Your Health


It's MORNING EDITION from NPR News. I'm Steve Inskeep.


And I'm Renee Montagne. Today in Your Health, how hard it can be to buy a health insurance policy on your own. But first: Just because you have insurance doesn't mean your cancer care will be covered. NPR's Joanne Silberner reports that you have to be very careful and very aware to get what you're due.

JOANNE SILBERNER: Susan Braig got the bad news five years ago.

Ms. SUSAN BRAIG (Cancer Patient): In July, 2004 a shadow on a mammogram indicated I had a Stage 2 invasive breast cancer tumor.

SILBERNER: She's a part-time artist and a part time grant proposal writer in Altadena, California. Braig had bought herself the lowest cost Blue Cross plan she could find. It just covered hospital care.

Ms. BRAIG: I thought that at least I would be covered for the big stuff, and the small stuff I would just have to take care of it myself. I thought cancer was the big stuff.

SILBERNER: Cancer is a big deal medically, but much of the care can be done in a doctor's office. Her hospital-only insurance didn't pay for her chemotherapy, MRIs, bone density scans, blood tests, doctors visits and more. As a result, Braig is now about $40,000 in debt.

In San Antonio, Nelda Lopez was diagnosed with breast cancer in September, 2007. Her insurance policy only covered certain doctors. She found a surgeon on the list to do the bilateral mastectomy. He recommended a plastic surgeon for the reconstructive work. Lopez thought the plastic surgeon was on the list too. The first physician had recommended him and the plastic surgeon's office had told her he was part of the network for this particular procedure. But…

Ms. NELDA LOPEZ (Cancer Patient): After my surgeries I started having excessive bills coming in and coming in. And I'm wondering, God, why, you know, there's just such a high balance now.

SILBERNER: Her insurer said her surgeon was not on the list and refused to pay. Lopez made countless call to the doctor's office and insurer during her lunch hour and breaks.

Ms. LOPEZ: You know, you fight one battle and then it's like I was fighting another battle.

SILBERNER: Lopez has given up, at least for the moment. She's paying off her $2,100 balance $50 a month. She's delaying the second stage of the surgery, routine patches to the scars and cosmetic restoration for the breasts.

Avoiding insurance pitfalls can be a challenge, says John Rowe. He headed insurance giant Aetna for six years. He says, though, that there are things you can do when your doctor tells you you have cancer.

Mr. JOHN ROWE (Former Aetna Executive): The first thing you should do is you should take out your insurance card and turn it over and call the number that says questions, help, call this number. Every insurance card has a number.

SILBERNER: Many insurance companies can point you to a hospital or program that's fully covered. Rowe's second suggestion would have helped Nelda Lopez. Get a list of in-network doctors from your insurer and bring it with you to every doctor's appointment. When all else fails, he says, negotiate.

Mr. ROWE: Many hospitals will be willing to work with you to reduce your exposure or to provide you with a payment schedule, a no-interest payment schedule. Just don't give up.

SILBERNER: All well and good, says health insurance expert Karen Pollitz of Georgetown University, except for one thing. It's tough to think clearly after hearing a cancer diagnosis. She recently told some cancer survivors how she felt when two weeks after her preauthorized mastectomy she got a claims statement.

Ms. KAREN POLLITZ (Cancer Patient): And it had been denied. And you know, it turned out to be a mistake. But there I was, you know, a health policy expert. I worked for the Secretary of Health of Human Services. I was pretty wired. You know, my husband worked for a Fortune 500 company. And I sat down on my kitchen floor and cried. I did.

SILBERNER: Her advice: be careful what you buy in the first place. Co-payments can add up when you have cancer. And a policy with a $10,000 annual cap won't even get you through your first surgery.

Joanne Silberner, NPR News.

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