When Joann was 27 years old and diagnosed with a blood clot in her lung, her insurance paid her emergency room bill. Her expensive blood thinners and office visits to her medical specialists were paid for as well. Unfortunately, her birth control wasn’t.

Because Joann had a blood clot, she could not take any birth control with estrogen in it, which means that the old fashioned birth control pill was off the table for her. She did her homework and decided an IUD would be ideal, and as her doctor, I agreed. But it wasn’t covered by her insurance, so she was referred from one doctor to another. She was asked to submit piles of paperwork, which got no response.

She had been working on this process for eight months when she found out she was pregnant. Her insurance then failed her again. She was able to come to see me for a consultation at six weeks of pregnancy, but couldn’t afford to have an abortion. She and her partner spent an entire a day in the hospital’s financial office going over numbers that would never add up. In the state of California, she could drop her insurance and switch to Medicaid and the procedure would be covered, but she liked her doctor and she had good insurance. Why should she be forced to give that up?

She and her partner each worked overtime for the next four weeks to pay for her procedure, which she ultimately had at 10 weeks, and thanks to special funding, she was able to have an IUD inserted immediately afterward.

I was so proud of Joann. She faced each of these medical and financial obstacles with grace. As her doctor, I am angered that she was unable to get the care she wanted and needed. She was the model patient—she didn’t complain, she did her research, she followed instructions. At every turn, we, the health care institution, let her down. Providing her with effective, non-hormonal birth control was the best medical care for her—but she had to fight for it and ultimately lost. Ending her pregnancy was the right medical decision for her given all of her risks, and I had to delay that care for weeks because of financial reasons. When I can’t provide the best medical care because of insurance issues, I am letting my patients down.