The worst side effects of cancer treatment can be financial: strokes

Carol Marley wants everyone to know what a life-threatening cancer diagnosis looks like in America today.

Yes, that's the chemotherapy that leaves you weak and unable to cross the room. Yes, it is the litany of tests and treatments – CT and MRI, biopsies, endoscopies, surgeries, blood tests, X-rays and visits to the doctor. Yes, it is your funeral that torment you day and night.

But none of these is his most gnawing preoccupation, ever present.

These are complicated medical bills that fill several workbooks, exhausted savings accounts that destroy early retirement plans, and so many phone calls with insurers and health care providers.

"I trust God that my cancer is not going to kill me," says Marley, who lives in Round Rock, Texas. "I have more difficulty believing that this will be solved and that we will not hurt ourselves financially.This is the bond of faith with which I struggle."

Dealing with the financial consequences of cancer is exhausting – and nerve-wracking. But the worst, according to Marley, is that it's unexpected.

When she was diagnosed with adenocarcinoma of the pancreas head in July, she had not expected as many bills, nor as many billing errors. After all, she is a hospital nurse and has a good private insurance which has allowed her to have access to doctors and hospitals of high quality.

Randall Marley, a computer systems engineer, explains that he often comes home from work to find his indisposed and frustrated wife having spent a precious day of convalescence making phone calls to understand and challenge medical bills. One recent night, she was in tears and "emotionally at a breaking point," he says. "The most difficult thing is to see the negative consequences for my wife."

Stress-inducing bills accumulate

According to a study published last year, more than 42% of the 9.5 million people diagnosed with cancer between 2000 and 2012 have exhausted their property in a day. American Journal of Medicine. Cancer patients are 2.65 times more likely to file for bankruptcy than people without cancer, and bankruptcy exposes them to a higher risk of premature death, according to studies.

But these statistics do not reflect the daily misery of a patient with a life-threatening illness, trying to manage the convoluted financial demands of the US health care system while facing a roller-coaster of treatment and cure.

Stephanie Wheeler, a professor at the University of North Carolina at Chapel Hill, said the number of invoices from different vendors could be overwhelming.

"It's often several different bills that come up over a period of months and sometimes even years," said Wheeler, who conducted a survey of patients with metastatic cancer. "When these bills start to accumulate, it can be very stressful."

Because many patients can not work during treatment, these bills can force even relatively affluent patients to take out a second mortgage, spend their university savings, or be afraid of leaving a debt to their family, says Wheeler.

Carol Marley is a light woman who loves her two dogs and is involved in her church. His father, who was 88 years old and had dementia, had moved in a few years before. She and her husband, Randall, are proud to live frugally. They pay their credit card every month and do not pay for their car.

Carol and her daughter, June Marley, a sophomore, have taken out health insurance with her employer, Ascension Health, a large, faith-based health care system with facilities across the country. Carol's husband has separate insurance by his job.

They hoped to retire early, buy a RV and tour the country. Instead, they see their meticulous plans disappear, even if Carol recovers.

Due to their high deductible insurance policy, they had to pay $ 6,000 before their insurance began to cover their processing fees. They reached their annual maximum of $ 10,000 well before the end of the year.

But Carol says she was ready for that. "What I did not anticipate was the decisive battle I would have to lead to people understanding that there were mistakes and correcting them.

As she is unable to work, the family lost her breastfeeding salary.

"The money does not come in and it goes out by the thousands," she says.

From nurse to patient

Carol had already cared for cancer patients. She had seen them arrive with unexplained pains and leave with devastating diagnoses. Now it was his turn.

Although she did not recognize her at the time, her symptoms were symptomatic. Tired. Back ache. Weightloss. In July, doctors told her that she had pancreatic cancer.

Her first thought was that she was going to die. A nurse friend asked her if her business was in order. Indeed, pancreatic cancer is usually discovered too late. Five years after diagnosis, only 9% of patients are alive, compared to 90% of patients with breast cancer.

Carol knew that she was lucky. His did not spread. She may be able to undergo surgery. But first, four months of chemotherapy and five weeks of radiotherapy.

Chemotherapy – seven or eight sessions, she does not remember anymore very well – has exhausted her. "I could not put words in my head," she says. She had muscle spasms and developed fevers that brought her to the emergency room.

In weakening, Carol realized that she could no longer look after her father at home. A recent morning, early January, she sat down with a nurse from a memory care facility where a space had become available. Retaining her tears, Carol told the nurse that she knew that day would come. "I did not think it would be so early and I did not know it in these circumstances."

Different insurers lead to different bills

Later that same day, Carol 's energy was up. She adjusted the colored scarf over her head, turned on her computer and took out a pen. Some days she spends hours trying to clarify and pay medical bills. "But I do not do it often because it's so sterile and stressful," she said.

Often, she is simply trying to understand what different bills mean. "Even as a nurse, I have the impression that it's impossible to understand," she said. "I can not make it head or tail."

Sometimes there are mistakes.

According to her, part of the problem is that one insurance company covers visits to Ascension's suppliers and hospitals, and another company covers pharmacy claims, specialty medicines, and non-hospital suppliers. Ascension. Some of the bills, including a $ 1,400 bill during an emergency visit, were sent to the wrong insurer, she said.

Carol cites other problems. A $ 18,400 chemotherapy bill containing missing information was submitted and then declined because it arrived late. An MRI invoice of $ 870 was declined because the vendor had stated that there was no prior authorization.

"It's not a particular individual, it's not a particular system or provider," she says. "The whole system is messy, there is no recourse for me if it is not to continue making phone calls."

In this afternoon, Carol has a long list of calls to make. One to understand why she could not access her insurance claims online. Another health care provider urged her to pay $ 380, even though she acknowledged that she owed him about $ 80 out of that total.

Someone who answers the phone again suggests that Carol pays the full amount. "Once your account has been posted and it is sent, we will send you a check," says the woman.

Carol shakes her head. "I'm sure you're all good people there, but I do not trust a refund," she says, referring to her experience as a cancer care consumer. "The problem is that they want their money and are going to get it one way or the other."

As for his hospital bills, Ascension declined to comment, citing protected health information. But spokesman Nick Ragone said: "The issue has been resolved favorably".

He did not say what problem had been solved.

Kaiser Health News is a non-profit news service covering health issues. It is an independent editorial program of the Kaiser Family Foundation and is not affiliated with Kaiser Permanente.