Cancer Patient Loses Coverage For Earning $4.25/Month Too Much

Over at the Phoenix New Times, they have the harrowing story of a young man who endured multiple surgeries and treatments for a rare type of brain tumor — and who was told by his health plan that they could no longer cover him because he and his wife had earned $4.25 too much to qualify for aid.

The tumor and subsequent surgeries had made it impossible for the man to work and his wife’s part-time job was not sufficient to pay for health insurance. So when he first entered the emergency room in October, both he and his wife were enrolled in the Arizona Health Care Cost Containment System (AHCCCS) which paid for the sky-high hospital bills.

However, in January they received a notice from AHCCS that they had been dropped from the program because they had earned a combined total of $612.25 the previous month; the threshold for AHCCS coverage is $608/month.

That meant that the couple would now be on the hook for the husband’s $8,227/month bill — just for his medication.

Not shockingly, when they took up arms against AHCCS, they found themselves bound up in all manner of red tape and ineptitude:

We were told by one person to do one thing — by someone else to do another… There’d be all these paperwork hoops. We’d send things in three times. They’d say, ‘We never got that. You’re lying.’ Or, ‘It’s processing.’ We’d call back a week later. ‘It’s processing.’ The week after that? ‘We never got it. You’re lying.’

After several months of bashing their heads against the wall, AHCCS finally gave in and put the husband back on the program.

His wife, however, was not re-added. The reason? During the stoppage in her coverage. she had stopped taking some medications she could no longer afford. Thus, she was unable to prove to AHCCS that her medical bills had been at a level that requires assistance.

‘Til Death Do Us Part: They Got Married. Then Everything Changed [Phoenix New Times] (Printer Friendly Version)

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  1. peebozi says:

    what next, they’re going to reinstate someone who made $5 more!??! When does it end?

    actually, the logical jump conservatives/trolls will make is “what next? they’re going to reinstate someone who made $5,000,000 more?!? When will it end?”

    • Geekybiker says:

      It doesn’t. However a soft cutoff will stop these sob stories. Make a 100% line and a 0% line and between there your coverage is based on the percentage of the difference. No sob story for making $5 more.

    • Bob says:

      So make them pay an additional $4.25 a month! Problem solved. No soft limits needed, you simply pay the overage to AHCCS. If they were $5 million/month over the limit, do you think they would pay this bunch of idiots at AHCCS $5 million in overage for a disease that cost only $8227 a month?

      • Beeker26 says:

        This. In NY it’s called a spenddown. If you’re disabled (as he clearly is) and on Medicaid, if you make more than the cut-off you simply have to pay them the difference.

        Of course NY has always been very progressive with Medicaid. Most states are at least 20 years behind.

    • coolkiwilivin says:

      Conservative/Trolls? Please, the issue conservatives have is that this situation clearly states the danger of bureaucratization of any service or industry. Bureaucracy has no ability to flex. Whether it’s a government bureaucrat or some soulless actuary, both are divorced from people. Do all of you free healthcare people actually think that the people who bring you the DMV, welfare and a whole other host of government inefficiencies will do any better than this?

      • kujospam says:

        But the point Most conservatives miss, is that more corporations are the same, and they are more difficult to change than the government.

  2. coren says:

    This is a fascinating read – but unfortunately page 4i s missing.

    (I really hope this article doesn’t get inundated with “obamacare is gonna suck, see?” type comments either)

    • TheGary says:

      No, But I think its crazy that AHCCCS will insure and pay for 100% of the costs for preggo’s to pop out as many kids as they want (srsly, there’s no limit) at the drop of a hat. Folks like this man and like my own mother who was denied aide by the state and died of brain cancer(she was unemployed for months even before the recession) are made to jump thru endless hoops. I guess the state figures it will keep them busy till their eventual death.
      My mother was even denied SS despite the fact that half her skull was removed. I find it INSULTING that people who do not deserve these benefits get them with ease, and the ones that need it are made to suffer.

    • TheGary says:

      No, But I think its crazy that AHCCCS will insure and pay for 100% of the costs for preggo’s to pop out as many kids as they want (srsly, there’s no limit) at the drop of a hat. Folks like this man and like my own mother who was denied aide by the state and died of brain cancer(she was unemployed for months even before the recession) are made to jump thru endless hoops. I guess the state figures it will keep them busy till their eventual death.
      My mother was even denied SS despite the fact that half her skull was removed. I find it INSULTING that people who do not deserve these benefits get them with ease, and the ones that need it are made to suffer.

      • guroth says:

        I guess they would rather pay a one-time preggo fee to produce life rather than pay 8k a month to sustain a dwindling life that no longer contributes to society due to disability.

  3. jaazzman says:

    Everytime I think, boy, it sucks to be Canadian…I read shit like this and immediately change my mind. I have surgery this Thursday. I don’t even know what its going to cost, never asked, never felt the need to since I automatically have coverage. Yes, our health care system has its issues, just like they all do, but at least I’ll never have to worry about BS like this…

    • dyzlexiK says:

      The only problem with Canada i’ve ever noticed (Being Canadian on a border city, so seeing both) is retail goods. The US has more selection on goods. I so, so miss my cherry coke.

      • kennedar says:

        My husband makes special trips to the states for his cherry coke.

        I have some issues with our health care here, esp since we are going through infertility treatment which is expensive. But then I hear about people having to worry about the cost of cancer treatment and such just to live and I can not imagine going through that!

        • Verdant Pine Trees says:

          Absolutely… I have good insurance and I still can’t get all infertility related stuff covered.

      • psm321 says:

        But you have ketchup chips!

        • JonBoy470 says:

          And poutine!

        • Fafaflunkie Plays His World's Smallest Violin For You says:

          And those ketchup chips are barred from exporting, too! %] Okay, maybe they’re not, but we’re hoarding them. Along with the dill pickle chips. None of them for you, either.

    • Branden says:

      i’m canadian, my wife and i recently had our first baby. healthcare costs ran $164. $100 for optional pre-natal classes (actual cost was significantly more, but was heavily subsidized by the provincial government), $39 for 3 days of parking, and $25 to upgrade from semi-private to private recovery room.
      by comparison, friends of ours in arizona said their second baby came with a $12,000 bill.

      • Nigerian prince looking for business partner says:

        That sounds about right. Pre natal care and birth came to about $14,000 for us in the USA. Because we mistimed conception, we had to pay two years worth deductibles (he was born in January). All in all, we had to pay $7,500 for a child with insurance picking up the rest.

        According to our obstetrician, it’s increasingly common for doctors to induce labor at the end of December to help couples who have due dates in early January.

  4. coren says:
  5. pax says:

    If only he had thought, before age 24, to save up 8 grand a month for chemotherapy. Or learned to make his own chemotherapy at home.

    [/sarcasm]

  6. ShruggingGalt says:

    I had a similar problem with a government run health care issue in CA.

    I finally gave up even though it took 1 year for my appeal to be heard, and then it took my effort over the next 6 months to actually get the problem “resolved”.

    And it was resolved by paying the doctor the claim amount that I had paid myself, due to an error on the government’s part. Like the woman who was declared dead by the SSA due to a CLERICAL error.

    Who will get the blame when these things happen more frequently?

  7. VeganPixels says:

    I dunno how to convert this to chickens. The only cancer-to-chicken choices I see are colon, prostate or breast. Can somebody help me out?

    http://lowdenplan.com/

    • catastrophegirl chooses not to fly says:

      the only brain thing there is ‘repair aneurysm’ coming in at 1533 Chickens. the article says he had multiple surgeries for the brain tumor. if you take the cancer average of 5249 [for the conversion rate for breast cancer, colon cancer and prostate cancer] add it to repair aneurysm and multiply it by the number of surgeries, you’ve probably got an estimate of the appropriate number of chickens.
      i suspect in this case you might want to just go ahead and convert the chickens to cows [large bills] for ease of transport.

  8. Loias supports harsher punishments against corporations says:

    The private insurance system is working just fine.

    Nothing to see here, move along.

    • craptastico says:

      this has nothing to do with private insurance, they were enrolled in a publicly funded state health plan. you can’t assume that a state plan would be able to provide unlimited coverage. they still have come up with the money to pay.

      • OnePumpChump says:

        The private health insurance system is part of why uncovered costs are so high. Also, it is part of why state health insurance systems are so overtaxed, since they cherry-pick the lowest-risk, highest-paying customers and dump people who would cost too much into the state systems.

  9. brinks says:

    It was for a much smaller amount, but my ex-boyfriend applied for aid to pay for an emergency room visit. The approval process took some time, as he applied while he was AT the emergency room at the suggestion of the triage nurse. He received a bill, but, before it was due, he received notice that he was approved for aid and it would cover the bill.

    He still kept getting billed for it anyway, but he refused to do anything about it. It went to collections…and that’s when we dropped our landline. That was the only number the were given.

    He’s fine now and he already had bad credit, so he never felt there was any reason to try and fix it. However, the poor guy in the story has got a long road ahead of him. I hope this matter stays resolved, but it seems like they could easily pull this on him again. I kinda hope his wife never gets a raise.

    • FunChefChick says:

      That’s just it – the poor guy in the story does not have a long road ahead of him. He’s likely to have a very, very short and aggressive and povery-stricken road ahead of him and will die destitute unless something is done, and fast. Glioblastoma Multiforme kills 98% of patients within 2 years. He is already beating the odds staying alive this long, and he had a painful progression of loss of sight and mobility ahead of him.

      This system is heartless and must be changed.

  10. Consumeristing says:

    The Arizona Health Care Cost Containment System (AHCCCS) that refused coverage to the cancer-stricken man is Arizona’s Medicaid program. Government messes up, it also runs out of money. It’s not a magical unicorn that automatically rights the wrongs of the private sector.

  11. axiomatic says:

    I now know that I could never work for an insurance company as I actually am capable of compassion.

    AHCCS obviously is not capable of compassion.

    • craptastico says:

      it has nothing to do with compassion, it has to do with reality. it’s a state run plan for low income people and there’s only so much money to go around. if they spend money on this guy it directly comes out of their ability to treat someone else. it sucks, but until the whole process is overhauled from the bottom up there’s always going to be tough decisions like this that have to be made.

  12. Rachacha says:

    I understand that an insurance program like this needs to have a cap as it appears to be intended for individuals with low income, but based on the consumerist article it appears as if qualification is based on a monthly salary rather than an annual or quarterly salary which seems like a terrible way to do things. If you are on a program like this, you are likely punching a time clock every day and get paid for the hours you work. In situations like this it is difficult to manage your hours and keep your job if you have to look at it on a monthly basis. Averaging out the monthly salry over 3 months or better yet, 12 months would be a better way to approach it to account for seasonal variations in work that typically accompany an hourly job.

    I understand why they dropped coverage (they need to have a cut-off at some point) and I am glad that he at least appears to be back under the program, but it sucks that they had all of that hassle and that she now was dropped from the program.

    • brinks says:

      The hours you get at hourly jobs vary enough during the year that determining eligibility for programs like this on a monthly basis makes no sense. Coming from a retail background, I can tell you that some “full time” managers only get 32 hours a week during slow periods, but might work 55 hours during peak times. Over the course of the year they still might be eligible for a program like this, but they would be dropped every few months when things get busy and they have to work overtime (i.e. Christmas and back to school). The overtime is mandatory. It’s not an option to just work your 40 and go home.

    • coren says:

      Yeah you hit the nail on the head – someone who isn’t making a consistent monthly wage shouldn’t be penalized because they had a few hours fall on the wrong side of an arbitrary group of days.

    • coren says:

      Yeah you hit the nail on the head – someone who isn’t making a consistent monthly wage shouldn’t be penalized because they had a few hours fall on the wrong side of an arbitrary group of days.

  13. Ramona_Little says:

    It sure sounds like they have a malpractice case against the therapist. The patient said he felt seizures on one side of his body, along with all the other symptoms, and she said it was panic attacks? The therapist should have recommended testing to rule out a brain tumor or other physical ailment.

  14. prizgrizbiz says:

    What? In Obama’s America?

    • Evil_Otto would rather pay taxes than make someone else rich says:

      Wow, took 3.5 hours for the conservatrolls to come out. Busy Monday?

    • The Porkchop Express says:

      awesome comment. Too bad nothing has changed as far as healthcare reform yet. If changes had been made and were in effect you may have a point. As it stands….

    • coren says:

      What? Before Obama signed the health care legislation?

  15. 44Wadeable says:

    http://www.photius.com/rankings/healthranks.html

    http://www.infoplease.com/ipa/A0934556.html#axzz0w8mjra95

    Summary: the US pays more per capita on healthcare than other governments listed (even those with ‘socialized’ healthcare), but is ranked by WHO as 37th in healthcare quality (if anyone can find a more up to date listing on WHO rankings, I’d be happy to eat my shoe if the US makes a big jump). And if I’m reading the information on the new healthcare bill right (http://www.healthcare.gov/law/timeline/index.html), then this poor guy is unaffected by the healthcare bill yet. He’s suffering the previous broken system, not Obama’s.

    • dreamfish says:

      Outcomes are irrelevent – the important thing is to make sure the healthcare system doesn’t look remotely OMG SOCIALIST!!

    • TuxthePenguin says:

      Why don’t you take a look what generated the rankings and then tell me if you think those are really accurate of what a health system should be.

      The one that gets me is the “fairness” portions. Trust me, what they say isn’t fair is not what most people would say is fair…

  16. H3ion says:

    There are so many of these issues that could be solved before they became a serious problem if caps were subject to some deminimis adjustment and if the CSRs were given a little latitude instead of being automatons.

  17. newfenoix says:

    This wouldn’t have happened if he was an illegal….

  18. smo0 says:

    Just makes you wonder if the next step in this up and coming health care reform will fix issues like this.

  19. Jecker says:

    This sucks. However, just for the sake of argument, doesn’t the line have to be somewhere? If we let this guy get it, then the next guy who is over by $8 should get it to, then $12 over, $20 over…

    • Beeker26 says:

      The solution is a spenddown that allows them to get coverage by paying them the excess income. Many state Medicaid plans allow this, and it’s there specifically to fix this issue.

  20. Difdi says:

    Washington state food stamp programs work a lot like this. The more money you get (from any source) in a month, while remaining below a certain wealth level, the more food stamps you qualify for. If you somehow lose half your monthly income, you also lose half your monthly food stamps.

  21. inputhike says:

    This is exactly why I’ve been in support of Obamacare. Because right now, Medicaid actually encourages not working — there’s not much you can do that nets you less than $608 a month (and where can you even live on $700 a month? That only works if you can live in your mom’s basement).
    We were once told by AHCCCS that because we made a few hundred dollars more than their limit, there was no way to qualify — period. Some sort of spend down was not an option. It was something like we were making $1,000, spending $800 on medical bills, but couldn’t join. If we could have found a way to reduce our income to $600 (without eliminating it entirely), we actually would have come out ahead by $400/month. My college education didn’t prepare me for this type of math.

  22. JonBoy470 says:

    In Canada, this wouldn’t have been an issue, because he would have waited for so long for the MRI that diagnosed the cancer to begin with, that it would be too far along to be cured and he’d be dead already.

    As for those who tout reports from the WHO that rank US healthcare as #37 in the world, you have to look at the criteria they’re using. They’re looking at equality of healthcare and how effectively a country is using the resources it has available. So a country with universally sucky healthcare, that has no possiblility of having better healthcare because they’re using their available resources efficiently, can come out ahead of the US. I’ll buy Singapore, or the United Arab Emirates being better than us. They’re small, and have ridiculously high GDP per capita. But Morocco? The Dominican Republic? The UK?

    I doubt there’d be so much “medical tourism” from Europe, or Canada, to the US if our healthcare system so as jacked up as this list makes it out to be.

  23. shibblegritz says:

    Well, well well, what do we have here … a case of *government* not being compassionate when it comes to health care? Can’t say I’m shocked.

    All of you who whined about how insurance companies had a market exclusive on “evil” and “heartless” acts? Guess what? This is what you would have gotten with public option, and it’s what you will get, sooner or later, if you keep up the ignorant whining about the perfection of government solutions.

  24. vonvand says:

    Pretty soon this will not even make the news – folks this is the state Medicaid program that did this. In a few years most of us will be FORCED on to this program, and a whole lot of us are going to die.
    Welcome to Obama’s AmeriKa

  25. TheBradOne says:

    @JonBoy470

    The wait lines for MRI’s in Canada are just totally crazy.

    I mean, when I called an ambulance with severe lower back pain three months ago and they wheeled me into outpatients for a series of tests and decided to do an MRI to rule out internal bleeding I ended up on this huge wait list

    I mean, how can they possibly get away with having a wait list that’s over two hours long! Its inhumane, I had to lay there in outpatients in my nice, toaster warmed blanket under the constant attention of pretty nurses for almost two and a half hours before they wheeled me upstairs to radiology.

    (Oh, and the trip was ludicrously expensive at a grand total of $0.00)

    /sarcasm

  26. Kibit says:

    I understand cut off amounts, but $608 a month, for two people? Seriously? This just makes me sick!

  27. BuyerOfGoods3 says:

    I understand why some people choose to abandon reality and live in a state of insanity; the Things we do to our People in the name of Corporate America are disgusting.

  28. omg says:

    This isn’t surprising. Programs for “the poor” (e.g. Medicaid is often called “health insurance for the poor”) target children and their parents; the Medicaid income cutoff in most states is usually in the neighborhood of one-half the poverty line. No kids and a minimum wage job? Fuhgeddaboudit.