Even the Insured Often Can’t Afford Their Medical Bills

By Helaine Olen

A chance trip to Long Island’s Adventureland amusement park just might have saved Cassidy McCarthy’s life. After Cassidy—whose family calls her Cassie—then 4, complained about pain and nausea following a ride on the Ladybug rollercoaster, her dad, Daniel, a registered nurse, felt her stomach and discovered a small bump. A CT scan ordered up at a local hospital’s emergency room revealed a kidney tumor.

It was another seemingly chance decision by Daniel McCarthy to sign on as a volunteer firefighter more than a decade ago that saved the family’s finances in the wake of Cassidy’s diagnosis with cancer. As it turned out, that activity allowed him to ask The Heather Pendergast Fund, a foundation set up in 2009 to help out the families of Long Island’s volunteer firefighters and EMS workers with their children’s medical expenses, to pay many of Cassidy’s medical bills.

McCarthy says the charitable foundation was a financial lifeline. Cassidy quickly racked up more than several thousand dollars in out-of-pocket medical expenses—for the surgeon, the anesthesiologist, radiologists, chemotherapy, you name it—since the family’s insurance policy had a $6,000 deductible. A few months later, Pendergast came through again when McCarthy lost his job at a local nursing home and rehabilitative center and the family suddenly had to find money for COBRA payments, which, at $2,100 a month, were more than the monthly mortgage payment on their West Babylon, Long Island, home.

“I don’t know how people who don’t have resources do this. I don’t. Many people work three, four jobs, and can’t afford the time to volunteer in an organization like the fire department that would be able to help them. There are many people living out there that need help that can’t find it,” McCarthy says.

The current debate over the future of the Affordable Care Act is obscuring a more pedestrian reality. Just because a person is insured, it doesn’t mean he or she can actually afford their doctor, hospital, pharmaceutical, and other medical bills. The point of insurance is to protect patients’ finances from the costs of everything from hospitalizations to prescription drugs, but out-of-pocket spending for people even with employer-provided health insurance has increased by more than 50 percent since 2010, according to human resources consultant Aon Hewitt. The Kaiser Family Foundation reports that in 2016, half of all insurance policy-holders faced a deductible, the amount people need to pay on their own before their insurance kicks in, of at least $1,000. For people who buy their insurance via one of the Affordable Care Act’s exchanges, that figure will be higher still: Almost 90 percent have deductibles of $1,300 for an individual or $2,600 for a family.

Even a gold-plated insurance plan with a low deductible and generous reimbursements often has its holes. Many people have separate—and often hard-to-understand—in-network and out-of-network deductibles, or lack out-of-network coverage altogether. Expensive pharmaceuticals are increasingly likely to require a significantly higher co-pay or not be covered at all. While many plans cap out-of-pocket spending, that cap can …read more

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