Operation Healthcare: Saving Sophie

By Ashli Sims, The News On 6

TULSA, OK – The U.S. Senate could finalize its version of a massive health care bill this week. The House already passed its own version by a narrow margin.

All this week, The News On 6 is taking an in-depth look at some of the big issues in the health care debate and the impact on Oklahomans. 

Two words, “pre-existing condition” changed a Green Country family's life during their struggle to save Sophie.

The O'Reilly's describe their little girl, Sophie, as sweet, a little shy and stronger than any eight-year-old should have to be.

"This can happen at any time to anyone. We’re a very average family and we never saw this coming," said Natalie O'Reilly, Sophie’s mother.

Sophie was born happy and healthy, but when she was four, she started getting sick. Her parents and doctors chalked it up to her starting daycare and being around other kids for the first time.

Her parents had private insurance, but decided to shop around for a better plan. They found an insurer, but it came with a shocking setback.

“We will cover you. We're happy to have you as customers, but we will need to exclude Sophie for any pulmonary or respiratory concerns," said Natalie.

Sophie did have a few bouts of pneumonia, but neither her parents, nor her doctors had identified it as a condition, yet. 

One insurance company told them if Sophie could go one year without seeing a doctor or taking any medication for respiratory problems she could be insured. Then one morning she woke up with a cold.

"We had to keep her. We felt we had to keep her at home and keep her out of that doctor's office so there wouldn't be any kind of paper trail for the insurance company that she had been sick again," said Natalie.

Natalie says they waited until they couldn't wait anymore. She rushed Sophie to the doctor.

"Sophie started shaking she threw up and she turned blue," said Natalie. "The nurse is yelling, ‘do I call 911? Should I call an ambulance?’ And the doctor said, ‘I don't think there's time.’"

Natalie had to throw her limp four-year-old in the car and rush her to the emergency room.

"There just aren't words as a parent for the guilt and the shame of pushing that so long. We should have had her to the doctor first thing in the morning," said Natalie.

Sophie was in the hospital for a week and the hospital bills started stacking up.

"In the back of your mind, in the back of my mind I’m thinking, ‘we're going to lose our house. There is no way we can ever pay this medical bill off ever in our lifetime,’’” said Natalie.

That's when a social worker told the O'Reilly's about SoonerCare, which is Oklahoma's version of Medicaid.

“Being able to apply for SoonerCare and then hearing that we had been approved, it changed the entire course of our lives," said Natalie.

Sophie had surgery to remove part of her lung. She has visited some of the best doctors in the country, all paid for by SoonerCare.

But it comes at a price. Both Natalie and Stephen have foregone promotions and raises to make sure they can still qualify for SoonerCare.

"Think about retirement, think about how you’re gonna provide, college. What are you gonna do about all of these things? Those parts of our plans are very much on hold," said Stephen O'Reilly, Sophie’s father.

Even their own health is sacrificed for their daughter's.

"We simply can't afford to have insurance for ourselves. It’s a calculated risk and it weighs on our minds every day," said Natalie.

Sophie's mom, Natalie, says she recently got a promotion, but the bump in pay would cost them Sophie's SoonerCare. She says she called the agency to ask what she could do and they told her she'd either have to quit the job or divorce her husband.

She decided to leave the job and keep her husband.

On Tuesday, The News On 6 will tackle the issue of the uninsured and some real fears that those who have good insurance, could lose it.