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  • KM

The Financial Burden of Chronic Disease

Updated: May 24

This is how the cost of care impacted my ability to receive the care I needed.

I was diagnosed with rheumatoid arthritis in 2012, and my disease escalated and became difficult to control in 2016. Insurance has slowed my care and limited access to treatments and medications throughout the course as well as requiring extensive phone calls on my part to obtain care.

Getting insurance approval for new biologics that have been required since my disease progressed, takes up to a month. During this process, I am often on the phone with the insurance and physicians’ offices up to two hours a day in order to advocate for my care and get approval. Then when a new treatment is approved, insurance dictates how many treatments I must receive before a new biologic can be tried when the old one is ineffective.

Initially, I had a family health insurance policy through my husband's small business making for high premiums and deductibles. My personal deductible was $6000 annually and 80/20 thereafter until a cap was reached. My personal health care expenses with insurance were about $12,000/ year after paying premiums.

My husband retired and went on Medicare in August 2021, after we had long met our annual maximum deductible where I should have been covered at 100%. I went on Cobra September 1. I was paying $773/month premium for myself only and I sent my first premium check September 1, which they immediately cashed. It took one month and near daily phone calls to get an insurance card. I had three physician appointments that month with no proof of insurance. Cobra could not promise they would reimburse for care or prescriptions during September. I was forced to skip some prescriptions due to cost. Then when I finally received the insurance card, I found my deductible was starting over. This took 2 ½ months to correct with numerous calls up to 2-3 hours daily, and then I was sent a new card. My health care was neglected during this period.

Insurance still did not fully pay bills for which they were obligated. It was March 2022 before I was assigned an advocate with the insurance company and most bills were paid. An outstanding bill from October 13, 2021 was finally paid July 26, 2022.

I am a conscientious person who pays my bills, so being called out at a physician's office about outstanding bills is embarrassing. The stress involved in having a chronic painful debilitating medical condition that has not been well controlled in 6 ½ years is enough, but difficulty with insurance paying their share exponentially increases my stress which of course adversely affects my disease. Thankfully I am not working outside the home. My full-time job is advocating for my health care.

Currently, I pay $806.39/ month for insurance with a $10,000 annual deductible and 80/20 thereafter. I don’t understand how people afford health care and continue to eat and have a roof over their head.

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