Peer-managed health insurance provides advantages

Veterinarians make hundreds of decisions every day—care decisions for patients, business decisions for the practice, and personal decisions about career, insurance, and financial planning. Health insurance—how much, what kind, and where to buy it—is a decision that is generally made at the start of a career, and then often re-evaluated each year at renewal time. Making informed decisions can offer peace of mind for healthy individuals; it can mean much more when a serious accident or illness happens.

Dr. Janet Nesbitt of Miami has experienced the fortunate consequences of making informed decisions about health insurance. She and her husband, Dr. Jim Block, have learned that having a good plan is only part of the equation; having an ally in your insurance plan provider and an agent who is responsive to your needs is also a key component.

Dr. Block has carried insurance through the AVMA Group Health and Life Insurance Trust since he was a veterinary student. Dr. Nesbitt purchased insurance right out of veterinary college.

In September 2002, Dr. Nesbitt entered South Miami Hospital with a sudden onset of Guillain-Barré syndrome. In this autoimmune disorder, the body's immune system attacks part of the peripheral nervous system and starts to destroy the myelin sheath that surrounds the axons of many peripheral nerves, or even the axons themselves. The syndrome is rare, affecting about one person in 100,000. Although the cause is unclear, Guillain-Barré syndrome usually follows a respiratory or gastrointestinal viral infection. Some cases have been triggered by surgery or a vaccination.

After the clinical manifestations of the syndrome, symptoms can progress over the course of hours, days, or weeks. Dr. Nesbitt's condition progressed rapidly, paralysis overtaking her body. Even her eyes were paralyzed open.

The seriousness of her illness was immediately apparent. Her condition was so grave it taxed the capabilities of the nurses in the intensive care unit.

"I was so much work to care for," Dr. Nesbitt recalled. "I couldn't lift a hand. I couldn't lift my head. I couldn't turn over."

Her husband stayed beside her and kept a log. Twenty-seven doctors cared for her as she was beset by a multitude of symptoms in those first critical days. Dr. Block realized how serious the situation was and made a decision he felt vital to his wife's recovery.

"From day two in the hospital, I hired a private-duty nurse," Dr. Block said. "The ICU nurses weren't able to provide enough care."

Dr. Nesbitt spent 101 days in the hospital, including five weeks in the ICU. Her arduous rehabilitation has continued for four years.

"My immediate concern was that we would run out of days of rehab, or that we would exceed our lifetime limit of $2 million," Dr. Block recalled. "I was worried that we would exhaust our coverage. I could see it coming if things did not progress."

The cost of private nursing for Dr. Nesbitt exceeded $40,000 overall. Her decision to purchase health insurance through the AVMA GHLIT following graduation from veterinary college proved to be a wise one. Dr. Block contacted the Trust directly to discuss the coverage.

"I called the Trust," Dr. Block said. "They agreed private-duty nursing was a medically necessary expense and covered the entire expense."

Having a responsive AVMA GHLIT agent, David Smith, also helped ease their minds.

"Jim would come in, and we'd talk for an hour," Smith remembered. "My job was mostly to comfort—it wasn't that I did anything really special."

"He stayed abreast of the situation and counseled us," Dr. Block said. "When needed, he was always available."

While Smith may describe his service to his clients as not that far out of the ordinary, all involved agree that the Trust is extraordinary. Every member of the GHLIT Board of Trustees is a veterinarian and an AVMA member. When an insured encounters extenuating circumstances, having a peer as an advocate is a valuable asset.

"The AVMA GHLIT is very good," Smith said. "You have the ability to go back to the board. Other plans are good, if you're healthy. If you get really sick, you're going to want to have the AVMA GHLIT coverage."

"I've always found that most providers welcome GHLIT insurance," Dr. Nesbitt said. "I hear about friends with other insurance who can't go to the doctor they want or have to get an approval to see a specialist. I never think twice about seeing the specialist I want."

With the lifetime limits for AVMA GHLIT health insurance increased to $5 million for eligible medical expenses, effective Nov. 1, 2004, Dr. Nesbitt knows she has a cushion there for her continuing medical expenses. Although Dr. Nesbitt has made great progress, the effects of Guillain-Barré syndrome lingers.

"I'm too young to retire and too ill to go back to work," she said. "When you're young, you think nothing will ever happen. That's exactly when you need to be covered."

"You can count on the AVMA GHLIT health coverage," Dr. Block added. "It's the most important insurance one can have."

The AVMA GHLIT program is underwritten by New York Life Insurance Company (NY, NY 10010). For more information on GHLIT plans, including eligibility, rates, renewal provisions, exclusions, and limitations, or to find a GHLIT agent in a particular area, call the Trust office at (800) 621-6360.