Monday, August 25, 2008

Paying For Your Life

“Aren’t you kind of young for this?” inquires the pharmacist at my local Walgreens. “It would seem that way except my mother was just diagnosed with colon cancer two months ago. So I am doing this as a precaution.” The pharmacist eyes widened, “Oh my gosh, I ‘m sorry.” “It’s ok…she is fine now thank god,” both breathing a collective sigh of relief.

My mother, a 59-year old of relative good health, underwent an endoscopy and colonoscopy to try to find out the reason she has always suffered stomachaches. Having dismissed it as something minor, both her and her doctor assumed they would just find some digestive valves not working.

Three days after the procedure, my mother phoned, asking me to come over after work. When I arrived, my father and her were sitting at the table. Composed, she explained that a tumor was removed during the colonoscopy and that the biopsy revealed it was malignant. Located near her appendix, this would require her to undergo surgery to remove a section of her large intestine, blood vessels, and lymph nodes all in the area where the tumor had been located, making sure the cancer did not spread. Cancer? Our family? Unable to hold back the tears, my sobs became uncontrollable. My mother’s once calm demeanor morphed as well.

A tense two weeks followed, but after a successful surgery and a clean biopsy, my mother was given the ‘green light.’ Now it was my turn. Although harboring my own fears of the outcome, I knew that I was doing the best for my health and if something was wrong-catching it early. My parents motto to my brother and I was that our health was most important. With that in mind, I made the arrangements.

Schedule the doctor, the hospital, pick up my ‘enjoyable’ prep-pack, and call the various billing departments to find out how much out-of –pocket I would be responsible for. Having insurance, I was floored by the $873.21 I shelled out for a 20-minute procedure. Maybe I should have had them take a kidney out while they were there so I could try to sell it to pay this medical bill. And this grand total is WITHOUT anesthesia.

When I was thirteen years old, I had a tonsillectomy, and remembered my parents’ shock at the cost of the anesthesiologist bill. With that engrained in my memory, I explained to my doctor that I do not want anesthesia for this. Understanding, it was the nurses that then urged me to ‘go-under’ when they wheeled me in. Explaining once again, it wasn’t necessary. After pressing me further, I told them flatly, “Not unless you want to pay the extra 700 dollars.” With that, silence.

Doctors, nurses, health care professionals…these are the people in our society that should be making the most money. Not actors, or sports figures, but those who choose to save lives, or at least help make lives longer and healthier. I begrudge them nothing, but there needs to be point where their efforts and the institutions they work for and with, do not cause people financial strain, and in many cases, bankruptcy.

The main reason so many people lack health insurance is because of its cost.(1) Currently 47 million Americans are without insurance(2) and increasingly, this is a problem for the middle class, not just the underemployed. Seventy-four percent of people without insurance are part of working families; sometimes they can’t afford their employer’s health plan (employee premiums have skyrocketed 74 percent since 2000) or their job doesn’t provide benefits. Michelle Jones is a single mother of two working as a case manager at a center for brain-injured adults. Grossing $36,000 a year, rent already gobbled half her take-home pay. The medical coverage that was offered with cost her over $200 per pay period and there was still a $500 deductible. Crunching the numbers, she turned down the coverage.(3)

For those looking to gain insurance, they can have doors slammed in their face because the insurance company may suspect that they will not make money off of you. Cheryl Gorham eats right; exercises regularly…can’t even remember the last time she took a sick day from work. Applying for an individual health plan, she was baffled when she was denied. “I’m young, I’m healthy, I don’t smoke,” says the 42-year old. “I never thought I’d have a problem getting insurance.” Turns out, the insurance company cited preexisting conditions, namely uterine fibroids and “infertility with consultation/treatment.” She had experienced bleeding from fibroids while on birth control pills but once she went off the Pill, the bleeding stopped. As for infertility, Cheryl had been trying to get pregnant but with no success. Her doctor sent her for a hormone test, which came back normal but the simple fact that he’d given her a referral, made Cheryl uninsurable. “I had no idea that anything you tell your doctor can wind up hurting you.” (3)

Even with the phony safety net of insurance, you can still be denied treatments and pay outrageous out-of-pocket expenses. In 1999, Sandy Flanigan was diagnosed with acute lymphocytic leukemia. Her insurance company promptly raised her monthly premiums to more than $2,000. Over the next four years, Sandy received chemotherapy and immunoglobulin treatments to boost her immune system costing $46,000. This expense does not include the doctor bills, body scans, lab charges, medicines, vitamins and special food. Sandy sold her jewelry, car and dining room set. She and her husband cashed in annuities and, as a last resort, their children’s college funds. One illness has shattered her family financially. Sandy had worked all her adult life and always carried health insurance, yet she cannot obtain the care that might keep her alive. An estimated fifty five percent of bankruptcy cases are caused at least in part by medical bills. As Sandy puts it, “you’re one diagnosis from being where I am.” (3)

Even people like my mother who had no symptoms, was lucky enough to find this tumor at the early stages, but even that ran a bill of almost $45,000. Screenings are recommended to start at age 50, but many people refuse because they cannot afford them. Deaths could be cut in half, meaning 26,000 lives a year could be saved, if all those who need screening where to receive it.(4) What costs $2000 for a pre-emptive colonoscopy could cost an insurance company tens of thousands for extended care for letting a condition develop further. Surgery, radiation, chemotherapy…for a tumor that might have been easily cured if it had only been found sooner. And why wouldn’t health insurers want their ‘customers’ to live longer and therefore, pay more premiums? Because with older age, usually concludes more health care expenses that an insurance company would have to pay out. With that, they look for excuses to deny coverage.

At 65-years old, Mary Rose Derks began scrimping together about $100 out of her grocery fund each month to pay for an insurance policy that promised to pay eventually for a room in a assisted living home. Twelve years later, after bouts of hypertension and diabetes had hospitalized her dozens of times, she reluctantly agreed it was time. Moving into Beehive Homes, she filed a claim with her insurer, Conseco. Conseco denied her claim stated that Beehive Homes was not an approved facility despite its state license and that Mrs. Derks was not sufficiently infirm, despite her early-stage dementia and the 37 pills she takes each day. More than four years has passed and she has yet to receive a penny from Conseco while her family has paid about $70,000. “The bottom line is that insurance companies make money when they don’t pay claims,” said Mary Beth Senkewicz, who resigned last year as a senior executive at the National Association of Insurance Commissioners. “They’ll do anything to avoid paying, because if they wait long enough, they know the policyholders will die.”(5)

With insurance companies having a stranglehold on our lives, we need each individual to push policymakers to enact regulation to protect Americans from financial devastation due to improper insurance and overwhelming medical bills. So far the cries have not been loud enough…in October 2007, a bill providing health insurance for 10 million children failed to override President Bush’s veto.(6) Administration officials had stated that it should be the states that make better use of the money they already have.(7) This is unacceptable and each representative that did not vote to override the bill, should have their constituents vote them out of office. Health care affects each American and there are representatives that want to help.

Visit your governor’s, senators’, and representatives’ websites to see if he or she has prioritized reforming health insurance. You can find their contact information at vote-smart.org. Call, write or send an email outlining your concerns. Also go to the National Conference of State Legislatures (ncsl.org) for up-to-date information on which states have proposed health-insurance legislation. Numerous non-profit organizations are dedicated to health-care reform such as CodeBlueNow! (codebluenow.org) and Health Care for All. The Commonwealth Fund (cmwf.org) has a quarterly online newsletter that outlines state initiatives...sign up and get informed!

How much will you pay for your life?

Sources:
(1)“Health Care as if Costs Didn’t Matter”, David Leonhardt, New York Times, June 7, 2007
(2)“Health Plan Used by U.S Is Debated as a Model”, Reed Abelson, New York Times, October 24, 2007
(3) “How Bad Does the Health-Care Crisis Have to Get”, Fran Smith, Redbook, June 2007
(4) “Cancer Patients, Lost in a Maze of Uneven Care,” Denise Grady, The New York Times, July 30, 2007
(5)“Aged, Frail and Denied Care by Their Insurers,” Charles Duhigg, The New York Times, March 26, 2007
(6)“House Fails to Override Child Health Bill Veto,” David Stout and Robert Pear, The New York Times, October 18, 2007
(7)“Child Health Care Splits White House and States”, Robert Pear, The New York Times, March 1, 2007

9 comments:

Anonymous said...

Great job Jenn. I suggest everyone see the movie Sicko by Michael Moore to see just how Americans get screwed by the big business of Healthcare. I fear getting sick and I would rather die then lose everything I own. At least my love ones will have something but bills to remember me by.

Tammy said...

I don't even want to go into the horrors of what I have to deal with - and I'm not even licensed yet. We hear so many stories of how crappy insurance companies are - denying claim after claim - hoping that the consumer will get fed up with the runaround and forget about the claim. It's horrible but true. . .

caitlynintherye said...

That piece was perfect and poignant. I lucked out with insurance when I had cancer, and lucky enough that my parents were able to field the additional costs.

Stephanie said...

This post was very well written. I'm going to lose my health insurance at the end of September, and I'm worried about it. Thanks for the information.

Anonymous said...

Hi Jen,

Excellent article. I am not sure where to start. Our health care / health insurance system is so mixed up that the best advice I could give is to do all you can to avoid it. Many have said that we don't need more health insurance we need more health. That can only be achieved naturally through the healthy lifestyle choices we make. Daily I hear how time consuming and difficult getting healthy is for the majority of people. I also see that people don't realize that HMO or PPOs really mean that your health insurance has limited care and coverage. Cut rate care means high deductibles and rejected claims and an insurance company making plenty off your health or denying your illness. It is simple an HMO is an agreement by an insurance company to cover a group of people for a set amount. Lets say you have 100 employees and your HMO agreement is for coverage at a certain rate, regardless of those employees conditions, the health insurance company has structured the plan so they make money. Health insurance is a business and in our country businesses are only concerned with making profits.

It is as frusterating for providers as it is for patients. Providers have 2 options, sign on with insurance companies and let them dictate how you care for patients or be an out of network provider and risk not having as much health insurance money coming in but have the right to help patient as you see fit. Also, many patient are weary of going to out of network providers b/c they may have to pay more. Our system sucks. Diagnosing is also tricky b/c you want to utilize a diagnosis that is valid and will be approved by the insurance company for care but not one that will limit people's future insurability.

On top of that it takes the average insurance claim 3-4 months to be paid or denied and the associated paperwork takes hours daily. For example, tonight I have over 50 notes to do from today alone and each note usually takes between 1-3 minutes after the hours we were open seeing patients.

One tip I would give everyone is not to die in our country. 1/3 of the 2.2 trillion dollars we spend on sickness care is in the last year of people's lives.

Sara said...

I wish the best for you and your family. My grandmother actually died from colon cancer a little over two years ago. Her doctor didn't associate her symptoms with that disease (she was 91 and they thought it was just old age). My father has also had to have polyps removed as well, so I know that I will need to be screened earlier rather than later...

Crowscious said...

It's shocking to read something like this. I never knew things were this bad. What about the free clinics? They don't cost anything right? I would assume they are the solution, even if there aren't many of those.

Nights_that_never_end said...

My mom was Dx with lung cancer a year ago and died a week later.

Insurance sucks ass, really it does. There are so many people out there losing jobs and can't afford it. Why does it have to be so much? It's the govorment not wanted to help because they just don't care. If they did they have enough money to help people!

Amanda said...

Wow this is a really great article -- it definitely describes our health care system right now perfectly. It's scary!