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Between the Cracks

Between the cracks is a frightening place to be.

During the course of trying to improve our family’s financial stability, my husband and I were blind-sided by one hidden detail: We’d face $10,000 in costs to continue my husband’s serious medical treatment because we found ourselves unexpectedly without coverage for 30 days.

This was money we simply did not have. We had been prepared to foot the full bill for good health insurance, but that wasn’t even an option, thanks to the circumstances of our career transitions and my husband’s health.

I was leaving my job of 10 years to begin a satisfying new position that came with excellent health care coverage. It was a beneficial move that would offset my husband’s impending loss of insurance as his employer downsized and prepared to go out of business. We knew the end result, but we didn’t know the timing. It just so happened that his coverage ended the same month that I began my new job, leaving a gap of one month before my new coverage would begin.

With this routine employment-benefits formality before us, we knew we’d have to purchase coverage. We had hoped to buy a Cadillac COBRA plan, given the circumstances that require very expensive care. But we learned that an out-of-business employer is not obligated to offer COBRA, and our plan to continue the same level of coverage at our expense was not available.


I then checked with my previous employer, whom I had left just two weeks earlier, to weigh my options. I had none, because, at the time of my resignation, I hadn’t been enrolled in that employer’s plan. At my new job, I had already initiated my flex plan withholding so I was too late to set aside pre-tax dollars to help ease the burden.

Because of my husband’s serious pre-existing condition, we were almost certain we wouldn’t qualify for insurance anywhere, and if we did, the price would likely be out of this world. With billing statements in hand, we began to panic about the outrageous price of care and the irony of trying to improve our lives through better jobs—a situation that led to our falling through a nearly invisible crack in the health care system.

The decisions before us were scary: suspend treatment for one month, potentially jeopardizing my husband’s health and setting us back even further in the long run, or find a way to pay $10,000 for his medications, hormone injections, lab work and doctor visits. We chose the latter.

Luckily, our doctor knew of some possibilities that might help. One was to enroll in a medical study that would cover all expenses as part of the research. Unfortunately, an additional health condition made my husband ineligible to participate. The doctor also told us about our insurance company’s conversion plan, which guarantees coverage (albeit less of it, with no drug benefit). The company charges a higher premium in exchange for the forfeiture of underwriting. Though the coverage was greatly reduced, we decided to purchase this nominal safety net for my husband while I took the chance on my own health by not buying coverage for that one month. (As luck would have it, I then contracted pneumonia. A purposeful delay in diagnosis and treatment happened just as I was beginning my employer-provided coverage.)

Finally, the doctor knew of a pharmaceutical company’s program that provides free medication to those who cannot afford the treatment. We applied, slogged through the red tape, waited with wringing hands, and received word that we were accepted. That was a godsend. Today, my husband’s health is nearly perfect and we are back on track to providing everything our family needs, including health care coverage.

When we slipped through the cracks in the health care system, we were emotionally taxed at a time when we could scarcely handle any more stress in our lives. Of course, we’re grateful for the excellent care and the help we had to patch together a plan of action we could afford, but we were taken by complete surprise when we viewed the costs from deep inside the crack.

On Labor Day Costs of Care, a Boston-based nonprofit, offered $1000 prizes for the best anecdotes from doctors and patients that illustrate the importance of cost-awareness in medicine. Two months later we received 115 submissions from all over the country – New York to California, Texas to North Dakota, Alaska to Oklahoma. We feel these stories are poignant because they put a face on some of the known shortcomings of our system, but also because they unveil how commonplace and pervasive these types of stories are. To learn more about the contest and read more of our stories please visit www.CostsOfCare.org (Twitter: @CostsOfCare).

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PaoloDr. FrankieGary LampmanMD MBA Recent comment authors
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Paolo
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Paolo

A good illustration of why it makes little sense to have your health insurance (or any other basic need) dependent on your employer. Imagine how much more efficient we would all be at finding employers or finding employees if health insurance was not part of the equation.

Dr. Frankie
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Dr. Frankie

One day, we shall accept to join civilization and this madness will end.
One day…

Gary Lampman
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Gary Lampman

Why won’t theses insurers and providers endeavor in defending their position on the fault lines of Health Care Follies? Insurers know they purposely define the limitations and indescretions of HealthCare. Then providers follow suite with what ever the insurers dictate in providing Care. Providers sign contracts with the insurance companies that have non competition clauses that prevent providers from providing services with patients at a rate below the contractual agreement. Ah, but the fun part of health insurance is denial of services and passing hugh chuncks of artifically inflated pricing onto their members.Passing the buck to the unexpecting fools who… Read more »

Gary Lampman
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Gary Lampman

We can all at some time tell stories as you just described. In between coverage and no real options. If you own a home :forget Medicaid or any other temporary measures. Cobra is ridiculiously higher and often is beyond reach. Access to medical treatment is pretty much restricted without insurance. Thus most patients are stablized in the ER and sent on their way. Stabilizing a patient only means that they have masked the symptoms with drugs and nothing more. Once off the property ,they are not responsible. Believe me , i have seen a large number of poor judgement Calls… Read more »

MD MBA
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MD MBA

Sorry folks, even if you have insurance, you will get screwed by the non profits: http://www.post-gazette.com/pg/10351/1111342-28.stm