With Son in Remission, Family Looks for Coverage

[babylonsister]

http://blogs.wsj.com/health/2009/04/21/after-layoff-family-struggles-to-solve-health-insurance-puzzle/

After Layoff, Family Struggles to Solve Health-Insurance Puzzle

By Sarah Rubenstein


Since Danna Walker lost her $37,000-a-year salary, the government’s recently enacted 65% break on Cobra health-insurance costs would still mean paying $476 a month for continuing coverage.

With little more than her unemployment check of $688 every couple of weeks as the family’s only predictable income, the Walkers say they can’t afford it, the New York Times reports this morning. So they’re searching, with little luck, to find something more affordable that would cover their 21-year-old son, whose metastatic testicular cancer is in remission, and provide him with the costly tests he still needs.

The son, Jake Walker, has already gotten nearly $2 million of care, almost all of it paid for by the insurance plan his mother had through her former employer, DHL. Now they’re being told that without coverage, they’ll have to pay upfront for his care at Houston’s M.D. Anderson Cancer Center, which the family credits for the son’s remission and where they’re applying for the charity program. (He got last-minute relief from making an advance payment last month, though the family says it can’t pay the $1,507 bill.)

The hospital told NYT it was “good financial counseling” to suggest Jake get his tests elsewhere; one of the criteria for charity care is whether a family can get comparable treatment somewhere else. (See more on controversy over upfront payments there.)

It’s an example of how much tougher it can be to pay for care without an employer in the mix. Due to his illness, Jake doesn’t qualify for an individual plan on the open market. He’s too old for Texas’s Medicaid program for kids, and it’s extremely difficult for adults to qualify for Medicaid in the state. Cobra coverage is costly, as is coverage through the state’s “high-risk pool” for patients who can’t obtain insurance on the open market.

“You feel like you’ve been kicked to the curb,” Jake’s mom told NYT. “It’s like, ‘As long as you have insurance, we’re willing to go over the moon to see you and make sure that everything is taken care of.’ And the minute you don’t, they don’t want you.”