Today’s Wall Street Journal chronicles the story of a California man’s struggle with a staph infection, which was riddled with quality of care issues and resulted in astronomical amounts of medical debt. Worth a look.
Mr. Dawson’s infection went undiagnosed for months, despite visits to his primary care physician, a dermatologist, and treatment from multiple doctors at a hospital for problems resulting from the undiagnosed infection. Finally, when he went to a spine center, doctors diagnosed the infection which had spread throughout his body. Treatment for the infection was begun, yet because of problems during surgery to remove his pacemaker, he was transferred to a cardiac hospital. He was in and out of the hospital and finally able to go home and start rehab.
His struggle didn’t end after he left the hospital. Like many Americans, his employer’s health insurance had a lifetime benefit cap. Just when he needed coverage the most, it let him down. Halfway through his hospital stay, Mr. Dawson “maxed out” his plan, leaving him uninsured facing huge hospital bills. To add insult to injury, with his insurance coverage expired, Mr. Dawson lost the advantage of his insurer’s negotiated rates for care. Like all uninsured, he was faced with charges for supplies and services far more than charged to private insurers or public payors with little relation to actual cost. His hospital bill alone accrued to over $1 million.
Could this happen to someone insured in Massachusetts? Yes. The Connector chose not to prohibit (or limit) lifetime caps in its Minimum Creditable Coverage standards. We hope they reconsider this issue as promised this year and think of people like Mr. Dawson when deciding whether insurance with lifetime caps provide people with adequate coverage. Mr. Dawson never would have had to deal with the bills if his care had been appropriate and if his doctors had considered all his symptoms and possible diagnoses.
There was a happy ending for Mr. Dawson. He survived his struggle and slowly returned to normal life. He now receives VA health care coverage and after a year of fighting with providers over the charges, Mr. Dawson found out he qualified for charity care from the hospital. It’s alarming to think of him as one of the “lucky” ones.