Cancer at 23: How Health Insurance Failed Me

"I'm too young for this," I thought. It wasn't the first time that those words had crossed my mind in the past few months. I thought it when I was diagnosed with advanced thyroid cancer. I thought it when the company I was working for began facing financial problems and my paychecks were bouncing. I thought it when I learned I would be dependent on a prescription drug every day for the rest of my life. And I thought it again when I got the bill. In spite of having insurance, I had been billed in full for my surgery and two nights in the hospital. The total was $20,759.89. I was 23 years old.

I had never felt healthier when I found out I had cancer. I was seeing an allergist in March of 2007 to get a refill of my asthma medicine when she noticed a large lump in the center of my throat. I was immediately sent for an ultrasound and a biopsy. The tumor was more than five centimeters wide and had apparently been growing there for months. The consensus was unanimous: It had to come out.

My first thought was, "I can't afford this." I was making an entry-level salary in the publishing industry and barely scraping by as it was. I didn't know much about cancer, but I knew it wasn't cheap.

Compared to other cancers, thyroid cancer is relatively easy to treat. I would undergo radiation, not chemotherapy. The treatments would carry few, if any, side effects. Still, I needed health insurance to pay for the radiation, and I was about to lose mine. My supervisor at work told me that she could only guarantee coverage for eight more weeks.

Up until that point, my perspective toward health insurance could be described as ignorant bliss. I had insurance through my school until graduation, and my mother helped me set up insurance to cover me until I landed a job. I had no idea how expensive it was or how horrific living without it could be.

I was rushed into surgery, and as soon as I could, I began the radiation treatment. By the first of June, I was stabilized. Other than some pain, swelling and a small scar in the center of my neck, I thought I was done.

By September, I found a new job. Though its benefits didn't kick in until I had worked there for 90 days, I was getting health coverage through COBRA, a continuation of the benefits I had through the insurance my former job had provided. At $300 a month, it was more than I could afford on a receptionist's salary, but I had to take the drug Synthroid every day and couldn't pay for my prescription without it. I also needed frequent -- and costly -- blood tests to monitor the calcium deficiency the surgery left me with. I couldn't not have insurance.

Then I got the bill. It came in the mail almost six months after my operation. The total for the surgery, the painkillers and the two nights in the hospital was a few thousand less than what I make in a year. But its amount was probably less shocking than the fact that there was a bill at all. I couldn't understand why my claim was being denied by my insurance company. Before I had the surgery, I had cleared everything. I had been told by more than one person that all of my surgery-related costs would be completely covered. Aside from the co-pays for each appointment, I was not supposed to be billed for a cent.

I began making phone calls, attempting to figure out what was going on. I could only call on weekdays, during my lunch break, and by the time I got through the 800 number's main menus and actually was able to speak to an actual person, I was out of time. On more than one occasion, my cell phone dropped the call. I did not have a private desk or phone, so I had to make the calls standing in the break room of my office.

It took two months, countless phone calls and more than one very high cell phone bill before I got through to someone who told me that my claim was denied because I had a lapse in coverage, so the cancer was considered a pre-existing condition.

Proving that she was wrong was easy enough. I got a certificate of creditable coverage from my insurance company and faxed it to the hospital. Right before Thanksgiving, I received confirmation that the bill was cleared. But the problems weren't over yet.

I had been on COBRA since June and had planned on continuing with it until December, when I would get insurance through my new job. In the middle of October, the accountant from my old company informed me that my coverage was being canceled because the company was declared insolvent. I tried to get coverage through Healthy New York, a program designed to help uninsured people obtain affordable coverage, but I made too much money to qualify for it. I tried to buy into my new insurance early but that wasn't possible. I tried to buy a plan from my old company's insurance broker at the last minute, but there wasn't enough time for the purchase to be processed in time. Nothing worked, and I was without coverage from October until December.

I was terrified. My friends laughed at the paranoid behavior I developed to protect my health: I refused to cross the street until there was a walk sign. I was scared to walk down the five flights of stairs in my apartment building. I wanted to go ice-skating at Rockefeller Center before Christmas, but I wouldn't go until I was covered under my new plan, in case I fell and hurt myself.

Being uninsured not only made me afraid to leave my apartment, but it brought up the issue of the pre-existing condition again. My lapse in coverage was 64 days, and the pre-existing condition clause with my new insurance required a lapse of 60 days or less. Even though my radiation treatment was successful, I am not done with doctor's appointments. I still have to have my blood tested. I still have to have my neck scanned. An uninsured office consultation costs $150.02. An echography costs $80.26. A fine needle aspiration with imagery is $118.90. These are all routine procedures that I am required to get every few months. I would have to pay out of pocket for the rest of my life, and there was no way I could afford it.

I didn't know what to do or who to go to. I had exhausted every opportunity I could think of, and I was about to give up. I even thought about moving back in with my parents in South Carolina because there was no way that I could afford to live in New York and pay those bills.

In the waiting room at the doctor's office or the hospital, people would ask me what I was there for. When I said I had cancer, everyone had the same reaction: "You're so young." But illness cannot be determined by age, and sadly, neither can financial disaster.

Stories in the media that describe people without health insurance typically fall into similar categories -- destitute, unemployed, homeless. I am a college graduate who was renting an apartment, working a full-time job and babysitting for extra cash. But if things hadn't changed, I might have ended up like all of the above.

By pure luck, I learned that the new insurance coverage I was getting ignores pre-existing conditions. As long as I stayed on that plan, I would be covered. That takes care of me at the moment, but who knows what will happen when I change jobs and as a result change insurances? I still might have to pay out of pocket in the future. I am cancer free but have to go to plenty of appointments to stay that way.

Repairing the health care system has been mentioned countless times this election season. It's widely acknowledged that the system is flawed. What will it take to change it? When a 23-year-old college graduate making less than $30,000 a year gets cancer, what can she do? I am lucky that my story has a happy ending, but I also know that many others don't.

The phrase "health care" has become a paradox. The economy is sinking and the dollar's worth is depreciating by the day. The only affordable way for many people to get health insurance is through a job, but increasingly, companies are downsizing and not obligated to provide coverage. And a McCain presidency would gut employer-based insurance across the board. Instead, he wants to replace it with tax credits of $2,500 per individual or $5,000 per family and eliminate the tax subsidies that support employer-based health insurance. Considering the average price of health insurance is $12,000 a year for a family purchasing coverage on the open market, McCain's plan would fall far short of providing the level of assistance people need. On top of that, it would make getting insurance nearly impossible for people with pre-existing conditions.

With employer-based options dwindling, what remains (besides federal entitlement programs like Medicare) are private plans and COBRA. However, on a meager salary, those options are almost impossible to afford, with even the cheapest costing several hundred dollars each month. The New York Times reported recently that people are getting married simply to obtain their spouse's health insurance, and in some instances, contemplating divorce to be eligible for a plan.

Affordable and effective health care has become an elusive dream of American citizens -- 16 percent of the population is uninsured -- and the search for it has become the ruin of many. A study from the Commonwealth Fund estimates that one in five Americans have medical debt. The study includes people with health insurance. In fact, almost two-thirds of those who reported having financial problems resulting from health care were in possession of health insurance at the time their debt was incurred.

According to the National Coalition on Healthcare, someone in the United States files for bankruptcy resulting from a serious medical problem every thirty seconds. And 54 percent of all bankruptcy filings have at least one medical cause, according to a 2005 Harvard University study.

The system is punishing people for being sick and desperately needs an overhaul. Sen. Obama promises change, but even his health care proposal is a patchwork plan that would leave about 18 million people uninsured. What we really need is a complete breakdown and reconstruction from scratch.