Election year coming up. And a picture of who suffers when health care legislation is neglected:
Patients with no insurance twice as likely to die within 5 years
The Associated Press
ATLANTA - Uninsured cancer patients are nearly twice as likely to die within five years as those with private coverage, according to the first national study of its kind and one that sheds light on troubling health care obstacles.
People without health insurance are less likely to get recommended cancer screening tests, the study also found, confirming earlier research. And when these patients finally do get diagnosed, their cancer is likely to have spread.
The research by scientists with the American Cancer Society offers important context for the national discussion about health care reform, experts say — even though the uninsured are believed to account for just a fraction of U.S. cancer deaths. An Associated Press analysis suggests it is around 4 percent.
Those dealing with cancer and inadequate insurance weren’t surprised by the findings.
“I would just like for something to be done to help someone else, so they don’t have to go through what we went through,” said Peggy Hicks, a Florida woman whose husband died in August from colon cancer.
Edward Hicks was uninsured, and a patchwork health care system delayed him from getting chemotherapy that some argue might have extended his life.
“He was so ill. And you’re trying to get him help and you can’t, you can’t,” said his 67-year-old widow.
The new research is being published in Cancer, the cancer society’s medical journal. In an accompanying editorial, the society’s president repeated the organization’s call for action to fix holes in the health care safety net.
“The truth is that our national reluctance to face these facts is condemning thousands of people to die from cancer each year,” Dr. Elmer Huerta wrote.
Hard numbers linking insurance status and cancer deaths are scarce, in part because death certificates don’t say whether those who died were insured.
Annual cancer death tollAn Associated Press estimate — based on hospital cancer deaths in 2005 gathered by the U.S. Agency for Healthcare Research and Quality information and other data — suggests that at least 20,000 of the nation’s 560,000 annual cancer deaths are uninsured when they die. Experts said that estimate sounds reasonable.
That’s around 4 percent of the total cancer death toll. One reason is that most fatal cancers occur in people 65 or older — an age group covered by the federal Medicare program. Another is that more than 80 percent of adults under 65 have some form of coverage, including private insurance or the Medicaid program for the poor, according to various estimates.
Some are enrolled in Medicaid or other programs after diagnosis, when the condition worsens and their finances erode. But such 11th hour coverage can be too late; early detection is the key to catching many cancers before they’ve grown beyond control, experts said.
“Insurance makes a big difference in how early you are detecting disease,” said Ken Thorpe, an Emory University health policy researcher.
In the new study, researchers analyzed information from 1,500 U.S. hospitals that provide cancer care. They focused on nearly 600,000 adults under age 65 who first appeared in the database in 1999 and 2000 and who had either no insurance, private insurance or Medicaid.
Plight of uninsuredResearchers then checked records for those patients for the five years following. They found those who were uninsured were 1.6 times more likely to die in five years than those with private insurance.
More specifically, 35 percent of uninsured patients had died at the end of five years, compared with 23 percent of privately insured patients.
Earlier studies have also shown differences in cancer survival rates of the uninsured and insured, but they were limited to specific cancers and certain geographic areas.
The new findings are consistent across different racial groups. However, the fact that whites have better survival rates cannot be explained by insurance status alone, said Elizabeth Ward, the study’s lead author.
The researchers were not able to tell if the numbers were influenced by patients’ education levels, or by other illnesses.
Experts said the study also hints at problems with quality of care after diagnosis: such as whether the patient got the appropriate operation from a high-quality surgeon, whether the tumor was thoroughly evaluated by a high-quality pathologist, and whether there was access to needed chemotherapy and radiation.
Blaming quality of care “The differences that we see in outcomes after people are diagnosed, even among those with early stage disease, suggests that problems with quality of care may be an important reason,” said Dr. John Ayanian, professor of medicine and health care policy at Harvard Medical School. He didn’t participate in the cancer society study.
The study makes an even stronger statement about the role insurance plays in the timing of screenings and how that can raise the likelihood of a late-stage diagnosis, experts said.
A Kaiser Family Foundation survey last year of 930 households that dealt with cancer found that more than one in four uninsured patients delayed treatment — or decided not to get it — because of the cost.
Such was the case of Edward Hicks.
The retired laborer, had surgery for colorectal cancer in 2005 and was thought to be clear of the disease. Chemotherapy was suggested after the surgery, but he didn’t get it.
In February of this year, his wife grew worried when he lost energy and appetite. In April, he told her he felt a lump in his stomach.
Hicks, who lived in Fort Meade, Fla., couldn’t get an appointment with a specialist, but a family doctor checked him into a hospital and specialists saw him in late May. They said he was terminal but that chemotherapy might extend his life a little, his wife said.
She was able to get donated chemotherapy drugs from a pharmaceutical company, but it took time to arrange the treatments, which didn’t start until mid-June. Meanwhile, her husband’s health deteriorated. In July, after just a few treatments, he stopped the chemo, saying it was too hard. He died on Aug. 21, at age 64.
Friends and family told Peggy they believe he would have lived longer had he got chemo earlier, when he was stronger. She doesn’t agonize over that, she said, trusting in God’s will.
But the devil’s in her mailbox — she is facing a $21,000 hospital bill and other costs from his death.
© 2007 The Associated Press. All rights reserved.
URL: http://www.msnbc.msn.com/id/22332573/
© 2007 MSNBC.com
Showing posts with label Soapbox. Show all posts
Showing posts with label Soapbox. Show all posts
Thursday, December 20, 2007
Tuesday, November 20, 2007
More soapbox time
And a word to the wise ...
http://articles.moneycentral.msn.com/Banking/YourCreditRating/WhyMedicalDebtsShouldntCount.aspx?page=all
Why medical debts shouldn't count
For many, the road to ruined credit is pockmarked with medical collections, often for tiny amounts or billed in error. The truth is that medical debt rarely indicates whether a borrower is high risk.
By Liz Pulliam Weston
It's a good thing Greg Hilfman of Los Angeles has health insurance because an unpaid medical bill has sent his blood pressure soaring.
Hilfman's wife was in a hospital two years ago for pancreatitis, and Hilfman said she was treated by a "cadre" of doctors and specialists. All but one submitted bills to their insurer, Blue Cross of California, in time to get paid.
Six weeks ago, however, a woman from a neurologist's office contacted Hilfman, explaining that the office "didn't have the right address for Blue Cross" and thus hadn't submitted the bill within the one-year period required for reimbursement. She demanded that Hilfman cough up $540.
Hilfman was furious. He'd never heard of the doctor and insisted he'd seen no bill or any indication there was a problem with payment. Now he's worried he'll have to pay a bill that should have been covered by insurance or risk damage to the couple's credit reports.
"How is this fair?" he asked. "They can say anything they want (to the credit bureaus), and I have no recourse."
Tiny debts with huge impacts Hilfman is right to be concerned. The Your Money message board is littered with complaints from folks whose otherwise pristine credit was sabotaged by a medical collection. Sometimes their records were besmirched over absurdly small amounts that nonetheless had big impacts on credit scores.
Poster "sunny_light," for example, recently discovered a medical-collection account for just $7.
"I pulled my credit report last week and found out," sunny_light wrote. "I promptly paid the collections people. But now my credit score is down by like 80 points."
Medical collections are surprisingly common, at least according to a 2003 Federal Reserve study of consumer-credit reports. Nearly one in three consumers (31%) with a credit report had at least one collection account reported, and more than half of those were medical collections.
The amounts owed weren't substantial: 36.5% of the medical collections were for $100 or less, and 86% were for $500 or less.
Medical collections make up half of all collection accounts:
Collection type
% of collection accounts
Median amount owed
Medical
52.2
$142
Utility
22.7
$199
Government
2.3
$199
Creditor*
5.8
$587
Other**
16.9
$116
All
100
$156
Source: Federal Reserve
*Includes large retailers, banks and finance companies
**Includes smaller retailers, law firms, individuals and educational institutions
Yet any collection account is considered a major negative to lenders and to the credit-scoring formulas they use. Though the impact of a collection on your scores fades over time, it will shave off points for as long as the negative mark remains on your report -- typically seven years.
Your chances of having your credit ruined by a medical bill are soaring for a variety of reasons:
More people are uninsured or underinsured. The U.S. Census Bureau counts nearly 45 million uninsured Americans. An additional 16 million or so are underinsured, with too little coverage to protect them from catastrophic medical expenses. Medical costs have been rising at a much higher rate than inflation, and those without insurance are often charged more than those with coverage (read "How to survive your hospital bills" for details). Thus a single accident, illness or emergency-room visit can easily result in an impossible-to-pay bill for many uninsured and underinsured families.
Medical-debt collection has become big business. An unpaid or disputed bill is more likely to wind up on your credit report because of a sea change in the way medical bills are treated.
"The reporting of medical debt (to credit bureaus) is becoming much more common," said Travis Plunkett, a spokesman for the Consumer Federation of America. "Medical-debt reporting has become more professionalized."
Get your insurance claims paid
Good records, detailed claims and persistence will help you get your money faster and avoid problems.
A decade ago, most hospitals did their own collections or assigned them to a collector who worked on contingency, collecting a portion of what was owed. Smaller providers typically handled collections in-house. Only the largest companies tended to report collections activity to the credit bureaus -- and then only after repeated collection attempts had failed.
Today, physicians groups and other small providers are more likely to outsource their collections to agencies that use negative credit-report entries as a tool to urge patients to pay.
Meanwhile, an increasing number of for-profit hospitals and even some nonprofits regularly sell their bad debts for 2 or 3 cents on the dollar rather than try to collect the money themselves. So-called debt purchasers buy huge portfolios of debt, and one of the first things they do is post the collections on the consumers' credit reports.
"Health-care-debt buying did not exist" 10 years ago, said Michael Klozotsky, an analyst for Kaulkin Ginsberg, which tracks debt-collection trends. In 2005, purchasers bought at least $3 billion of bad medical debts, and the market seems to be growing 11% to 15% a year.
Continued: Confusion abounds
Medical billing is a mess. Even when a consumer is covered by insurance, confusion abounds. Doctors and hospitals often insist the consumer is ultimately responsible for the bills, saying medical providers bill insurers only as a courtesy. Yet frequently the providers have agreements with insurers and government agencies to accept discounted reimbursement as payment in full; the providers aren't supposed to pursue patients for payment.
Meanwhile, insurers are constantly changing what's covered and by how much, and providers move in and out of covered networks. Providers also claim some insurers deliberately drag their heels on reimbursements, adding to the chaos and uncertainty.
"Insurance companies are often contributing to the false reporting of medical debt," the Consumer Federation's Plunkett said, as tussles over payment increasingly get turned over to collection agencies.
Medical debt is no predictor of risk Even when medical debts are legitimately owed and left unpaid, though, some experts question whether they belong on credit reports.
There's no question that medical bills pose huge risks for the finances of many families. Medical problems were cited as a factor in nearly half of the bankruptcies studied by Harvard University professor Elizabeth Warren (.pdf file).
Still, many mortgage lenders who specialize in serving low-income communities have discovered that discarding medical debts often gives them a better picture of a borrower's true creditworthiness, said Michael Stegman, the director of policy for the MacArthur Foundation's program on human and community development.
"If all their other credit accounts are in good shape, or they haven't established credit but they've had no delinquencies on their rent," Stegman said, "the fact you have a bad medical debt or an outstanding judgment over a medical bill is not a good predictor of default."
One such lender, Self Help of Durham, N.C., has a 1% default rate on its mortgages, which public-policy director David Beck said is comparable to mainstream lenders that use credit-scoring formulas that take medical debt into account.
"Our experience has been that medical debt isn't generally reflective of a borrower's ability or willingness to repay," Beck said.
It's not clear that these lenders' experiences with low-income borrowers can be extended to the population in general, but it's time to find out. Credit-scoring companies such as Fair Isaac, the creator of the leading FICO scoring formula, should research whether medical debt really is predictive or not.
In a bind? 4 tips Personally, I think we could solve much of the problem of unfair medical-debt reporting by excluding all collections under $100 from credit reports. I also think medical debts should be treated differently, with shorter statutes of limitation on collection and reporting (say, four years instead of the current seven), to reflect the fact that medical bills are a fundamentally different kind of debt from credit cards and auto loans.
Unless that happens, here's how to reduce the chances of your credit getting run over by medical debt:
Bird-dog your medical bills. Don't assume your health-care provider and your insurance company will eventually work it out. Follow up on every bill or claim with an unpaid balance. If a debt remains after more than a month or two, ask your provider and your insurer what the problem is and what you can do to help.
Negotiate if you're uninsured. As I discussed in "How to survive your hospital bills," you may be able to qualify for charitable assistance that could reduce or eliminate your bills. Even if you don't qualify, you should try to get the amount you're charged reduced to what an insurer or government agency would pay.
Get payment agreements in writing. If you don't have insurance and want to make payments, make sure your agreement is in writing. One Your Money message boardcontributor agreed to pay her health-care provider $50 a month to pay off a $1,600 bill. No agreement was signed, however, and the provider recently started demanding $150 a month.
Try to talk your way out. If despite your best efforts a medical bill lands on your credit report, you have a couple of options. One is to dispute the bill with the credit bureaus as "not mine"; sometimes collection agencies won't bother to verify the disputed account, and it will fall off your reports. Option two is to negotiate with the collection agency to remove the account from your credit reports in exchange for payment.
Get your insurance claims paidGood records, detailed claims and persistence will help you get your money faster and avoid problems.
Ideally, you'd get that promise in writing before you pay anything, but sunny_light managed to sweet-talk a collection agency rep into clearing a credit report after sending the $7.
"I called that collection agency woman again and talked and talked and talked to her with lots of 'please' . . . and then it was quiet for a while so I thought she hung up . . . but then she said she was looking at my file . . . and finally she said 'normally we don't do this' and then she told me to check my report in about 30-45 days," sunny_light wrote. Two weeks later, sunny_light checked, "and the $7 medical bill (paid) has been removed from all three credit reports . . . and my credit scores went back up!!"
Columns by Liz Pulliam Weston, the Web's most-read personal-finance writer and winner of the 2007 Clarion Award for online journalism, appear every Monday and Thursday, exclusively on MSN Money.
Published Nov. 19, 2007
http://articles.moneycentral.msn.com/Banking/YourCreditRating/WhyMedicalDebtsShouldntCount.aspx?page=all
Why medical debts shouldn't count
For many, the road to ruined credit is pockmarked with medical collections, often for tiny amounts or billed in error. The truth is that medical debt rarely indicates whether a borrower is high risk.
By Liz Pulliam Weston
It's a good thing Greg Hilfman of Los Angeles has health insurance because an unpaid medical bill has sent his blood pressure soaring.
Hilfman's wife was in a hospital two years ago for pancreatitis, and Hilfman said she was treated by a "cadre" of doctors and specialists. All but one submitted bills to their insurer, Blue Cross of California, in time to get paid.
Six weeks ago, however, a woman from a neurologist's office contacted Hilfman, explaining that the office "didn't have the right address for Blue Cross" and thus hadn't submitted the bill within the one-year period required for reimbursement. She demanded that Hilfman cough up $540.
Hilfman was furious. He'd never heard of the doctor and insisted he'd seen no bill or any indication there was a problem with payment. Now he's worried he'll have to pay a bill that should have been covered by insurance or risk damage to the couple's credit reports.
"How is this fair?" he asked. "They can say anything they want (to the credit bureaus), and I have no recourse."
Tiny debts with huge impacts Hilfman is right to be concerned. The Your Money message board is littered with complaints from folks whose otherwise pristine credit was sabotaged by a medical collection. Sometimes their records were besmirched over absurdly small amounts that nonetheless had big impacts on credit scores.
Poster "sunny_light," for example, recently discovered a medical-collection account for just $7.
"I pulled my credit report last week and found out," sunny_light wrote. "I promptly paid the collections people. But now my credit score is down by like 80 points."
Medical collections are surprisingly common, at least according to a 2003 Federal Reserve study of consumer-credit reports. Nearly one in three consumers (31%) with a credit report had at least one collection account reported, and more than half of those were medical collections.
The amounts owed weren't substantial: 36.5% of the medical collections were for $100 or less, and 86% were for $500 or less.
Medical collections make up half of all collection accounts:
Collection type
% of collection accounts
Median amount owed
Medical
52.2
$142
Utility
22.7
$199
Government
2.3
$199
Creditor*
5.8
$587
Other**
16.9
$116
All
100
$156
Source: Federal Reserve
*Includes large retailers, banks and finance companies
**Includes smaller retailers, law firms, individuals and educational institutions
Yet any collection account is considered a major negative to lenders and to the credit-scoring formulas they use. Though the impact of a collection on your scores fades over time, it will shave off points for as long as the negative mark remains on your report -- typically seven years.
Your chances of having your credit ruined by a medical bill are soaring for a variety of reasons:
More people are uninsured or underinsured. The U.S. Census Bureau counts nearly 45 million uninsured Americans. An additional 16 million or so are underinsured, with too little coverage to protect them from catastrophic medical expenses. Medical costs have been rising at a much higher rate than inflation, and those without insurance are often charged more than those with coverage (read "How to survive your hospital bills" for details). Thus a single accident, illness or emergency-room visit can easily result in an impossible-to-pay bill for many uninsured and underinsured families.
Medical-debt collection has become big business. An unpaid or disputed bill is more likely to wind up on your credit report because of a sea change in the way medical bills are treated.
"The reporting of medical debt (to credit bureaus) is becoming much more common," said Travis Plunkett, a spokesman for the Consumer Federation of America. "Medical-debt reporting has become more professionalized."
Get your insurance claims paid
Good records, detailed claims and persistence will help you get your money faster and avoid problems.
A decade ago, most hospitals did their own collections or assigned them to a collector who worked on contingency, collecting a portion of what was owed. Smaller providers typically handled collections in-house. Only the largest companies tended to report collections activity to the credit bureaus -- and then only after repeated collection attempts had failed.
Today, physicians groups and other small providers are more likely to outsource their collections to agencies that use negative credit-report entries as a tool to urge patients to pay.
Meanwhile, an increasing number of for-profit hospitals and even some nonprofits regularly sell their bad debts for 2 or 3 cents on the dollar rather than try to collect the money themselves. So-called debt purchasers buy huge portfolios of debt, and one of the first things they do is post the collections on the consumers' credit reports.
"Health-care-debt buying did not exist" 10 years ago, said Michael Klozotsky, an analyst for Kaulkin Ginsberg, which tracks debt-collection trends. In 2005, purchasers bought at least $3 billion of bad medical debts, and the market seems to be growing 11% to 15% a year.
Continued: Confusion abounds
Medical billing is a mess. Even when a consumer is covered by insurance, confusion abounds. Doctors and hospitals often insist the consumer is ultimately responsible for the bills, saying medical providers bill insurers only as a courtesy. Yet frequently the providers have agreements with insurers and government agencies to accept discounted reimbursement as payment in full; the providers aren't supposed to pursue patients for payment.
Meanwhile, insurers are constantly changing what's covered and by how much, and providers move in and out of covered networks. Providers also claim some insurers deliberately drag their heels on reimbursements, adding to the chaos and uncertainty.
"Insurance companies are often contributing to the false reporting of medical debt," the Consumer Federation's Plunkett said, as tussles over payment increasingly get turned over to collection agencies.
Medical debt is no predictor of risk Even when medical debts are legitimately owed and left unpaid, though, some experts question whether they belong on credit reports.
There's no question that medical bills pose huge risks for the finances of many families. Medical problems were cited as a factor in nearly half of the bankruptcies studied by Harvard University professor Elizabeth Warren (.pdf file).
Still, many mortgage lenders who specialize in serving low-income communities have discovered that discarding medical debts often gives them a better picture of a borrower's true creditworthiness, said Michael Stegman, the director of policy for the MacArthur Foundation's program on human and community development.
"If all their other credit accounts are in good shape, or they haven't established credit but they've had no delinquencies on their rent," Stegman said, "the fact you have a bad medical debt or an outstanding judgment over a medical bill is not a good predictor of default."
One such lender, Self Help of Durham, N.C., has a 1% default rate on its mortgages, which public-policy director David Beck said is comparable to mainstream lenders that use credit-scoring formulas that take medical debt into account.
"Our experience has been that medical debt isn't generally reflective of a borrower's ability or willingness to repay," Beck said.
It's not clear that these lenders' experiences with low-income borrowers can be extended to the population in general, but it's time to find out. Credit-scoring companies such as Fair Isaac, the creator of the leading FICO scoring formula, should research whether medical debt really is predictive or not.
In a bind? 4 tips Personally, I think we could solve much of the problem of unfair medical-debt reporting by excluding all collections under $100 from credit reports. I also think medical debts should be treated differently, with shorter statutes of limitation on collection and reporting (say, four years instead of the current seven), to reflect the fact that medical bills are a fundamentally different kind of debt from credit cards and auto loans.
Unless that happens, here's how to reduce the chances of your credit getting run over by medical debt:
Bird-dog your medical bills. Don't assume your health-care provider and your insurance company will eventually work it out. Follow up on every bill or claim with an unpaid balance. If a debt remains after more than a month or two, ask your provider and your insurer what the problem is and what you can do to help.
Negotiate if you're uninsured. As I discussed in "How to survive your hospital bills," you may be able to qualify for charitable assistance that could reduce or eliminate your bills. Even if you don't qualify, you should try to get the amount you're charged reduced to what an insurer or government agency would pay.
Get payment agreements in writing. If you don't have insurance and want to make payments, make sure your agreement is in writing. One Your Money message boardcontributor agreed to pay her health-care provider $50 a month to pay off a $1,600 bill. No agreement was signed, however, and the provider recently started demanding $150 a month.
Try to talk your way out. If despite your best efforts a medical bill lands on your credit report, you have a couple of options. One is to dispute the bill with the credit bureaus as "not mine"; sometimes collection agencies won't bother to verify the disputed account, and it will fall off your reports. Option two is to negotiate with the collection agency to remove the account from your credit reports in exchange for payment.
Get your insurance claims paidGood records, detailed claims and persistence will help you get your money faster and avoid problems.
Ideally, you'd get that promise in writing before you pay anything, but sunny_light managed to sweet-talk a collection agency rep into clearing a credit report after sending the $7.
"I called that collection agency woman again and talked and talked and talked to her with lots of 'please' . . . and then it was quiet for a while so I thought she hung up . . . but then she said she was looking at my file . . . and finally she said 'normally we don't do this' and then she told me to check my report in about 30-45 days," sunny_light wrote. Two weeks later, sunny_light checked, "and the $7 medical bill (paid) has been removed from all three credit reports . . . and my credit scores went back up!!"
Columns by Liz Pulliam Weston, the Web's most-read personal-finance writer and winner of the 2007 Clarion Award for online journalism, appear every Monday and Thursday, exclusively on MSN Money.
Published Nov. 19, 2007
Wednesday, August 15, 2007
When staying alive means going bankrupt
This is just appalling.
Health insurance didn’t keep cancer-stricken California woman solvent
By Mike Stuckey
Senior news editor
MSNBC
In our second Gut Check America vote, readers rated health care as the issue of most concern for them. After a false start in Oregon, we found reader Kathleen Aldrich, a Lompoc, Calif., resident who wrote to us about how her battle with cancer drove her to bankruptcy, even though she had health insurance. Here is her story:
LOMPOC, Calif. - Kathleen Aldrich, financially ruined by two bouts with ovarian cancer, is not who you might assume she is.
She raised three kids as a single mom. She worked hard for years. She had good jobs. She paid her bills. She lived in a nice house and drove a nice car. She had a decent credit rating. She had health insurance.
Now she has a record of bankruptcy and is the embodiment of the fear that nags at millions of U.S. families: that they are but one medical calamity away from losing everything. Like Aldrich, they — and perhaps you — could be.
“I didn’t do anything wrong,” Aldrich says thoughtfully, sitting in the neat, pale green living room of her tiny stucco duplex in the middle of this mostly middle-class American town. “I don’t see that I did.”
Just turned 50, tall and blond with a quick smile, Aldrich is gratefully in remission for a second time from the ovarian cancer, the No. 5 cancer killer of women. Despite “feeling like a little black cloud follows me around all the time,” she has a lot to live for, from a budding long-distance romance to a precocious 6-year-old granddaughter named Alyssa.
A cat named Jack and a great boss
She has a friendly cat named Jack, a boss she adores and a grassy park nearby where she can stroll for miles as the long summer evenings unwind in Lompoc, a flat checkerboard between the bumpy brown California hills to the east and the Pacific Ocean to the west. The town, best known for a federal lockup that has housed the likes of junk bond king Michael Milken and Nixon confidant H.R. “Bob” Haldeman, also is home to Vandenberg Air Force Base, diatomaceous earth mines and 42,000 residents.
But her life is hardly idyllic. Two years and four months after her second trip through the hell of chemotherapy, Aldrich is embarking on the painful new journey of trying to rebuild her life and her credit rating. The bankruptcy has quashed all thoughts that she might someday retire. More immediately, it has left her unable to obtain thousands of dollars of work on her teeth, which likely were weakened by the powerful anti-cancer drugs.
And it has left deeper wounds of shame and guilt over having to walk away from unpaid bills after a lifetime of responsible living.
Aldrich’s situation is "asinine" but increasingly common, said Dr. Deborah Thorne of Ohio University. Thorne, co-author of a widely quoted 2005 study that found medical bills contributed to nearly half of the 1.5 million personal bankruptcies filed in the U.S. each year, said that ratio has likely worsened since the data was gathered.
Bankruptcy in the light of large medical bills is “unfortunately the only choice many people have," she said. "They will never in their lifetimes pay them off.
“To talk with these people again and again is so frustrating. They’re such thoughtful, kind folks who are being set up by the system we have now. What’s most appalling is they’re ashamed.”
Like Aldrich, Thorne said, three-quarters of the individuals in the study who declared bankruptcy because of health problems were insured.
"When the illness began ... they were floored," she said. "They assumed incorrectly that if you have health insurance that you’re fine and that you’ll get the treatment that you’ll need and not have to mortgage the farm to pay for it.”
In the beginning, that assumption appeared accurate to Aldrich.
She was working at a credit union when she was first diagnosed with cancer in 2001. Her employer-paid insurance covered most of her expenses as she underwent surgery and her first round of chemo, which continued well into 2002. She changed jobs later that year, carefully paying her own insurance premiums through a COBRA extended health benefits program until she qualified for the group plan offered by her new employer, a title company in Montecito, an hour down the coast.
But while she was on leave for surgery to repair hernias and a bowel obstruction caused by her first operation, she was laid off. Once more, she used the COBRA process — established by a federal law that lets employees who lose their jobs maintain their health insurance for up to 18 months by paying their own premiums. Again, her insurance paid most of the bills.
Aldrich had landed a new job as a processor for a Lompoc mortgage company when her cancer returned in 2004. Though she didn't have health insurance through her employer and her COBRA benefits had been exhausted, she had continued to buy health insurance, paying $533 a month.
She underwent more surgery and returned to chemotherapy treatments at Santa Barbara Hematology and Oncology, a large medical practice in the area. As the nausea and hair loss subsided in the spring of 2005, she began to receive bills from the practice that eventually totaled more than $15,000.
Where's the $7,000 cap?Aldrich was stunned, since her policy with Blue Shield of California had a $2,000 annual deductible and a co-payment schedule that was supposed to cap her maximum annual “out-of-pocket” cost at $7,000 when using a “preferred provider,” as Santa Barbara Hematology is.
Still dazed by the chemo, she said, she tried to get the bill corrected, calling both the medical practice and Blue Shield. When nothing seemed to work, she turned to her sister, Mary Beth Fisher, a registered nurse for 35 years who spent the last part of her career in administrative jobs for medical practices, handling plenty of insurance matters.
“I said, ‘I know you can get ahold of someone who can help you get through this mess,’” Fisher told MSNBC.com. In the end, though, she said all they got was the run-around from both the medical practice and Blue Shield. “It was always ‘talk to another person, put your request in through e-mail.’”
Fisher said that in her experience, case workers are available on both sides to help resolve such problems. “I was astounded that she wasn’t offered that kind of assistance or support," she said. "… It really was that nobody would talk to you.”
No help from Blue Shield
Fisher believes the source of the problem was that the oncology practice had been paid more for the same services under Aldrich's previous insurance policy and did not change its billings to reflect the terms of its contract with Blue Shield, Aldrich’s new carrier. But she said Blue Shield did little to make the change clear to the doctors group.
Blue Shield spokeswoman Elise Anderson said privacy laws prohibited her from even acknowledging that Aldrich is a Blue Shield client, but she was confident the company’s customer service process works well.
Lynn Humphrey, administrator of Santa Barbara Hematology, also declined to discuss Aldrich’s case.
According to the sisters, Santa Barbara Hematology sent Aldrich’s case to a collection agency just a few months after the dispute began and refused to discuss the bill after that, a common practice in collections cases. Then, they say, Aldrich was dismissed as a patient for being “a pain.”
The sudden severing of the relationship with the young doctor whom Aldrich still reveres as the woman who twice saved her life was particularly painful.
“I was so devastated and embarrassed,” she said. “Was I a pain during chemo, the whole time? Am I a piece of crap or what?”
Fisher stated repeatedly that she was not looking for any kind of handout for her sister. Seventeen years older than Aldrich, and Aldrich’s guardian after their mother died when Aldrich was 14, Fisher said, “I told Kathleen she had a part in this." She owed money for her treatment. But not any more than $7,000, they believed.
Aldrich and Fisher say they continued trying to work the problem out with Blue Shield, the medical group and the collection agency over the next year. But on July 24, 2006, the collection agency sued Aldrich, seeking nearly $20,000 in debts, attorneys’ fees, court costs and interest. The lion’s share of the total was the $15,239.52 that Santa Barbara Hematology claimed it was owed.
A short time later, Aldrich said, a sheriff’s deputy showed up with the paperwork to attach her wages from Santa Fe Mortgage, where she is the sole employee of owner Fred Bittle, a loyal supporter throughout her ordeal who pays Aldrich more than the going rate specifically so she can purchase health insurance. The prospect of having her $3,820 in monthly pay drastically reduced to satisfy the debt was nightmarish for Aldrich.
Her bank account already had been wiped out as a result of her unemployment and periods when her medical treatments had robbed her of the ability to work full time. She also had borrowed more than $15,000 from Fisher and another sister and had no way to repay the $7,000 she agreed that she owed other than a little at a time.
Nothing in the bank“I have no savings,” said Aldrich. “I probably have 10 bucks saved. I live paycheck to paycheck.” Her No. 1 goal was to keep up with the premiums on her health insurance, and she remembers thinking, “I might as well quit my job if they’re going to garnish me because there’s no way I can make it.”
After consulting with an attorney, the sisters came away believing that the only solution was for Aldrich to declare bankruptcy. “He said, 'This is such an incredible mess that I don’t think you can afford the amount of money that it would take if we could ever figure it out,’” Fisher said.
“I did not want to do that,” Aldrich said. “That is not how I was raised.” She tried to figure out how to pay the judgment, to avoid the blemish of bankruptcy any way that she could. “I was willing to drive a crappy car. I’m not very materialistic. I was even at one point looking to just rent a room somewhere to cut costs,” she said. It seemed hopeless.
So, swallowing a bit more of her pride, Aldrich borrowed $1,800 more from her sister to pay the legal and court costs for the bankruptcy. Her debts were discharged in U.S. Bankruptcy Court in April, including the $15,239.52 billed by Santa Barbara Hematology. In total, the medical group was paid more than $74,000 for Aldrich’s treatment, which got so expensive that her final round of chemo cost nearly $17,000, according to copies of billing records filed in court.
A familiar situationAldrich’s attorney did not respond to MSNBC.com’s request for an interview, but a well-known California lawyer who specializes in medical insurance cases said Aldrich’s experience is not unusual.
“We see it all the time in our practice,” said William Shernoff, who said insurance companies often leave patients on their own to deal with medical providers who bill too much. “None of these carriers go out of their way to help these people. They’re just looking after their own interests, and they don’t seem to have any consumer-friendly people out there trying to assist their customers. They take the first opportunity they can to get rid of any problems, especially if it’s going to cost them money.”
Shernoff doubts that a recent announcement by the California Department of Insurance that it will score Blue Shield and other big carriers on a "healthcare report card" will do much to help consumers.
Blue Shield stands by its serviceAnderson, the Blue Shield spokeswoman, said the carrier has a clear path for handling customer problems. “On anybody’s card there is an 800 number, and you call that 24/7,” she said. "There’s a whole process. The key is you start with the customer service number, and anyone at that number should be able to help you.” Calls placed by MSNBC.com to the 800 number were answered immediately by Blue Shield representatives.
Thorne, the Ohio University professor, said that a larger problem illustrated by Aldrich's case is the out-of-control nature of health-care costs and insurance. "We already spend enough in premiums and co-pays that to be asked to pay tens of thousand more for health care is asinine.”
Indeed, Aldrich was paying 17 cents out of every dollar she took home for her Blue Shield policy when she ran up the disputed charges. And she recently got a “birthday card” from the insurer stating that now that she has turned 50, her monthly rate will rise to $619 — just slightly less than her $650 rent. In any year that she needs any major treatment, she’ll be liable for an additional $7,000 in deductible and co-payments, meaning that she would have to devote $14,428 — well over a third of her take-home pay — to health care.
It’s hard for Aldrich to talk about her situation without strong emotions, and some tears, surfacing. But she does not want to be seen as a pity case. She sees herself as a cautionary tale for average Americans: “It can happen to you.”
Her sister agrees, saying that the moral of this story is for people at all levels of the treatment and billing process to pay close attention to details and, especially, to listen. “They don’t realize how critical it is to be exact, what a nightmare it can be for someone else,” Fisher said.
Amid the photos of family and friends, there's a sign on the wall over the TV in Aldrich's little living room. “BELIEVE,” it says, in 6-inch letters carved out of wood. And despite all that has happened to shake her faith in our health care system and doctors’ offices and insurance companies, Kathleen Aldrich still believes.
She believes in working, in getting up and going to the office every day and doing the best she can. She absolutely believes in paying her $619-a-month health insurance premium. She believes that someone is watching out for her. And she believes in love.
“I had some pretty dark times during chemo,” she recalled. “I spent a lot of time alone. I asked God, and I told him the one thing that I wanted to do was to love again, to feel how it feels to be in love and to have a companion.” She gazes fondly at a picture on a nearby table of a handsome man posing in the cab of a truck with a happy dog.
“I met Richard last year. It’s a wonderful feeling to have a companion again and look forward to the little things in life that some couples maybe take for granted. I feel pretty good about the way my life is right now.”
© 2007 MSNBC Interactive
Health insurance didn’t keep cancer-stricken California woman solvent
By Mike Stuckey
Senior news editor
MSNBC
In our second Gut Check America vote, readers rated health care as the issue of most concern for them. After a false start in Oregon, we found reader Kathleen Aldrich, a Lompoc, Calif., resident who wrote to us about how her battle with cancer drove her to bankruptcy, even though she had health insurance. Here is her story:
LOMPOC, Calif. - Kathleen Aldrich, financially ruined by two bouts with ovarian cancer, is not who you might assume she is.
She raised three kids as a single mom. She worked hard for years. She had good jobs. She paid her bills. She lived in a nice house and drove a nice car. She had a decent credit rating. She had health insurance.
Now she has a record of bankruptcy and is the embodiment of the fear that nags at millions of U.S. families: that they are but one medical calamity away from losing everything. Like Aldrich, they — and perhaps you — could be.
“I didn’t do anything wrong,” Aldrich says thoughtfully, sitting in the neat, pale green living room of her tiny stucco duplex in the middle of this mostly middle-class American town. “I don’t see that I did.”
Just turned 50, tall and blond with a quick smile, Aldrich is gratefully in remission for a second time from the ovarian cancer, the No. 5 cancer killer of women. Despite “feeling like a little black cloud follows me around all the time,” she has a lot to live for, from a budding long-distance romance to a precocious 6-year-old granddaughter named Alyssa.
A cat named Jack and a great boss
She has a friendly cat named Jack, a boss she adores and a grassy park nearby where she can stroll for miles as the long summer evenings unwind in Lompoc, a flat checkerboard between the bumpy brown California hills to the east and the Pacific Ocean to the west. The town, best known for a federal lockup that has housed the likes of junk bond king Michael Milken and Nixon confidant H.R. “Bob” Haldeman, also is home to Vandenberg Air Force Base, diatomaceous earth mines and 42,000 residents.
But her life is hardly idyllic. Two years and four months after her second trip through the hell of chemotherapy, Aldrich is embarking on the painful new journey of trying to rebuild her life and her credit rating. The bankruptcy has quashed all thoughts that she might someday retire. More immediately, it has left her unable to obtain thousands of dollars of work on her teeth, which likely were weakened by the powerful anti-cancer drugs.
And it has left deeper wounds of shame and guilt over having to walk away from unpaid bills after a lifetime of responsible living.
Aldrich’s situation is "asinine" but increasingly common, said Dr. Deborah Thorne of Ohio University. Thorne, co-author of a widely quoted 2005 study that found medical bills contributed to nearly half of the 1.5 million personal bankruptcies filed in the U.S. each year, said that ratio has likely worsened since the data was gathered.
Bankruptcy in the light of large medical bills is “unfortunately the only choice many people have," she said. "They will never in their lifetimes pay them off.
“To talk with these people again and again is so frustrating. They’re such thoughtful, kind folks who are being set up by the system we have now. What’s most appalling is they’re ashamed.”
Like Aldrich, Thorne said, three-quarters of the individuals in the study who declared bankruptcy because of health problems were insured.
"When the illness began ... they were floored," she said. "They assumed incorrectly that if you have health insurance that you’re fine and that you’ll get the treatment that you’ll need and not have to mortgage the farm to pay for it.”
In the beginning, that assumption appeared accurate to Aldrich.
She was working at a credit union when she was first diagnosed with cancer in 2001. Her employer-paid insurance covered most of her expenses as she underwent surgery and her first round of chemo, which continued well into 2002. She changed jobs later that year, carefully paying her own insurance premiums through a COBRA extended health benefits program until she qualified for the group plan offered by her new employer, a title company in Montecito, an hour down the coast.
But while she was on leave for surgery to repair hernias and a bowel obstruction caused by her first operation, she was laid off. Once more, she used the COBRA process — established by a federal law that lets employees who lose their jobs maintain their health insurance for up to 18 months by paying their own premiums. Again, her insurance paid most of the bills.
Aldrich had landed a new job as a processor for a Lompoc mortgage company when her cancer returned in 2004. Though she didn't have health insurance through her employer and her COBRA benefits had been exhausted, she had continued to buy health insurance, paying $533 a month.
She underwent more surgery and returned to chemotherapy treatments at Santa Barbara Hematology and Oncology, a large medical practice in the area. As the nausea and hair loss subsided in the spring of 2005, she began to receive bills from the practice that eventually totaled more than $15,000.
Where's the $7,000 cap?Aldrich was stunned, since her policy with Blue Shield of California had a $2,000 annual deductible and a co-payment schedule that was supposed to cap her maximum annual “out-of-pocket” cost at $7,000 when using a “preferred provider,” as Santa Barbara Hematology is.
Still dazed by the chemo, she said, she tried to get the bill corrected, calling both the medical practice and Blue Shield. When nothing seemed to work, she turned to her sister, Mary Beth Fisher, a registered nurse for 35 years who spent the last part of her career in administrative jobs for medical practices, handling plenty of insurance matters.
“I said, ‘I know you can get ahold of someone who can help you get through this mess,’” Fisher told MSNBC.com. In the end, though, she said all they got was the run-around from both the medical practice and Blue Shield. “It was always ‘talk to another person, put your request in through e-mail.’”
Fisher said that in her experience, case workers are available on both sides to help resolve such problems. “I was astounded that she wasn’t offered that kind of assistance or support," she said. "… It really was that nobody would talk to you.”
No help from Blue Shield
Fisher believes the source of the problem was that the oncology practice had been paid more for the same services under Aldrich's previous insurance policy and did not change its billings to reflect the terms of its contract with Blue Shield, Aldrich’s new carrier. But she said Blue Shield did little to make the change clear to the doctors group.
Blue Shield spokeswoman Elise Anderson said privacy laws prohibited her from even acknowledging that Aldrich is a Blue Shield client, but she was confident the company’s customer service process works well.
Lynn Humphrey, administrator of Santa Barbara Hematology, also declined to discuss Aldrich’s case.
According to the sisters, Santa Barbara Hematology sent Aldrich’s case to a collection agency just a few months after the dispute began and refused to discuss the bill after that, a common practice in collections cases. Then, they say, Aldrich was dismissed as a patient for being “a pain.”
The sudden severing of the relationship with the young doctor whom Aldrich still reveres as the woman who twice saved her life was particularly painful.
“I was so devastated and embarrassed,” she said. “Was I a pain during chemo, the whole time? Am I a piece of crap or what?”
Fisher stated repeatedly that she was not looking for any kind of handout for her sister. Seventeen years older than Aldrich, and Aldrich’s guardian after their mother died when Aldrich was 14, Fisher said, “I told Kathleen she had a part in this." She owed money for her treatment. But not any more than $7,000, they believed.
Aldrich and Fisher say they continued trying to work the problem out with Blue Shield, the medical group and the collection agency over the next year. But on July 24, 2006, the collection agency sued Aldrich, seeking nearly $20,000 in debts, attorneys’ fees, court costs and interest. The lion’s share of the total was the $15,239.52 that Santa Barbara Hematology claimed it was owed.
A short time later, Aldrich said, a sheriff’s deputy showed up with the paperwork to attach her wages from Santa Fe Mortgage, where she is the sole employee of owner Fred Bittle, a loyal supporter throughout her ordeal who pays Aldrich more than the going rate specifically so she can purchase health insurance. The prospect of having her $3,820 in monthly pay drastically reduced to satisfy the debt was nightmarish for Aldrich.
Her bank account already had been wiped out as a result of her unemployment and periods when her medical treatments had robbed her of the ability to work full time. She also had borrowed more than $15,000 from Fisher and another sister and had no way to repay the $7,000 she agreed that she owed other than a little at a time.
Nothing in the bank“I have no savings,” said Aldrich. “I probably have 10 bucks saved. I live paycheck to paycheck.” Her No. 1 goal was to keep up with the premiums on her health insurance, and she remembers thinking, “I might as well quit my job if they’re going to garnish me because there’s no way I can make it.”
After consulting with an attorney, the sisters came away believing that the only solution was for Aldrich to declare bankruptcy. “He said, 'This is such an incredible mess that I don’t think you can afford the amount of money that it would take if we could ever figure it out,’” Fisher said.
“I did not want to do that,” Aldrich said. “That is not how I was raised.” She tried to figure out how to pay the judgment, to avoid the blemish of bankruptcy any way that she could. “I was willing to drive a crappy car. I’m not very materialistic. I was even at one point looking to just rent a room somewhere to cut costs,” she said. It seemed hopeless.
So, swallowing a bit more of her pride, Aldrich borrowed $1,800 more from her sister to pay the legal and court costs for the bankruptcy. Her debts were discharged in U.S. Bankruptcy Court in April, including the $15,239.52 billed by Santa Barbara Hematology. In total, the medical group was paid more than $74,000 for Aldrich’s treatment, which got so expensive that her final round of chemo cost nearly $17,000, according to copies of billing records filed in court.
A familiar situationAldrich’s attorney did not respond to MSNBC.com’s request for an interview, but a well-known California lawyer who specializes in medical insurance cases said Aldrich’s experience is not unusual.
“We see it all the time in our practice,” said William Shernoff, who said insurance companies often leave patients on their own to deal with medical providers who bill too much. “None of these carriers go out of their way to help these people. They’re just looking after their own interests, and they don’t seem to have any consumer-friendly people out there trying to assist their customers. They take the first opportunity they can to get rid of any problems, especially if it’s going to cost them money.”
Shernoff doubts that a recent announcement by the California Department of Insurance that it will score Blue Shield and other big carriers on a "healthcare report card" will do much to help consumers.
Blue Shield stands by its serviceAnderson, the Blue Shield spokeswoman, said the carrier has a clear path for handling customer problems. “On anybody’s card there is an 800 number, and you call that 24/7,” she said. "There’s a whole process. The key is you start with the customer service number, and anyone at that number should be able to help you.” Calls placed by MSNBC.com to the 800 number were answered immediately by Blue Shield representatives.
Thorne, the Ohio University professor, said that a larger problem illustrated by Aldrich's case is the out-of-control nature of health-care costs and insurance. "We already spend enough in premiums and co-pays that to be asked to pay tens of thousand more for health care is asinine.”
Indeed, Aldrich was paying 17 cents out of every dollar she took home for her Blue Shield policy when she ran up the disputed charges. And she recently got a “birthday card” from the insurer stating that now that she has turned 50, her monthly rate will rise to $619 — just slightly less than her $650 rent. In any year that she needs any major treatment, she’ll be liable for an additional $7,000 in deductible and co-payments, meaning that she would have to devote $14,428 — well over a third of her take-home pay — to health care.
It’s hard for Aldrich to talk about her situation without strong emotions, and some tears, surfacing. But she does not want to be seen as a pity case. She sees herself as a cautionary tale for average Americans: “It can happen to you.”
Her sister agrees, saying that the moral of this story is for people at all levels of the treatment and billing process to pay close attention to details and, especially, to listen. “They don’t realize how critical it is to be exact, what a nightmare it can be for someone else,” Fisher said.
Amid the photos of family and friends, there's a sign on the wall over the TV in Aldrich's little living room. “BELIEVE,” it says, in 6-inch letters carved out of wood. And despite all that has happened to shake her faith in our health care system and doctors’ offices and insurance companies, Kathleen Aldrich still believes.
She believes in working, in getting up and going to the office every day and doing the best she can. She absolutely believes in paying her $619-a-month health insurance premium. She believes that someone is watching out for her. And she believes in love.
“I had some pretty dark times during chemo,” she recalled. “I spent a lot of time alone. I asked God, and I told him the one thing that I wanted to do was to love again, to feel how it feels to be in love and to have a companion.” She gazes fondly at a picture on a nearby table of a handsome man posing in the cab of a truck with a happy dog.
“I met Richard last year. It’s a wonderful feeling to have a companion again and look forward to the little things in life that some couples maybe take for granted. I feel pretty good about the way my life is right now.”
© 2007 MSNBC Interactive
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