Nothing in the lifestyle, past or family history of my friend could have warned her that she would be struck by an aggressive form of cancer. Even her diagnosis of breast cancer seemed to go the way of treatable cancer. She had radiation following a lumpectomy and was cleared to return cancer-free to her busy family and work life.
About six months later, she began to experience pain in her hip and abdomen and was referred to her medical oncologist for an evaluation. The oncologist wanted her to have an MRI to rule out the possible return of cancer. It was two months before her health insurance approved the MRI.
After the two-month wait, the now-approved MRI revealed the cancer had returned and spread to my friend’s bones. Cancer invading her bones was the source of her pain.
No one said and she doesn’t know if the delay resulted in two more months of cancer spreading that could have been treated earlier. She likes to think it would not have made a difference.
The day we met to talk for this column, she deployed her usual cheerful manner in telling me she took a pain pill so she may not be coherent. We laugh and I tell her I will wake her if she falls asleep mid-sentence.
I see that she is coping with a great deal of discomfort, but still she is here, willing to share, willing to make a difference.
Her eyes grow dark. “It could happen, you never know,” she says, as if it was a sort of reckoning that explains why this is happening to her or what keeps her putting one foot in front of the other each day.
Perhaps, the cure could come as easily as the disease.
I learned she’s had more delays in receiving approvals and, in some cases, not getting approval. I asked her what it’s like for her to have insurance processes control her fate while she continuously tries to use her energy to battle cancer, to save her life.
“I’m pissed!”
She brought a couple letters of denial she’s received, one original and one in response to an appeal. I read them and wondered at the cold uncaring messages that could mean her premature death. One was for a genetic test that could lead, I assume, to immunotherapy or something like it. What must it be like to deny someone a chance — a chance for cure, for remission, for life?
My friend is a strong, capable, warm, caring and smart woman. She is and will not be easily defeated. She says she cries in arms of caring family and alone; she knows the sadness of others and, as I’ve seen on many occasions, she balances her messages with good news and bad news.
Her only break in talking with me was the terrible prospect that her health insurer would fail her and she would have to choose death over leaving a bankrupt family.
Our bankrupt healthcare payment system
My friend contemplates a very real dilemma faced by millions of people, not the poor, not the wealthy, but the middle class depending on their level of health insurance. We should be saddened and alarmed that any person and particularly those that have been responsible throughout their lives would face a choice between bankruptcy and death.
That choice is not uncommon as shown by statistics that also show us many choose life.
The No. 1 cause of personal bankruptcies in America is the inability to pay for medical expenses such as deductibles, co-pays and uncovered care or to pay off the loan secured in order to pay those costs.
No wonder that access to affordable health is the reported No. 1 concern of voters. What isn’t as clear is why our president and Congress are unable to agree on a single remedy for a dire situation. As noted in my last column, “all” or “none” is a recipe for more of the same.
The goal of most insurances, health or otherwise, is to stay in business and make a profit. Companies have a few means that they employ to those ends. Included among them is balancing the risk pool, setting the right premiums and controlling expenses which means pre-approval of some tests and treatments.
Health insurers go into high alert and scrutinize payment requests in the face of the cost of a catastrophic illness or injury such as metastatic cancer and traumatic brain injury or multiple gunshots to the torso.
Catastrophic illness or injury means the condition is life- or ability-threatening in some way. The person with the catastrophic condition goes into an even higher alert over saving his or her life. The condition impacts every aspect of one’s life and focus of living becomes testing, waiting, treatment and waiting for cure.
That is, until the focus becomes financial and the person discovers that health insurance doesn’t pay for all that’s needed.
Add on that many are unable to work at the same level required to meet daily expenses, let alone medical expenses.
It’s a nightmare of anxiety on so many levels.
It’s personal with care providers, patients
Besides her own strength, my friend is held together by her faith in her medical oncologist and the oncology team. Her oncologist works tirelessly to get her what she needs in tests and treatments through the insurer and health system.
She, as most patients are, is confounded that her oncologist, a renowned expert in the field, does not carry any weight in the insurer’s decision.
Remember, too, the enormous amount of paperwork generated to justify treatment that takes valuable clinician time away from patients. That is the dispassionate paper that leaves out the story of a human being struggling through waves of hope and despair.
Every day oncology doctors and nurses guide patients through the struggle of the disease, the treatment and the complications of treatment. They provide the caring haven all while doing their best to keep the wolf from the door.
My friend would warn, “It could happen (to you), you never know.”
And I would add, “Any health care insurance should be a comfort and part of the solution, never part of the problem.”
Bertha Cooper spent her career years as a health care organization and program administrator and consultant and is a featured columnist in Sequim Gazette. Cooper has lived in Sequim with her husband for nearly 20 years. Reach her at columnists@sequimgazette.com.
