It had been two hours, but I still felt weak from the burden.
I couldn’t speak about it. So instead, I tried to listen.
I listened as James, my husband, shared thoughts of playing music again. He spoke of possible venues, putting a band together and living a life with joy after being given a second chance.
As much as I tried to focus on his words, my mind was stuck.
“How is this fair?”
How can you be lucky to be alive from an unpredictable, unexplainable catastrophic illness, but unlucky to become the latest debtor in a broken health care system. How is this a system any of us can stand behind?
I couldn’t tell him what I had found in the day’s mail. Not that night.
Compiling the Cost
It had been over three months since James returned home. He was hospitalized for six weeks and endured several brain surgeries after bacteria mysteriously entered his brain and formed five abscesses.
During these months of recovery and rebuilding, I would grow accustomed to a new routine.
I’d flip through the mail and open up medical bills that ranged between $20-$1500 after insurance. I’d glance, sigh and throw them on top of the stack barely contained in a file folder.
At last count: 46 bills, totaling $31,841 after paying over $16,000 in health insurance premiums last year.
But this envelope, on this day, was different.
It was for $142,099.
It was for 10 days in November. It was for our first 10 days on an insurance plan acquired on the ACA’s Health Insurance Marketplace. At the time, there was only one plan offered in Arizona.
Insurance rejected the claim for using a non-contracted hospital.
An Unthinkable Choice
Did I have a choice? I suppose.
I suppose at the end of October, when our old plan expired and with an external drain implanted in his brain, I could have moved James away from the surgeon he needed. The one with the experience to create an artificial hole between the ventricles in his brain. He had that, his 6th surgery, on November 5, 2018.
He had been moved from two other hospitals to this one for a reason. The others didn’t have the capability to handle his case.
As a wife, the only decision I had was to risk his life or take a financial gamble.
No one should ever be put in that position. Ever.
Yes, Even with Insurance
The ACA saved our family. Pre-existing coverage saved our family. We have insurance for our kids and for my husband’s follow up care.
But in the over 15 years since I shuffled through bills from my father’s battle with cancer, not enough has been done.
The system has far too many gaps, and it often still results in a “you get what you pay for” capitalistic result to health care.
It is a system that puts the burden on families who are dealing with high levels of emotional stress. It is a system that neglects a changing economy, where self-employment is on the rise, but individuals lack a safety net for loss of work due to illness.
And as I write this, I also know my story — this story — is not unique. It is almost the norm.
And that is the problem.
Most American families facing a high-price tag, struggling with the stress of medical debt or even filing bankruptcy have “good” insurance. In fact, data shows that of those filing for bankruptcy, one in four people had their insurance claims denied.
There are also the surprise out-of-network charges so many face. For us, it was four ambulance trips ordered by doctors to transfer James between hospitals. All were considered out-of-network even with our private insurance. Add in the cost of prescription medications in this country, and debts quickly snowball into a financial burden nobody should have to bear.
A Grateful Fight
As the days passed, I finally found the strength to tell James about the bill. I rattled on for nearly 30 minutes about what we do next, the options, the appeal process, etc.
I had been processing for days. He had just begun.
“I just know I am grateful to be here,” he finally said.
And with that, we called it a night.
The price tag on his life can’t dampen our appreciation for living. We won’t let it. Instead, we’ll move forward with renewed purpose.
*We are appealing that super-sized bill, working on payment plans for the rest and we are forever grateful to every medical professional that worked on James’ case.