As told by Jessica Spear, St. Louis, Missouri: Brendon is four-years-old and has cerebral palsy caused by a pre-natal stroke. He requires physical, occupational and speech therapy each week. Every year, we are faced with being under-insured. Brendon is only allotted 60 therapy visits per calendar year. Those 60 visits include all the types of therapies he needs - physical, occupational, and speech - for the entire year. Thankfully, Brendon is doing amazingly well and is progressing by leaps and bounds. However, he will require therapy and treatment throughout his development. That is pretty much indicative of cerebral palsy. We burn through the 60 therapy visits within the first five months of the year. We are left to pay out-of-pocket for the remaining therapies in excess of $15,000 per year. We requested a more inclusive policy and were denied through my husband's employer. Brendon is uninsurable based on his "pre-existing" condition. As of May 2009, my husband's employer switched to a new insurance company. I was informed that none of Brendon's therapies are covered by this particular plan. We finally got physical, occupational and speech therapy visits approved after several appeals. The reason for the denials is because our insurance policy "does not cover chronic brain injury...congenital birth defects." I was even told by a case manager that, "It's a shame that he had his stroke before he was born or he would have otherwise been covered." Insurance companies don't want to cover "habilitative" care and they claim that Brendon is receiving "habilitative" care based on the idea that he never had a baseline to "rehab" to. This is blatant control of healthcare by the insurance companies. Children with brain injuries have brains that are plastic and with early intervention can accomplish the unimaginable.

The information provided in this document is a personal account, provided by the individual, of their experience in the health insurance market.