Stress and Insurance, the High Emotional Costs of Healthcare

Every year seems to bring a shift in health expenses. Tax rules change -- sometimes dramatically -- and it is very difficult to keep up with the policies that affect insurance coverage and costs. As much as scanxiety is influenced by the uncertainty leading up to what the image reveals, I have found it is also affected by the fluctuating, ever-higher costs associated with each exam, each new treatment. Expenses mount, out of balance with any increase in income -- especially for those among us fixed with a disability check or mounting debt. Add to that the nature of our healthcare market, which has only gotten more confusing for many, and the stress increases rapidly.

Navigating the options

Insurance decisions affect more than just the patient's individual care. Choices about coverage will affect entire families, sometimes even beyond the life of the patient. It can be useful to consult with a social worker, but that commonly leads to more phone calls and personal legwork because, let's face it, the one social worker assigned to a hospital is already going to be over-burdened before you even show up to ask your questions. But at least you can be pointed in the right direction and know the right questions to ask when you get there.

More cancer centers are employing nurse navigators to help patients interface with their insurance companies and make sense of the available options, but that does not (and cannot) remove every hoop that needs to be jumped through or clear-cut the jungle of red tape.

With the constantly expanding market of new drugs and treatment options, patients can become quickly overwhelmed just trying to make sense of what opportunities might work for them. Being prepped for a potential new treatment comes with both promise and uncertainty; will insurance cover something new or insist upon something cheaper, will a patient make plans for a new treatment only to be denied at the last minute because of some minor or unforeseen disqualification? I have witnessed patients who have a treatment in front of them that should be perfect, told that it will only be given to them if they first go through chemotherapy and it does not work. Rules are rules.

The impossible task of keeping up

But keeping on top of the rules is a veritable full-time job. For those patients who are actually trying to hold down a career, it can be mind-numbing. Most of us find ourselves -- at least to some degree -- at the mercy of our insurance company and the limited resources of whatever clinic or hospital we rely upon for guidance. We do not need the extra burden of wondering from one month to the next whether our (now) pre-existing conditions will prevent us from getting the coverage we need when it already often seems so capriciously decided. And that is assuming that the patient even has appropriate medical insurance to begin with.

Let's not forget about mental health

When patients and caregivers talk about the cost of healthcare, there is more to the discussion than simply finances. Dealing with the expenses associated with care compound the stresses of treatment. Families go bankrupt to cover expenses that insurance won't. Lives are mortgaged out of love, with no guarantee on return. All of this needs to be part of the discussion because it all ties in to quality of life issues and medical outcomes. We often forget that mental health is as much a part of patient care and concerns as physical health. And if not addressed, the cost of stressed mental health may ultimately outweigh the hard costs of financial expenditures.

Editor’s Note: We are extremely saddened to say that on October 21, 2018, Jeffrey Poehlmann passed away. Jeffrey’s advocacy efforts and writing continue to reach many. He will be deeply missed.