us about it in our discussion forum!
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