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 V.18 No.23 | June 4 - 10, 2009 

Health

Medical Debt

Overcoming an illness is only half the battle for cash-strapped New Mexicans

Jeff Drew

Rebecca says she felt safe because she had medical insurance.

That sense of security lasted until she was diagnosed with cervical and colon cancer in August. Rebecca, whose name has been changed for this story, says her medical expenses quickly mounted. "What they don't tell you is, even with insurance, when you have cancer and surgery and chemo and every test in the book, it costs a lot of money," Rebecca says. "You kind of gotta look around and dig up the money."

Her insurance covered some of the cost, but Rebecca's out-of-pocket expenses came to almost $5,000. Rebecca used what little savings she had and credit cards to cover some of the bills. She also got help from the Anita Salas Memorial Fund, which helps New Mexico women diagnosed with breast cancer or cervical cancer.

“... even with insurance, when you have cancer and surgery and chemo and every test in the book, it costs a lot of money.”

Rebecca, a cancer patient

But the single mother of three still has credit card debt from those expenses. She says ponying up the cash affected how much she spent on things like food, gas and rent. Unable to cook because of the exhausting cancer treatment, Rebecca says she and her family ate a lot of cheap fast food for dinner. "I imagine that it's a lot worse for people who are not insured," Rebecca says. "I think I had it easy, but I still wouldn't define it as easy."

Rebecca's not alone. The state doesn't collect data on the number of state residents burdened by medical bills, but the New Mexico Hospital Association says hospitals spent $384 million on uncompensated care last fiscal year. That means many New Mexicans are unable to pay for the care they receive.

Roxane Spruce Bly, executive director of the nonprofit health advocacy organization Health Action New Mexico, says medical debt is the leading cause of bankruptcy nationwide. "When you look at credit card debt or student loans, those are choices people make," Bly says. "Nobody chooses to take on medical debt. It's generally totally unexpected."

From her group's community outreach work, she says she's discovered common scenarios that force people to fall into the trap of insurmountable health costs. She points to unplanned emergencies, like a sports injury, where a family member needs to be rushed to a hospital because of a sudden health problem. Hospital bills can quickly climb out of control, according to Bly, especially if the person is uninsured.

People are also ensnared by cash problems when they develop chronic diseases, she says. Medical bills start to mount because the need for treatment is constant. "It's really impacting their quality of life in terms of paying medical expenses or paying other bills," she says. "People are asking, Should I get groceries this week or get my prescription?"

Insurance doesn't guarantee patients can avoid being strapped with high medical expenses, but it does help. The problem, Bly says, is that more than 400,000 New Mexicans don't have medical coverage. Our state has the second-highest rate of uninsured people in the country, according to Bly. More than half of the uninsured are eligible for state and federally funded health coverage, she says. "The state should aggressively enroll people in the public programs."

The anxiety of unpaid health expenses is especially potent because those who owe money are also dealing with illness, Bly adds. "The worry of the debt is compounded by whatever health issue they're facing," she says. "That is the reality that people in our community are facing."

How can I avoid medical debt?

There may be no surefire method for staving off indomitable medical expenses, but getting insurance is one of the best ways to keep things under control. Betina Gonzales McCracken, spokesperson for the state Human Services Department, says there are several coverage options for low-income residents. Medicaid, Premium Assistance and State Coverage Insurance are available to New Mexico taxpayers and their families. To find out whether you qualify for any of these programs, call the Insure New Mexico! Solutions Center at (888) 997-2583, or go online to insurenewmexico.net.

Jeff Drew

What do I do if the bills have already stacked up?

Health Action's Bly says many hospitals have financial assistance programs. Dr. Andru Ziwasimon at Casa de Salud medical clinic says there are several ways patients can try to climb out of debt. "The squeaky wheel gets the attention," Ziwasimon says. "You need to speak up for yourself, and you need to push until you've gotten a final answer." Hospitals are often willing to negotiate a lower price, he says, even if patients don't quite meet the low-income requirements. "The rules are all bendable," Ziwasimon adds. "We've seen situation after situation where people make a little too much to fit, but the administrators will flex."

It's also crucial to keep your cool. If you're too forceful, hospital staff might ask you to leave. "If you go too far and are too aggressive, you'll be escorted out by security, and you won't get any assistance," he says. "You have to be nice."

 

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