"Individuals shouldn't have to confront the battle against cancer concurrently with insurance challenges"
Diagnosed with leukemia three years ago, Tsoukalas, 26, was shocked to discover that her insurance company only covered the essential drug she required with a hefty $13,000 monthly copay, which the recent college graduate couldn't afford. Forced to go without the medication for three grueling months, she eventually managed to secure it through the drug manufacturer's assistance program.
"It's just unfair that someone has to battle cancer and insurance simultaneously," Tsoukalas, a West Lafayette, Indiana, resident, now attending law school, told CNN. "It's such a heartless system. We live in a country where individuals are actually pushed down when they are at their weakest and most vulnerable, not just physically, but emotionally as well."
Tsoukalas is not alone in her struggle. The frustrations of the US healthcare insurance industry came to the forefront last week following the tragic shooting of UnitedHealthcare CEO Brian Thompson in midtown Manhattan. In response, people shared their grievances on social media – from medical treatment denials, to unresolved claims issues, to the general complexity of the system.
On Monday, police arrested Luigi Mangione, the suspect in Thompson's murder. Mangione had undergone back surgery, according to a friend and online posts, which included a photo of his spine with screws in it. He also showed interest in books about coping with chronic back pain on the book review website Goodreads.
A survey by KFF, a nonprofit health policy research group, in June 2023 revealed that 81% of insured adults experienced health insurance problems – from claim denials to other frustrations – within a year. Despite that, the majority rated their health insurance as "excellent" or "good."
Since the shooting, CNN has received over 200 letters from individuals sharing their experiences with their insurers. While some had positive stories, many faced obstacles with receiving treatment, unexpected medical bills, and difficulties in resolving issues – all while paying high premiums and out-of-pocket costs.
Treatment Denials
Isaac Rosenbloom, 43, is unsure if he has cancer because his insurer refuses to approve an MRI for nodules found on his lungs following an appendectomy. He plans to appeal, but due to prior experiences, he doesn't hold much hope for a reversal.
"Do I have to wait until I start coughing up blood?" Rosenbloom, a paramedic and father of four, asked. "Will it be too late then when the insurance company finally takes it seriously?"
Feeling backed into a corner, some Americans opt for recommended treatments, even if their insurers deny them, resulting in exorbitant medical bills. According to a 2022 KFF Health Care Debt Survey, nearly 41% of adults have medical or dental bill-related debt. A separate KFF analysis of 2021 Census data suggested that individuals have a staggering $220 billion in medical debt.
Melanie Duquette, 70, faced trouble after her extensive back surgery earlier this year. Despite her doctor's recommendation to attend a rehab center, her insurer refused to cover further time there, even though her medical team argued it was essential. Duquette, a registered nurse with nearly 50 years of experience, felt forced to stay for several more weeks due to her physical limitations.
Now, Duquette faces a $14,000 bill she can neither afford nor pay back, potentially leading to bankruptcy. She had spent several hundred dollars a month on her employer's top-tier insurance plan to secure extensive coverage.
"They deny people care while pocketing millions," said Duquette, a Worchester, Massachusetts, resident. "It's shameful."
"Despite her dire situation, Melanie Duquette, a Worcester, Massachusetts, resident and registered nurse with decades of experience, was unable to secure full coverage for her post-surgery rehabilitation, leading to a significant financial burden."
"In light of these challenges, many individuals find themselves accumulating medical debt, as evident in the KFF Health Care Debt Survey, which revealed that nearly 41% of adults in the US have such debts."
