When Catastrophe Outpaces Insurance (2008)

Cancer Survivor

The words "charity care" struck Diana Wilde with the same kind of horror as the word cancer had a month earlier, even as she began processing the miraculous possibility that Emory Healthcare did not expect her to pay the $50,000 she already owed and the $100,000 more that would accrue for the complex treatments already scheduled.

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Let Us Worry About That

When Catastrophe Outpaces Insurance

When Children with Cancer Grow Up

Lifting the Burden of Being a Burden

"But my husband and I are not charity people," she said. "We have worked hard to keep our bookstore going, and we have always maintained the best health insurance we could afford."

"I know that," said the social worker. "But we are talking about catastrophic care: medical bills your insurance won’t pay, bills that would permanently shatter your lives."

Life-shattering sounded about right. Two months earlier, Wilde had noticed a firm, shiny lump, maybe a quarter of an inch wide, on her leg. It doubled in size in less than a week, before being excised. The pathology report was alarming—Merkel cell carcinoma—and further tests indicated that the aggressive cancer already had spread to her lymph nodes. Her doctor immediately referred her to Emory Healthcare. She would need doctors with experience in treating this infrequent but highly malignant form of skin cancer.

By the time Wilde arrived at Emory, she was in a panic. The 58-year-old had read everything she could about metastatic Merkel cell carcinoma. It was not encouraging. She knew that without radiation therapy, she had little chance of surviving and that the personalized, technologically complex treatment was expensive. She also knew that her admittedly minimal health insurance was already headed toward its lifetime limit. The family's savings had pretty much vanished with a daughter's health problems. Medicaid was not an option because Wilde was not completely disabled. A state program to help cancer patients already had run out of funds by mid-year. What would Emory say?

The doctors focused on what needed to be done: removing more tissue from the site of the tumor and beginning radiation. Medically, the series of treatments appeared successful. Financially, they appeared, well, catastrophic.

When the social worker gave Wilde the forms she would need to fill out for her past, present, and future treatment at Emory Healthcare to be classified as catastrophic care, she asked Wilde again, "What do you think?" Suddenly it didn't seem stigmatizing; it seemed a gift from heaven—and from Emory. Wilde reached for the pen. Now that she had been given more life, she was ready to get on with living it.