Cancer and Coverage in Chicago

Julie was a medical worker in downtown Chicago who put her insurance coverage to work when she was diagnosed with cancer. Here’s her story.

• How is she covered? Individual coverage. Her employer didn’t provide benefits to part-time employees, so Julie bought a BCBS plan “before and after the Affordable Care Act.” But when it became too expensive—she didn’t qualify for a subsidy—she switched to a “no name” plan in 2020.
• What changed? Ovarian cancer. She needed an oncologist and surgeon, as well as ongoing radiation therapy. At the time she switched carriers, she was healthy so she wasn’t worried about having a limited provider network.
• What did she do? Provider search. The network was limited, and information was scarce. She eventually found an in-network oncologist and surgeon who both specialized in ovarian cancer and practiced at an in-network hospital.
• What about her finances? Very difficult. Her treatment began in 2020, and she quickly met her deductible and out-of-pocket maximum. But on January 1, 2021, she had to start again with a new plan year. “I wasn’t working so I’ve gone through a lot of my savings.”
• What else? The bills. Like many patients, she learned (after the fact) that services such as anesthesia were out of network. She asked an oncology advocacy firm for help. She found the financial offices at the hospital and the carrier to be understaffed, inexperienced, and uncoordinated.  

Julie was cancer free and working again. She had bills to pay, including her monthly health plan premium. President Biden’s American Rescue Plan meant that she may now qualify for a subsidy.

Julie was an educated and engaged consumer with family support. But she had a frustrating experience despite a successful outcome. All during the pandemic. Fortunately for her, she is Mastering Health Insurance.

Photo: Downtown Chicago