The cost of under-insurance reported by Bob Herbert

For Sandra Hightower, the nightmare began in the summer of 2005 when (her daughter) Brittney had to have a cyst on an ovary removed. More cysts developed and in early 2006 doctors found that Brittney had cancer. She underwent surgery in Houston and the prognosis, according to Ms. Hightower, was good. “Everything was fine,” she said. “All results came back clear.”

Ms. Hightower did not think at the time that she would take too much of a financial hit because she had health insurance at her job, and the policy covered Brittney. “All I had on my mind was Brittney,” she said.

The cancer recurred three or four months later and more surgery was required, followed by chemotherapy. The 15-year-old who loved to dance, and who wasn’t sure whether she wanted to be a model or a pediatric nurse, was now having to battle for her life like a warrior in combat.

The next round of bad news came in a double dose. One night, after coming home from school, Brittney suddenly found that she couldn’t walk. The cancer had attacked her spinal cord. As the doctors geared up to treat this new disaster, Ms. Hightower received word that her insurance policy had maxed out. The company would not pay for any further treatment.

Ms. Hightower was aghast: “I said, ‘What do you mean? It was supposed to be a $3 million policy.’ ”

She hadn’t understood that there was an annual limit of $75,000 on benefits. “It was just devastating when they told me that,” she said.

Most of the debate about access to health care has centered on people without insurance. But there are cases like this one all over the country in which individuals are working and paying for coverage that, perversely, kicks out when a devastating illness kicks in.

Americans with inadequate health coverage — the underinsured — are a major component of the national health care crisis. Like the uninsured, they can be denied desperately needed treatment for financial reasons; they often suffer financial ruin; and in many cases they die unnecessarily.

“This is a very significant problem,” said Daniel Smith, president of the American Cancer Society’s Cancer Action Network. “We want to help educate Americans more broadly about the idea that while they think they might be insured, when they’re diagnosed with something as devastating as cancer their policies may not give them the coverage they need.”

Sandra Hightower became almost frantic with the combined tasks of caring for her daughter and trying to figure out how to pay for the increasingly expensive treatments.

“Her back surgery, with the reconstruction and all that, was over three hundred and some thousand dollars,” she said. “I had to start doing fund-raisers, bake sales. And the community kicked in, my community here in Nacogdoches. Definitely the high school. And people donated to a benefit fund at the bank.”

After several months, Brittney was declared eligible for federal disability benefits, which enabled her to qualify for Medicaid. “But we still owed for everything before that,” said Ms. Hightower.

Brittney fought like crazy to survive, her mother said. But in the end, she didn’t make it. She died, at age 16, on June 5.

“I see her everywhere,” said Ms. Hightower, who still owes thousands of dollars in medical bills. “When I go to the grocery store, I see her favorite food. I go shopping, and I see the perfect little outfit that she would love.

“I’m so lost right now. And I feel like I failed my baby because I couldn’t bring in all the help she needed.”

New York Times, Opinion, November 17, 2007

While the uninsured are most at risk, researchers estimate that about a fifth of insured individuals are underinsured and face limits on coverage or substantial financial costs if faced with an illness.

—Kaiser Commission on Medicaid and the Uninsured, 2002