Prescriptions Blog | The New York Times

by Erica Rex

Finding out I had breast cancer came as a shock. But the really rude awakening was learning I’m not middle class anymore.

I found a lump in my breast last March. This wasn’t like the lumps of my youth. Those earlier iterations had been hard as pebbles, painful, nested between my sternum and the base of my breast. They had come and gone with my monthly cycle.

This new lump, a lima bean in size and shape, lay recumbent, a half-inch south of my right nipple, just under the skin. And it didn’t hurt. At all. When I pressed on it, it seemed to dip, as though
bobbing on water.

“It’s probably nothing,” my doctor said a few days later. “Nine times out of 10 they’re nothing.” She ordered an ultrasound.

“It’s not nothing,” I told my fiancé, Roger, over the phone that evening. “It’s the wrong lump. It’s different.”

“Well, do as they say,” he said, as practical and English as ever. “Have the sonography, and we’ll see what comes of it.”

What came of it, after sonography and biopsy, was a diagnosis of mucinous colloid adenocarcinoma of the breast.

The timing couldn’t have been worse. At 52, I’d gone back to school. In six weeks, I was to receive an M.A. from Columbia Journalism School, assuming I finished. The good news: Columbia’s student health insurance plan covered just about everything.

Everything except what it didn’t cover.

The first bill arrived while I lay in bed in a post-operative Percocet-induced haze: $13,805 for outpatient, same-day surgery. “That’s just a statement, right?” asked Roger. “That’s before the insurance, correct?”

“Oh yes,” I said. “They’ll pay 80 percent.”

“And what about the rest?”

I smiled. “You’re looking at her.”

Over the next few days, the flurry of bills and explanations of benefits from Aetna became a blizzard.

A co-pay of $173.16 from Anesthesiology Services. Co-pays of $301.31 and $523.86 from NewYork-Presbyterian Hospital. Bills for expenses that Aetna didn’t cover from doctors whose names I didn’t recognize: from Dr. Matthias Szabolcs for $121.12, from Dr. Rose S. Thayaparan for $131.52. Another $124.64 from NewYork-Presbyterian. Some $76 for someone named Wen Fan.

Who was Wen Fan? Why did I owe him money?

All told, along with the co-pay for the actual lumpectomy, the bills came to over $4,000. “Just put them in a folder,” Roger said. “Don’t worry about them for now.”

“How can I not worry about them?” I asked. “They’ll have collection agencies after me.” I started to cry.

I’ve always paid bills on time. But as it turned out, I couldn’t afford to have breast cancer. The sensation that followed this revelation I’d characterize as akin to undergoing a personality transplant. I became an entirely different human being. Someone who might receive food stamps. Who might someday live in a homeless shelter.

I applied for charity care. I filled out forms, submitted tax returns, bank statements, credit card bills. NewYork-Presbyterian was courteous, swift and generous. Over $4,000 became $28.72.

I’m on daily radiation therapy until the end of this month. After that, I’m moving to the U.K. Roger and I will marry, somewhat sooner than I’d planned. But no matter. In England, under the care of a general practitioner I’ve already met, I’ll start on tamoxifen. Until I qualify for the British National Health Service in about six months, we’ll pay about $15 a month out of pocket. Here in the U.S., without insurance, tamoxifen would cost about $100 a month.

Once I qualify, my treatment will be entirely free. In the U.K., cancer has become one of the diseases for which there’s no co-pay, not even for drugs. In the U.S., I’ve read, 31 cents of every health care dollar is spent on administrative overhead.

The U.S. health care system may change; I hope it does change. For now, though, I can’t really drum up any guilt about jumping ship. It’s too late for patients like me. I’m about to become a new kind of expatriate: the U.S. health care refugee. As for Wen Fan and the others, I suspect they’ll have to settle for what they got from Aetna and call it good.