This Is Us: How My Family Navigates the Health Insurance System

By Mackenzie Myers, Special to the AFRO

$513,512

That’s how much money Aetna, my family’s insurance company, was billed between January and October 2019. Aetna did not pay that total amount because they have prior agreements with our health providers. However, that’s how much it costs to keep our family alive and well.

Our cheapest billed amount for the entire year was $35 for my mom to get her iron levels checked. The most expensive and most recurring bill is the daily $1,112.70 that it costs to do peritoneal dialysis. Peritoneal dialysis is the kidney cleansing program my Dad — we call him “Muskie” — does at home. That rounds up to about $406,135.50 for the entire year, which doesn’t include the extra monthly bills for the supplies needed.

I’ve decided to do an investigation into my personal life because African Americans are three times more likely than the Caucasian population to develop some sort of kidney disease. My dad is one of those unfortunate people. With the 2020 election around the corner and our healthcare system in shambles, I need more than ever for people to hear this story and think twice when voting on our healthcare policies. If not for people like my father but yourself. The average person is one medical bill away from bankruptcy or death.

My brother’s medical bills for the 2019 fiscal year were the cheapest. Only $490 was billed this year, which were for his annual checkups. However, we are all on some type of daily medication, which didn’t show up on our reports. My mother’s employer encourages their employees to use Express Scripts. It helps to lower the cost and you can usually get a longer supply. Express Scripts will always give you the generic prescription unless written otherwise. Some of my Dad’s medication still must come directly from the pharmacy.

“I worry about what type of insurance we’ll have in the future. I hope that my employer continues to provide good health care,” Mom says.

According to the University of Virginia health website, anti-rejection medications can cost up to $1,800 a month. Prices do vary depending on the dosage, brand, and the amount you’re receiving. However, either way, this is an expensive drug. You also must take immunosuppressants to suppress your immune system to help prevent rejection of the new kidney. These again vary in price. The National Medical Library says the average is between $10,000 to $14,000 a year.

Nicholas Castle, a public health professor at West Virginia University, teaches a class on healthcare costs and why they’ve become so expensive. According to Castle, some of the reasons are third party payment, growth of technology, and the increase in the elderly population.

Castle says that millions of people are filing for bankruptcy due to medical bills. Ten percent of patients are making up for 70 percent of all health care costs. Those people in the 10 percent have one or more chronic diseases. Being in renal failure and having diabetes would put you into this category. That being said, my family reflects the same issues thousands of other people are facing as well. However, we still are luckier than many since we have insurance that covers almost everything.

Dr. Matthew Weir is the director of the division of nephrology at the University of Maryland Hospital. He gave my Aunt Shelia — nicknamed “Lucky” — a kidney transplant. Now he’s been treating her brother — my dad — for almost a decade. And Muskie is glad about it.

“The rapport with the previous doctors wasn’t very good,” Muskie said. “Dr. Weir and I really connected, and he has great bedside manner.”

Muskie and Dr. Weir have developed a quirky relationship.

I asked Dr. Weir if he gets angry when patients can’t afford medicines that keep them alive. His answer was direct: “We do not let that happen.”

Dr. Weir says my Dad was on 10 various medications after receiving the transplant. We’ve never had to pick and choose between which medications we can afford, but Travis, a pharmacy intern at West Virginia University, has seen it plenty of times while working.

For our smaller bills, we use our flexible spending card. Before each year when the insurance resets my Mom estimates out how much money to put towards our flexible spending. Since we now have more medical bills were hitting our deductible in the first half of the year.