A lack of adequate health insurance coverage and the complexities of navigating U.S. healthcare systems can cause a heavy financial burden, as ELi has been hearing from readers in response to our reporting on the pandemic and disparities in health coverage.
Stories shared with ELi – from people including Michigan State University retirees, working younger residents, and others – show that East Lansing-area residents sometimes face unexpected curveballs and a system that makes it very hard to cope with medical expenses. Kris Green, a bicyclist severely injured by a crash in East Lansing, for example, has had a fundraising campaign set up to help him cover his medical expenses.
ELi reported last year that while 95 percent of East Lansing residents have some form of health insurance, not everyone has insurance that adequately covers needed emergency room visits, imaging, and medications. But more financial assistance may be available than some realize – including from the Sparrow and McLaren healthcare systems.
When MSU’s retiree insurance suddenly switched, some were left worse off.
Retired MSU faculty and academic staff were involuntarily switched from insurance provided by Blue Cross Blue Shield to Humana, effective January 1, 2021. MSU Spokesperson Emily Guerrant told ELi that the change occurred “to increase cost savings to the university and to expand programs and services for retirees.” Guerrant referred to free gym memberships and other offers to enrollees and said that Humana provides “comparable out-of-pocket costs” to retirees.
But some have found their out-of-pocket costs rise substantially following the switch. Sheila Teahan, a professor in the MSU Department of English who retired in 2019, reached out to ELi to explain that she was already facing sizeable bills with her new plan as early as February 2021, just a month after the change.
She asked ELi to cover the story, believing the change probably impacts many retirees negatively. For her health needs, copays for most medicines have tripled, Teahan told ELi, and her glaucoma medication, which cost her $10 a month under Blue Cross Blue Shield, now costs her $80 a month out-of-pocket.
But most concerning, Teahan told ELi, is how Humana has repeatedly denied coverage of practitioners who are in-network, claiming they were actually out-of-network. This significantly raises her costs.
Prior to the insurance switch, Teahan told ELi that she had verified with all her providers that they would be in-network. Then bills started rolling in, and Humana said some providers were out-of-network. The biggest challenge came with how Humana was covering costs related to her psychologist. Despite both her psychologist’s office and several Humana representatives saying her psychologist was in-network, Humana repeatedly claimed he was out-of-network and therefore Humana refused to cover the cost.
Teahan believes that MSU retirees should not have been forced to find new practitioners to replace those they have developed relationships with, sometimes over many years. She has seen her psychologist for about a decade, and he has helped her navigate some of the most difficult periods of her life.
Teahan filed a grievance with Humana in April 2021 after Humana canceled coverage for her psychologist. An explanation of benefits provided by Humana had said that mental health care was covered completely after a $100 deductible. But Humana later told her that she lost her mental health care when MSU switched her insurance.
Humana initially denied the grievance in April 2021. In early May, ELi asked MSU for comment on Teahan’s case.
In response, MSU spokesperson Guerrant acknowledged that some retirees faced difficulties, but said, “Humana is willing to work with patients and their providers to bring services in-network to help them leverage their insurance coverage to the fullest, which is what happened in Dr. Teahan’s case.”
When we shared Guerrant’s statement with her, Teahan wrote to ELi, “I’m not sure which is worse, the large rise in health care costs or the unpaid part-time job dealing with Humana.”
But then suddenly, in May, Humana contacted Teahan to say it had changed its position on her case and is now billing her psychologist as in-network. Still, Teahan remains apprehensive that everything is really settled, citing conflicting and confusing wording in the letter she received.
When facing health crises or injuries, estimating and managing costs can be nearly impossible, some in East Lansing find.
Manasi Mishra told ELi about what happened after her husband broke his knee during the summer of 2017. The couple is originally from India and moved to Michigan to earn degrees at MSU. His injury was their first experience with healthcare in the U.S.
Mishra’s husband, who wished not to be named in the article, went to Sparrow Hospital’s emergency room after his accident, where he received a cast and was told to contact an orthopedic surgeon as soon as possible. While the surgery was necessary, the couple worried about what it would cost and tried to get an estimate from surgeons, the hospital, and Blue Cross Blue Shield. No one could provide any answers, pointing to unknown variables, like time to be spent in the surgery suite.
In the end, the couple found themselves on the hook for approximately $1,000, a considerable amount of money since they relied solely on the husband’s graduate student stipend from MSU. They turned to family in India to help them pay off the bill.
Mishra told ELi that smaller bills totaling about $500 slowly trickled in for over 6 months after the accident.
East Lansing resident Ramya Swayamprakash, who has had multiple surgeries and gave birth to her child while a graduate student at MSU, also told ELi about a constant trickle of bills she has received for months after necessary medical care. Even for one hospital visit, bills are issued from various departments, so it is very difficult to know how much one has paid or might be charged in the upcoming months.
For international residents, the healthcare economy can be confusing since other countries do not rely on private insurance and better estimate costs in advance. According to Guerrant, MSU Human Resources can help both domestic and international students navigate their health insurance and noted that MSU’s Office for International Students and Scholars (OISS) also provides assistance.
But Mishra told ELi that while OISS offers information and sometimes even financial aid, it is not reliable. She recounted meeting with a representative about the possibility of receiving aid to defray medical costs, but in the end, she found it difficult to receive responses from OISS.
Swayamprakash said she has learned to hold off on paying medical bills as soon as she receives them and to keep records of payments. She has noticed that requested payments sometimes drop a month or so after a bill is issued and that she is sometimes sent bills despite already having made a payment.
Options to defray or cover the cost of medical care are available to the financially vulnerable.
Many nonprofit hospitals, including Sparrow and McLaren, are legally required to have financial assistance programs.
Sparrow covers 100% of medically necessary care for those enrolled in the Ingham County Health Plan and those without insurance living under 200% of the federal poverty line. It also provides some discounts for the uninsured living over 200% of the federal poverty line and those with insurance facing large out-of-pocket costs.
If you have been treated in the Sparrow Health System (except services provided at Fast Care), you can apply for financial aid with this application. You will have to provide supporting documentation like recent paystubs and tax returns.
Similarly, McLaren offers financial aid for those who make up to 400% of the federal poverty line and received “emergency, catastrophic, and medically necessary services.”
For both, make sure to submit paperwork as soon as possible, since it can take time to gather documents and have your application reviewed.
Swayamprakash also brought the nonprofit “Dollar For” to ELi’s attention. Dollar For helps patients facing large bills receive financial aid from hospitals. The organization asks patients facing large medical bills to fill out an intake form on its website to see if they are eligible. If eligible, Dollar For will help patients claim aid.
This story was updated at 1:30 p.m. on May 31, 2021 to clarify vocabulary related to medical billing and insurance coverage.