Cancer Debt: The Hidden Costs Beyond Health Insurance

Hospital bills leave Susan Braig $40,000 in debt. And she had insurance
Originally on NPR Morning Edition
April 2, 2009 -- Having health insurance is no guarantee that cancer won't bankrupt you. Even people with insurance can run up large debts for cancer care, according to a new report from the Kaiser Family Foundation and the American Cancer Society.

"It's not necessarily not having insurance — it's not having adequate insurance," says John Seffrin, CEO of the American Cancer Society. "Our best data would indicate that roughly 1 in 5 people in this room today think they have health insurance that will cover them, but if they get a diagnosis of cancer, it's inadequate," says Seffrin, speaking at the presentation of the report.

Treatment In The Doctor's Office
Susan Braig knows what Seffrin is talking about. The 59-year-old jewelry-maker and grant writer in Altadena, Calif., was diagnosed with breast cancer in 2004. She had bought the cheapest insurance she could find, a so-called "catastrophic" policy that just covered hospitalization.


When she learned she had cancer, she assumed her policy would cover all of her treatment. "A lot of it was my own inexperience, assuming every cancer treatment was a hospitalization or surgery," says Braig. "I didn't realize a lot of cancers are now being treated like chronic diseases."


Most of Braig's care was conducted out of the hospital. The MRIs, bone density scans, ultrasounds and chemotherapy were all done in her doctor's office. Her medical bills have now put her $40,000 in debt.


Braig has started making something she calls "prescription jewelry." She uses pills, capsules and medical supplies that have been sealed or glued so they're no longer usable. Her goal in making jewelry out of medical gear is "to show that health care, like cancer, is a luxury."


Bills Looming, Surgery Incomplete
Nelda Lopez, age 48, had a different problem with her health insurance policy. The San Antonio resident was diagnosed with breast cancer in September 2007. She had a double mastectomy that October. Her insurer had a list of doctors it would cover, and her surgeon was on the list.


The surgeon had recommended a plastic surgeon to do the reconstructive work that immediately followed the mastectomy. Lopez remembers being told by the plastic surgeon's office that her insurer considered him to be on their list for the particular type of procedure she received.
But then, she says, "I started having excessive bills." She was shocked. "It was just such a high balance."


She expected to pay $800 for the surgery, but the insurer insisted the plastic surgeon was not in its network. She was stuck with a $2,100 bill that she's still paying off one-and-a-half years after the procedure. Meanwhile, she has postponed steps two to four of the reconstructive surgery, which would make her reconstructed breasts look more natural.


There's no clear count of how many people have had trouble getting their insurance to pay for their cancer care. But officials at the American Cancer Society say that with the bad economy and people buying cheaper insurance policies, the number is growing. The cancer society has set up a hotline for people having trouble paying for cancer treatment. Without much advertising, call volume was up 12 percent in January compared to the previous year, and up 37 percent in February.


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