I'm in shock right now.  A spouse's cancer diagnosis should be enough for any couple to deal with.  But no.  I see an impending tsunami of medical bills rushing our way, and there is no escape.

We have health insurance.  But we chose the "catastrophic" option for four years, hoping that taking on more risk would save some money.  The "catastrophic" option cost us nothing in premiums, while the "richer" option would have cost $4,000/year in premiums deducted from my paycheck.  I could see no way to afford that, not on our income of  $48,900 gross last year (I'm the sole support of a family of five.) 

The "catastrophic" option had a $1,000 deductible and the obligation to pay 50% of the next $20,000.  Okay, $11,000 would be steep, but what was the likelihood of that happening?  We were both healthy.  We took the gamble, and for three years, we won.

Along comes year four.  We're one month into the 2008 fiscal year, that's back last August.  Suddenly, Will is in excruciating pain.  Emergency surgery is required for a perianal cyst.  Below are the medical bills for this, captured from my computer screen from the claims administrator.  A quick explanation.  Allowed amount is what the insurer considers "reasonable & customary," and that usually brings the cost down significantly.  Paid amount is what the insurer actually is responsible for paying, taking deductibles and the percentage the insured person is responsible for into consideration.  Patient liability is what we the insured must pay.

Cha-ching: 

So far, not so bad.  We can manage $1668. 

But that's just the start.  The surgeon recommends a routine colonoscopy for Will.  Our insurer tells us they cover it at 100%--this is an extra perk written into our insurance plan.  Okay, let's do it.  Will's not looking forward to it, but he finally schedules his colonoscopy for December 27, 2008. 

I go with him that day.  There's a jarring little caveat emptor sign that I notice.  "Hey," I say to Will, pointing out the sign.  "Look at that."  The sign says that patients should check their insurance coverage.  Most insurance plans that pay for a colonoscopy screening at 100% will get stingy on you if it turns out you have a problem.  Then, buddy, all bets are off.  Then it's considered a "therapeutic" colonoscopy, and it's subject to deductibles and coinsurance.  "Talk about kicking someone when they're down," I say.  Will just shakes his head.  He lived 22 years in New Zealand and 23 in Australia.  Both countries offer absolutely free health care to anyone who needs it, even visitors.  There is a nominal charge for prescription drugs.  Will still hasn't gotten over our having to pay so much for his emergency surgery back in August.  He was, and still is, horrified at the barbaric way the U.S. treats those who are ill.

Fast forward two hours.  Will is emerging from his anesthetized sleep.  The colonoscopy is over?  That wasn't so bad.  Except, wait, there's the surgeon.  He begins saying words that neither Will nor I can grasp.  Will has a medium-sized mass in his colon.  The doctor recommends that eight to ten inches of Will's colon be removed.  This will require a five to seven day hospital stay.  We should do this soon. 

"Are you sure it's malignant?"

He nods with certainty.  The biopsy will identify exactly what kind of malignancy, but he's sure.  He wants Will to have something called a cat pet scan, to see if there are any other tumors.  Will and I consult briefly.  Will's $1000 deductible is paid for the calendar year.  If we do this right away, we won't have to start 2009 paying his deductible all over again.  We schedule the surgery for December 31.  Hell of a way to ring in the new year. 

Cha-ching:  

Above, you can see the charges for the cat pet (first item) and the three separate bills we received once the colonoscopy was no longer covered at 100%.  In total, we have paid out just over $3,100 so far.  That won't break us.  Yet.  Our savings, ever minuscule despite developing frugal living habits into an art form, can cover this amount.

Will's hospital stay is only five days.  Knowing, as he does, that we must pay 50% of reasonable and customary charges, he valiantly wears a track into the carpeting, walking with his IV pole and assorted tubes dangling, around and around the unit.  He endures pain, asking for medication as little as he possibly can.  That surely helps him to leave sooner.  The very day he is finally allowed to eat, he is discharged.  For the next week, I stay home from work in order to nurse him, and wait nervously for the EOB's (explanation of benefits, from the insurer) and bills to arrive.

Cha-ching:

Wow, we've got some problems here.  There's a doctor we've never heard of on the list of people we owe money to.  What's the story?  When we check, it turns out she is the assistant our surgeon always uses.  She is also not a preferred provider.  Under our catastrophic plan, no benefits are paid to non-preferred providers.  We're on the hook for this.  But wait--we had no choice in this.  We didn't even know.  How could we have avoided this?  Answer--we couldn't have, but nonetheless, the bill goes to us.  And our insurer wouldn't even apply "reasonable and customary" to it, so it's the full amount we owe. 

Then, take a look at that whopping hospital bill.  Yikes!  Our share of this brings us to the $11,000 stop-loss limit (actually more, because of the non-participating doctor.)  Bad news: we owe various medical providers $12,684.  Good news: insurance now pays at 100%.  More bad news: with the start of 2009, our liability starts all over again.

Wait a minute.  We always thought $11,000 would be unlikely, but at least that's the most we would pay.  Wrong.  I can transfer us out of that catastrophic plan and into the richer plan, where $4,000 in annual premiums sounds pretty darn good now.  But my school district operates on a July - June fiscal year.  I can opt out of this catastrophic plan, but it won't take effect until July 1.  Oops, slight miscalculation.  All this time, it wasn't an $11,000 maximum risk we chose to take, it was a $22,000 maximum risk since our deductibles and coinsurance are based on calendar years.  And, by the way, that's for each of us.  If both of us had been diagnosed with expensive and life-threatening illnesses that straddled two calendar years, we could have been looking at $44,000.  Suddenly, that catastrophic plan seems deceptive.  Should an employer of integrity even offer this?

I won't burden you with any more cha-chings.  Suffice it to say that cancer treatments are not cheap.  Two weeks ago, Will had a scan called an otreoscan, and I found out today that the charge for it is $9,000, of which $7,500 is considered "reasonable and customary."  Our share?  $4,500.  Yesterday, he had an MRI.  I have no idea what that will cost.  As matters stand right now, we are well on our way to ringing up another $11,000 in medical expenses for 2009.  July 1 can't come soon enough.

We've looked into bill forgiveness/relief.  The hospital, our biggest creditor by far, checked two programs offered to those who can't pay their medical bills.  We don't qualify.  We make "too much money." 

If any health care reform is in the works, it will not come soon enough to help people like us.  I offer this story in hopes that people who rail against the evils of socialized medicine will understand that catastrophic illness happens, and even if you're covered by insurance, that may not be enough to save you from financial disaster.  In a civilized country where the basic needs of all are met, Will and I would have only his illness to worry about--not medical bills and how in the world they'll ever be paid. 

Will and I have discussed his leaving me to move back to New Zealand, thereby avoiding future medical expenses.  At this point, though, we are not sure New Zealand would take him back.  Besides, once he's there, who knows when, if ever, he could return?  What a terrible choice to consider.  What sort of compassionless society do we live in, where such  choices are even entertained?

Yes, there's a call to action in conclusion.  Please share our story with your friends and relatives when they start griping that the lazy no-accounts who can't pay their medical bills because they can't handle money are going to lead this country into the nightmare of socialized medicine.  Hard-working people who have lived prudently are getting hurt, too.  Something must be done--whether Medicare for all, or some other relief.  Devastating illnesses strike without regard to status or money in the bank.  You could be next.