Tuesday, August 2, 2011

Despite insurance, medical bills push family to bankruptcy

Orlando Sentinel
Kate Santich

The day their daughter was born should have been one of the happiest of Simon and Marsha Sutherland's lives. Both previously married, they were having their first child together, a 6-pound, 10-ounce, dark-haired girl they would name Ellie Marguerite.

The pregnancy had seemed perfectly healthy. But moments after Ellie made her entrance into the world, doctors ordered her rushed to Winnie Palmer's neonatal intensive-care unit, fearing she'd had a seizure. Marsha didn't even have a chance to hold her daughter in her arms.

Ellie's birth on Aug. 30, 2007, began a 25-day, $74,000 stay in one of the most expensive places in any hospital. More daunting, it would launch a four-year journey of fear, hope, devotion and grief — a journey made all the more difficult by financial devastation.

Ultimately, it led two middle-class parents with good jobs, two major health-insurance policies and a house in suburbia into foreclosure and bankruptcy.

"To this day," Simon said, "we still have creditors calling us, wanting to talk to Ellie. They'll say things like, 'We want to discuss how she's going to take care of this overdue bill.' I just lose it."
 
Ellie Sutherland died June 26. She was two months shy of her fourth birthday.

Though financial failures often have been blamed on careless consumer borrowing or the widespread layoffs of the recession, the Sutherlands' financial storyline is strikingly common.

Two years ago, researchers at Harvard and Ohio universities reported that 62 percent of all bankruptcies were related to medical debt. An American family, they said, filed for bankruptcy in the aftermath of illness every 90 seconds — and three-quarters of those families had health insurance.

Although the data used for the study is now 4 years old, most experts interviewed said the problem is likely only to have worsened, at least until this year, as out-of-pocket medical costs have continued to spiral.

In addition, widespread layoffs have contributed to the rapid rise in uninsured Americans, who now number more than 59 million. For most of them, any major medical expense threatens to overwhelm their resources, leading to further bankruptcies and driving up costs for those who can pay. According to Families USA — a nonprofit, nonpartisan consumer-advocacy group — the shifting of uncompensated care onto insured patients results in a "hidden health tax."

For an average family health-insurance policy, that means an additional $1,017 a year in deductibles, copays and other out-of-pocket expenses.

Pointing fingers

When Marsha Sutherland became pregnant with Ellie, she was a full-time reading teacher at Windy Ridge School in southwest Orange County. Husband Simon was a manager of a chain pizzeria. Together, they made about $100,000 a year. Each had insurance.

She had two children from a previous marriage; he had three. They had a nice three-bedroom home with plans for a swimming pool — plans they put on hold when they found out about the pregnancy, long before they knew Ellie would have extensive needs.

For most of their daughter's life, Marsha and Simon would have no diagnosis. Ellie was nearly deaf, couldn't sit up and was prone to dangerously high fevers. Half her face had almost no muscle tone, and in the second year, she began scratching at her eyes and cheeks and biting her lip until she bled profusely.

"I'd go to get her up, and she'd be a mess," Marsha said.

Eventually, doctors removed eight of her front teeth to protect her. But in her scratching, Ellie managed to damage one of her corneas.

There were two trips to The Johns Hopkins Hospital. There were extensive blood panels conducted to look for missing genes. And there were almost weekly visits to Central Florida specialists for Ellie's hearing, eyes, spine and gastrointestinal system.

With two insurance companies — Marsha's was the primary coverage — "we were thinking that what one didn't cover, the other would," Simon said. "Instead, they were both pointing the finger at each other, and neither wanted to pay anything. It was a royal battle."

Though Marsha tried to continue working part time, after only a few months it became clear that taking care of Ellie wasn't just full-time; it was virtually around the clock. Simon became the lone breadwinner.

Marsha tried to sign Ellie up for Social Security disability, and when that failed, for Medicaid. Even after the family was down to a single income, though, the couple made too much to qualify.

"I was very overwhelmed at first," Marsha said. "Now I know that the game is that they automatically deny you at least three times — any parent in our world knows that. But back then, I was naive, and I was exhausted trying to keep Ellie going and me going, and I just didn't have it in me at the time to keep up the fight."


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