RACHEL MARTIN, HOST:
This morning, we're looking at the kind of health insurance plan the Trump administration has promoted as an alternative to Obamacare. These plans could be a cheaper alternative to the ACA, but that's because they can end up covering a lot less. We have Elisabeth Rosenthal here to tell us about this. She is editor-in-chief at our partner Kaiser Health News, and she joins us now for our series Bill of the Month.
Elisabeth, thanks for being with us.
ELISABETH ROSENTHAL: Thanks for having me back.
MARTIN: So the whole point of this series is to focus on one person and one medical bill that tells a larger story about health care right now. So with that, who are you introducing us to today?
ROSENTHAL: This month, we're going to meet Arline Feilen, who lives in suburban Chicago. She's 56 years old and a medical transcriptionist and bought one of those bare-bones plans knowing that it didn't cover mental health, which she didn't expect to need.
MARTIN: But I think we're about to hear she did end up needing it. Christine Herman from member station WILL in Urbana, Ill., paid Arline a visit. Let's listen.
CHRISTINE HERMAN, BYLINE: Over the past several years, Arline Feilen has been hit by loss upon loss, starting when her husband died by suicide in 2013.
ARLINE FEILEN: Lost my husband, lost my dad, lost my mom, had to put my dog down. But losing my mom really knocked - it was, like, the last thing - you know, knocked my feet out from under me.
HERMAN: Arline and her mom had a very close relationship.
FEILEN: We would talk six, seven times a day about the silliest things. I liked to cook for her and, you know, bring her food. That was kind of my niche (laughter).
HERMAN: Arline says her mom's death didn't really sink in at first.
FEILEN: And then, you know, after the dust settled, then it was - OK, you know, that's when the grief started to, you know, come in.
HERMAN: After her first Mother's Day without her mom, Arline spiraled into a depression. On a particularly hard night, she drank too much. She sent a text message to friends that made them worry she'd harm herself. So her friend called 911. An ambulance came and took Arline to a nearby hospital. She spent five nights there in psychiatric care.
FEILEN: I must have met 25 professionals while I was there. OK, this is the person who's going to talk to you about this, then you're going to go to this person's office. It was all very head-spinning.
HERMAN: The whole time, Arline worried about money. She had skimpy health insurance that didn't cover mental health care, so she asked questions.
FEILEN: I asked several times, what is this going to cost me? What is that going to cost me? I'm underinsured. And there were no answers. It was just like, it's been ordered, so just go with the program, you know?
HERMAN: Arline says the group counseling helped, and so did the antidepressant she got. Since her hospitalization, she has continued therapy, stopped drinking and has felt her grief recede.
FEILEN: When I got home, I felt happy and safe and like it was - you know, I hadn't gotten the bills yet - but like it was all kind of worth it in a weird way.
HERMAN: But then those bills arrived - $1,400 for the ambulance, $185 for lab tests.
FEILEN: And then the big whopper came.
HERMAN: Four days in the psych ward came out to a whopping $21,000. Her insurance won't cover it. Arline is a freelance medical transcriptionist who struggles to make ends meet, so she doesn't know how she'll pay for it. Through all of this, Arline's sister Kathy McCoy has been one of her biggest advocates. On a recent Sunday, they walked through the neighborhood where they'd grown up as kids and discussed plans for their next family gathering.
FEILEN: I was watching Food Network the other day, and they made oxtails.
KATHY MCCOY: Oh, my gosh.
FEILEN: Remember when Mom used to make oxtail soup and stew?
MCCOY: She made it...
HERMAN: Kathy says she's happy Arline is feeling better but frustrated that she's saddled with an enormous medical bill. She compares it to a twisted form of grocery shopping.
MCCOY: So you get to the checkout, and then you have to figure out how are you going to pay for that? It's kind of like that.
FEILEN: Yes, it's very frustrating and maddening and stressful. And it's unfair. Like Kathy said, who can get away with that?
MARTIN: Wow. Elisabeth, I mean, $21,000 for four days in treatment. Is that even typical - that price tag?
ROSENTHAL: Well, it sounds really high, right? It's twice what many insurers would've paid. And Medicare and Medicaid would've paid even less. But the real question to me is, should a patient who's in the midst of a medical crisis have to be negotiating price, thinking about, oh, my gosh, what's this going to cost?
MARTIN: Right. We should just point out, though, again, she did buy this policy knowing it didn't cover mental health, though. That's on her. Is it not?
ROSENTHAL: Well, not exactly. I mean, many mental health conditions are chronic, like depression or anxiety. And that wasn't the case here. You know, kind of - grief sometimes comes out of the blue.
ROSENTHAL: And mental health crises catch you off guard. So, you know, that's what health insurance is for - things that you don't expect. So, yeah, it's a little bit on her, but isn't this what we want health insurance to do?
MARTIN: Right. So let me ask, why is it that some policies just leave mental health care out in the first place?
ROSENTHAL: Well, that's a great question. The Affordable Care Act tried to fix loopholes like this, saying that to count as health insurance you had to cover a certain basket of services, including mental health. But the Trump administration rolled back these policies, saying that it could make insurance really expensive. It's allowed these cheaper bare-bones policies to be sold, like the one Arline bought. And, you know, they're really tempting to people trying to look after their pocketbooks because they're cheap.
ROSENTHAL: But if you need something they don't cover, you're stuck, and a hospital or a provider can charge whatever it wants.
MARTIN: So let's get back to Arline. What is next for her?
ROSENTHAL: Well, she's going to keep trying to negotiate with the hospital. And patients should always remember that they can negotiate. When you get a crazy bill, fight it. Hopefully she can get it down to a number that's more in line with what some of these others insurers would pay.
MARTIN: Well, we wish her well.
Elisabeth Rosenthal, thank you so much. We appreciate it.
ROSENTHAL: Thanks for having me.
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MARTIN: Elisabeth is editor-in-chief at Kaiser Health News. And if you have a confusing or outrageous medical bill you'd like us to take a look at, go to NPR Shots blog.
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