Good Insurance, Good Care
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With regard to health insurance, I am quite fortunate. I am retired from the Air Force, and I therefore have the benefit of Tricare insurance. This is a government sponsored insurance for active duty military and dependents, and retired military and dependents. With this insurance, deductibles are reasonable, and I do not need to fight for medical care.
Last year, I was diagnosed with metastatic lung cancer. My workup included CT scans, a PET scan, MRI’s, a bone scan, and two CT guided biopsies with pathology and tumor markers as well as multiple consults with specialists. These were all very expensive, but my out of pocket expenses were very reasonable. Further, there were no long delays along the way while waiting for authorization for any tests or appointments. As my plan is a PPO, I was not restricted in which providers I could see. Ultimately, I was found to have a specific tumor marker which allowed for an oral targeted therapy instead of traditional chemo. The medication costs >$15,000/month. I pay $24/month for the medication. All of my care has been very easy. I have never had to directly contact my insurance to receive care, and the prescription process has gone very smoothly as well.
The stress associated with the diagnosis was great, and not having the additional stress of overwhelming medical bills or gaps in care related to issues with insurance was wonderful.
The Financial Burden of Chronic Disease
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This is how the cost of care impacted my ability to receive the care I needed.
I was diagnosed with rheumatoid arthritis in 2012, and my disease escalated and became difficult to control in 2016. Insurance has slowed my care and limited access to treatments and medications throughout the course as well as requiring extensive phone calls on my part to obtain care.
Getting insurance approval for new biologics that have been required since my disease progressed, takes up to a month. During this process, I am often on the phone with the insurance and physicians’ offices up to two hours a day in order to advocate for my care and get approval. Then when a new treatment is approved, insurance dictates how many treatments I must receive before a new biologic can be tried when the old one is ineffective.
Initially, I had a family health insurance policy through my husband’s small business making for high premiums and deductibles. My personal deductible was $6000 annually and 80/20 thereafter until a cap was reached. My personal health care expenses with insurance were about $12,000/ year after paying premiums.
My husband retired and went on Medicare in August 2021, after we had long met our annual maximum deductible where I should have been covered at 100%. I went on Cobra September 1. I was paying $773/month premium for myself only and I sent my first premium check September 1, which they immediately cashed. It took one month and near daily phone calls to get an insurance card. I had three physician appointments that month with no proof of insurance. Cobra could not promise they would reimburse for care or prescriptions during September. I was forced to skip some prescriptions due to cost. Then when I finally received the insurance card, I found my deductible was starting over. This took 2 ½ months to correct with numerous calls up to 2-3 hours daily, and then I was sent a new card. My health care was neglected during this period.
Insurance still did not fully pay bills for which they were obligated. It was March 2022 before I was assigned an advocate with the insurance company and most bills were paid. An outstanding bill from October 13, 2021 was finally paid July 26, 2022.
I am a conscientious person who pays my bills, so being called out at a physician’s office about outstanding bills is embarrassing. The stress involved in having a chronic painful debilitating medical condition that has not been well controlled in 6 ½ years is enough, but difficulty with insurance paying their share exponentially increases my stress which of course adversely affects my disease. Thankfully I am not working outside the home. My full-time job is advocating for my health care.
Currently, I pay $806.39/ month for insurance with a $10,000 annual deductible and 80/20 thereafter. I don’t understand how people afford health care and continue to eat and have a roof over their head.
Harm and the Restricted Network
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As a student in Texas, the insurance plan offered by my school was very expensive. Therefore, I went through the open enrollment system and purchased health care through that. For several years, I didn’t have any issues; however, in my last year living in Texas, I began to have some minor health issues that were persistent. These health issues required frequent visits to the doctor and several rounds of medication. I was able to manage this until I moved to a different state for a job.
In the two weeks prior to the start of my job, I desperately needed to see a doctor, as my health issues returned. Unfortunately, my health insurance only covered for me to see a doctor in the state of Texas and not in my new state of residence. I was going to be without my new job’s provided insurance for another six weeks.
With panic, I made an appointment through an organization that provides access to health care, and they provided me with the care I needed. Unfortunately, a few days later, I received news that I needed further treatment for a potentially more serious issue. I wanted to establish care with a doctor so that I could better manage this new issue. So, I called my new insurance for a list of potential doctors. After receiving this list, I had to call at least seven doctors before I found one who either accepted my insurance (even though their name was provided to me by my insurance company) or were taking new clients in less than 8 weeks.
Although I finally found a doctor who would see me, it was a stressful couple of weeks. Luckily, I had family to lean on during this time and the ability to advocate for myself; however, the system should not include so many roadblocks for people to access basic health care.