In seven months, MaryAnne LaRosa has logged 25 hours on the phone with Humana.
"I have a real bad infection. I may have to go to the hospital," she told a representative Thursday morning. "So, this is all urgent."
LaRosa recently cut her leg, which is normally an easily treatable injury. Except, LaRosa's immune system doesn't work.
"I can't fight an infection and that's exactly where I am right now," she said.
For 4 years, LaRosa has received a monthly infusion of GAMMAGARD, a costly medication that does what her immune system can't.
One bottle costs about $450. Many patients need at least six bottles, and infusions often cost between $5,000 and $9,000.
Since her initial diagnosis, LaRosa's infusions have been completely covered by her insurance. In February, however, she found out she would now have a 33% co-pay. According to LaRosa, Humana representatives often quote different co-pays, telling her she will owe somewhere between $1,000 and $1,900 for each monthly infusion.
"And I said, 'You know I can't afford $1,000 every four weeks. Who can afford that much money?'" she said. "I never get the same answer twice."
Jeff Persky, and insurance consultant with Wasson Bay Area Insurance, called LaRosa's case an increasingly common story, as insurance companies prepare for changes under President Obama's healthcare plan.
"Anybody who tells you they know what's going on really doesn't because it's a metamorphosis. It's constantly changing," Persky said.
In January 2014, health insurance companies will have to conform to new guidelines required by the Patient Protection and Affordable Healthcare Act, including providing coverage for everyone, regardless of pre-existing conditions.
Most estimates count about 48 million uninsured Americans who will soon be legally required to have insurance.
Persky believes insurance companies may pass the buck to patients and doctors.
"Unless the patient is aware of this change, then their out-of-pocket can be vastly different than it was the year before," Persky said.
Doctors like Jaime Kratz are concerned about their patients with high-cost treatments.
"Most recently, because it's come up a lot, I would say 3 out of every 4 patients, we have some difficulty," Dr. Kratz said.
Dr. Kratz often has to send patients to large infusion centers so they can afford their treatment. Though it's better than nothing, he is concerned about a lack of oversight over patient care.
"Most physicians would like to keep control, watch their patients," he said.
Dr. Kratz is also concerned about an effect that LaRosa's dealing with now. Though her infusions were costly, a hospital visit would be much worse, and that's exactly where she may end up within a day.
Her cut is infected and may require an IV antibiotic treatment.
"Essentially, it's too expensive to keep us healthy. That's the most important piece," she said. "Don't let them do this to you."
ABC Action News has compiled the following list of helpful websites and contact information for those facing changes to health insurance coverage:
Immune Deficient Patients: http://primaryimmune.org/
Insurance Consulting: http://www.wassonandassoc.com/
You can also contact, e-mail Jeff Persky, Insurance Consultant: Jeff@wassonbayarea.com
Elder Helpline : 1-800-336-2226
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