Lawsuit: NRA’s Unpaid Bills Could Shutter NRATV

Bloomberg via Getty

The National Rifle Association is overdue on more than $ 1.6 million in unpaid bills, according to a new court filing made by its longtime advertising firm.

On Wednesday, Ackerman McQueen, an ad agency that has for years worked with the National Rifle Association and runs the gun group’s media arm NRATV, filed a motion for a preliminary injunction against the NRA. It’s the latest move in a brutal court battle between the ad agency and the powerful pro-gun organization.

It could also spell the death of NRATV, a pro-Trump online TV network known for its culture-war content.

Read more at The Daily Beast.

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http://www.acrx.org -As millions of Americans strive to deal with the economic downturn,loss of jobs,foreclosures,high cost of gas,and the rising cost of prescription drug cost. Charles Myrick ,the President of American Consultants Rx, announced the re-release of the American Consultants Rx community service project which consist of millions of free discount prescription cards being donated to thousands of not for profits,hospitals,schools,churches,etc. in an effort to assist the uninsured,under insured,and seniors deal with the high cost of prescription drugs.-American Consultants Rx -Pharmacy Discount Network News

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Heartbeat Bills: Which States Have Passed Early Abortion Laws?

In the fight for reproductive rights, abortion access is currently being discussed at the state level all over the United States. Many states are currently imposing stricter abortion bans — here’s your guide to what’s happening, including how new laws compare to the old laws, and when they’ll be enforced.
Allure

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Harriet Tubman Is Already Appearing on Some $20 Bills Thanks to Artist’s Clever Stamp

The Trump Administration decided to delay the release of the Harriet Tubman $ 20 bill, so one artist decided to take matters into his own hands.

He created a stamp, retailing for $ 20, that allows people to put Harriet’s face on whatever $ 20 they already have.

via NYDN:

Brooklyn artist Dano Wall has taken the money matter into his own hands, designing a 3D stamp big spenders can use to replace Andrew Jackson’s mug with a picture of their favorite abolitionist and Union Army spy.

The final design for the new $ 20 bill was originally set to be revealed next year, marking the 100th anniversary of the 19th Amendment that gave women the right to vote.

But after Treasury Secretary Steven Mnuchin told a congressional panel this week that the government would be pushing back the plan to replace Jackson with Tubman on the bill to 2028, Wall took to social media to voice his displeasure.

“We’ll see about that,” Wall tweeted, along with a doctored picture of the bill.

Wall designed the stamp in 2017, soon after President Trump took office. The 3D image of Tubman’s picture covers the face of the nation’s seventh President, a slave owner whose sordid history includes the 1830 Indian Removal Act.

Will you be buying one?

The post Harriet Tubman Is Already Appearing on Some $ 20 Bills Thanks to Artist’s Clever Stamp appeared first on lovebscott – celebrity news.

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GOP, Democrats team up to address surprise medical bills

Senior senators from both parties release draft legislation to address ‘surprise medical bills’
ABC News: Health

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http://www.acrx.org -As millions of Americans strive to deal with the economic downturn,loss of jobs,foreclosures,high cost of gas,and the rising cost of prescription drug cost. Charles Myrick ,the President of American Consultants Rx, announced the re-release of the American Consultants Rx community service project which consist of millions of free discount prescription cards being donated to thousands of not for profits,hospitals,schools,churches,etc. in an effort to assist the uninsured,under insured,and seniors deal with the high cost of prescription drugs.-American Consultants Rx -Pharmacy Discount Network News

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Female lawmakers speak about rapes as abortion bills advance

As more Republican-led states seek to ban abortions, female lawmakers go public.
ABC News: Health

SPECIAL NEWS BULLETIN:

http://www.acrx.org -As millions of Americans strive to deal with the economic downturn,loss of jobs,foreclosures,high cost of gas,and the rising cost of prescription drug cost. Charles Myrick ,the President of American Consultants Rx, announced the re-release of the American Consultants Rx community service project which consist of millions of free discount prescription cards being donated to thousands of not for profits,hospitals,schools,churches,etc. in an effort to assist the uninsured,under insured,and seniors deal with the high cost of prescription drugs.-American Consultants Rx -Pharmacy Discount Network News

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Abortion bills push women’s reproductive rights into political spotlight

Eight months after the contentious hearings over Supreme Court justice Brett Kavanaugh, progressives fear that the most dire warnings of abortion rights groups are now coming to fruition.


CNN.com – RSS Channel – Politics

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http://www.acrx.org -As millions of Americans strive to deal with the economic downturn,loss of jobs,foreclosures,high cost of gas,and the rising cost of prescription drug cost. Charles Myrick ,the President of American Consultants Rx, announced the re-release of the American Consultants Rx community service project which consist of millions of free discount prescription cards being donated to thousands of not for profits,hospitals,schools,churches,etc. in an effort to assist the uninsured,under insured,and seniors deal with the high cost of prescription drugs.-American Consultants Rx -Pharmacy Discount Network News

BEST DEAL UPDATE BY AMERICAN CONSULTANTS RX:

Click today to request your free ACRX discount prescription card and save up to 80% off of your medicine!

SPECIAL DONATION REQUEST UPDATE:

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Listen: A Blitz Of Health Care Bills


Julie Rovner, Kaiser Health News’ chief Washington correspondent, talks with Robin Young on “Here and Now” about Democrats’ plans to push a package of health care bills through the House this week. The measure will give lawmakers a talking point about their efforts to bolster the Affordable Care Act after the Trump administration has sought to weaken it. The package, however, includes several bills with bipartisan support to get generics on the market sooner. So, voting against the package will prove tough for Republicans. Rovner and Young also discuss bipartisan efforts on Capitol Hill to eliminate surprise medical bills that patients get when their doctors or hospitals are outside their insurance network and the administration’s new requirement for drugmakers to add medications’ list prices in TV ads. You can listen to the discussion here.

Kaiser Health News

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Listen: Trump’s Plan To End ‘Unpleasant Surprise’ Bills


President Donald Trump called for an end to the “unpleasant surprise” of certain medical bills on Thursday. Specifically, he outlined a plan that would forbid bills beyond in-network insurance rates in emergencies. For elective procedures, patients would have to consent in advance to receiving care from an out-of-network provider — and get only one bill after a surgery. NPR reporter Selena Simmons-Duffin covered the White House announcement, which featured two patients from the KHN-NPR “Bill of the Month” series.

Kaiser Health News

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White House takes on surprise medical bills in continued push to lower US health-care costs

President Donald Trump announced a new push Thursday for legislation designed to end surprise medical bills that leave Americans saddled with costs for care that they thought were covered by their insurance.
Health and Science

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Click today to request your free ACRX discount prescription card and save up to 80% off of your medicine!

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Texas Lawmakers Take Aim At Surprise Medical Bills

A bipartisan group of lawmakers announced plans to address surprise medical bills in a way that would take the “burden” off Texans.

During a press conference Thursday, state Sen. Kelly Hancock, a Republican from suburban Fort Worth, announced he had filed a bill aimed at preventing medical providers from balance-billing patients, among other things. State Rep. Trey Martinez Fischer, a Democrat from San Antonio, is filing a similar bill in the House.

If passed, the legislation would force medical providers and health insurers to mediate payment disputes before they send bills to patients. Hancock said the point of SB 1264 is to take “the burden off of patients.”

“[It] takes it off of their plates completely,” Hancock said.

He highlighted the case of Drew Calver, a public school teacher in Austin whose six-figure hospital bill after a heart attack was featured in a “Bill of the Month” investigation by KHN, NPR member station KUT and CBS. Hancock noted Calver’s bill was reduced after the media attention, but it shouldn’t take such attention for a patient to get a reasonable bill.

Under this legislation, both sides of the payment dispute would settle their issues through an existing balance-bill mediation program. The Texas Department of Insurance program has been successful in lowering medical bills across the state.

The legislation would beef up the program, which addresses surprise balance bills greater than $ 500 from all emergency providers, including free-standing emergency departments and all out-of-network providers working at a network facility.

“This is designed to apply in situations where patients don’t have any choice which facility they go to or which physician is involved in their care,” Hancock said.

The insurance department’s mediation program, historically, had many loopholes and few consumers qualified for help. It was expanded in 2017, though, and more patients have been filing complaints.

For example, in 2014, the department was asked to mediate 686 medical bills. During the 2018 fiscal year, it received 4,445 bills.

Hancock said the program, so far, has saved Texas patients $ 30 million.

Consumer advocates argued the system works only when patients know mediation is an option, however.

Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities, said patients don’t always know help is available or they find the process intimidating.

“The instructions for how to do it are on your medical bill and your explanation of benefits — the most indecipherable documents you are going to get,” she told KUT earlier this year.

She and others have argued Texas should adopt a program similar to those in states like New York, California and Florida, whose systems are more consumer-friendly.

Martinez Fischer said it’s time Texas officials step in to help patients who are caught in the middle of disputes between medical providers and health insurers.

“It has been an industry issue for a few years — I grant you that,” he said, “the health plans and the providers fighting over their business interests, and I respect that. But 10 years later, it is a consumer issue.”

Among other things, Hancock’s bill would allow people with federally regulated self-funded health plans to opt into the state’s mediation program. According to Hancock, those plans make up about 40 percent of Texas’ insurance market, but those consumers are currently not able to take part in the program. Hancock said this should provide relief to consumers while federal lawmakers weigh their own efforts to address surprise medical bills.

“Texas will send a loud and clear signal to D.C. that similar consumer protections need to be passed at the federal level,” Hancock said. “Until then, Texas … [is] committed to doing something about it.”

U.S. Rep. Lloyd Doggett said he’s encouraged by Texas’ efforts, but called federal protections “essential.”

“Only approval in Congress of legislation like my End Surprise Billing Act can both protect those who work for large employers with self-funded, federally regulated ERISA plans and assure that patients across America are not forced to pay the price for conflicts between insurers and health care providers,” he said in a statement.

This story is part of a partnership that includes KUT, NPR and Kaiser Health News.

Kaiser Health News

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Texans Can Appeal Surprise Medical Bills, But The Process Can Be Draining

In Texas, a growing number of patients are turning to a little-known state mediation program to deal with unexpected hospital bills.

The bills in question often arrive in patients’ mailboxes with shocking balances that run into the tens or even hundreds of thousands of dollars.

When patients, through no fault of their own, are treated outside their insurers’ network of hospitals, the result can be a surprise bill. Other times, insurers won’t agree to pay what the hospital charges, and the patient is on the hook for the balance.

The Texas Department of Insurance’s mediation program can intervene when Texans complain about an unexpected bill — often after an emergency in which a patient is rushed for treatment at an out-of-network hospital.

Historically, the state program had many restrictions that left few consumers eligible for help. But the Texas Legislature expanded it in 2017.

Since then, more patients have been filing complaints. In 2014, the department was asked to mediate 686 medical bills. During the 2018 fiscal year, however, it received 4,445 bills, more than double the 2,063 bills received in 2017.

Even after the changes, the mediation program could be a lot more robust and is likely addressing only a fraction of these problematic bills, consumer advocates say.

The Road To A Surprise Medical Bill

Brad Buckingham had to deal with a surprise medical bill after a bicycle accident in 2016.

Buckingham sent his bill to Kaiser Health News and NPR’s “Bill of the Month” portal last year.

The Austin, Texas, dentist said he was on a ride with friends in December 2016 when he crossed train tracks at an angle to avoid a pileup. His wheel slipped out from under him, and he landed hard on his left hip.

“All I could do was scream,” he said. “I couldn’t even make words.”

His friends called an ambulance, and Buckingham was taken to the nearest hospital: St. David’s South Austin Medical Center.

“I specifically remember I gave them my health insurance information in the ambulance,” he said. “And they put me in the ER, and from the ER they took my insurance information again.”

Buckingham had insurance through Baylor Scott & White Health, which he bought through the Affordable Care Act marketplace. St. David’s was out of his plan’s network, but no one told him that — at first.

Buckingham had broken his hip, and doctors took him into surgery the same day.

“They held me in the hospital for three days just for recovery and never told me I was out of network until the time of my discharge,” he said.

A few weeks later, Buckingham got a bill that said he owed $ 71,543.

The total bill eventually came to $ 75,346. Baylor Scott & White, which left the ACA marketplace the following year, paid only $ 3,812.

Buckingham thought it was a mistake, he said. He called the hospital and the insurer to sort it out. But after weeks of inquiring about it, there was no resolution.

Both the hospital and insurer insisted payment was his responsibility.

“I’m sitting there thinking to myself that there is no way — there is no way — this is right,” he said.

Baylor Scott & White said it couldn’t discuss Buckingham’s bill “due to confidentiality requirements.”

After Buckingham gave St. David’s permission to discuss his case with the media, the hospital released a statement saying his bill was actually the amount he owed from his deductible and coinsurance — not a balance bill.

The hospital also said the bill was so large because of his “high deductible plan.”

Those plans “may be attractive to some people because they cost less, though they place more financial responsibility on the patient,” the statement from St. David’s said.

Buckingham said his policy had a deductible of $ 5,000 for in-network care and $ 10,000 for out-of-network care. He still doesn’t know how his bill got to be so high, he said.

Buckingham didn’t know about the state’s mediation program. But even if he had known, he wasn’t eligible for the program at the time. His bike accident and the billing dispute with the hospital happened months before the Texas Legislature decided to expand the pool of eligible patients. So he hired his own lawyer to help him negotiate with the hospital.

Buckingham now owes a couple of thousand dollars to St. David’s, he said, but he remains frustrated by the experience.

“You know, whenever I tell my story to anybody, they kind of agree — like, ‘Oh my gosh, this is ridiculous,’” he said. “But then when you talk to the people that have any control over it, it’s the exact opposite. It’s: ‘You owe it; we don’t.’”

‘A Total Roll Of The Dice’

A surprise bill can happen to anyone who makes an urgent trip to the nearest emergency room.

“It’s a total roll of the dice,” said Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities in Austin. She has been looking into balance billing for years. “The medical emergency that’s going to send you to the hospital where you could get a surprise bill — is that emergency room going to be in or out of network?”

Pogue said the Texas Department of Insurance’s mediation process forces an insurance company and the hospital or medical provider to negotiate a fair price for services. Ninety percent of the time those negotiations happen over the phone, she said.

There are two big reasons the number of bills sent for mediation more than doubled from 2017 to 2018, Pogue said.

“One is just increased awareness,” she said. “There is constant media attention now to surprise medical bills because the stories are so shocking, right? We see them covered more, so people are more aware that when they get one, they could do something about it.”

The second reason is that, in 2017, the Texas Legislature opened the mediation program up to more people, including teachers.

Stacey Shapiro got a $ 6,720 bill after being treated in the hospital for a hypoglycemic attack.(Gabriel C. Pérez/KUT)

Can’t Wish It Away

Stacey Shapiro, a first-grade teacher in Austin, also received a surprise bill from St. David’s South Austin Medical Center after she landed in the emergency room last March.

The marathon runner said she woke up one Saturday for an early run and wasn’t feeling well.

“All of a sudden the whole room started spinning. … I started sweating, sweating like buckets,” she said. “It was terrible, and then all I remember is that my ears started popping, my vision got blurred and then the next thing I knew, I had passed out.”

Shapiro’s boyfriend heard her hit the bathroom floor. He found her passed out, with her eyes open and hardly breathing. He took her to St. David’s because it was the closest hospital.

Shapiro was taken care of in a few hours, she said. Hospital staff gave her fluids and anti-nausea medication. Doctors found she had a dramatic change in her blood pressure that was likely due to a spell of hypoglycemia, or low blood sugar.

Two months later, a bill for $ 6,720 came in the mail.

Like many teachers in Austin, Shapiro gets her health insurance from Aetna.

In a statement, the insurer said Austin school district employees are supposed to use the Seton Accountable Care Organization network, comprising several Catholic hospitals in the area. The parent company for St. David’s, the for-profit hospital chain HCA, doesn’t participate in that network.

“Unfortunately, HCA is not currently accepting payments through Aetna’s [contracted payment] program, which provides set payment fees for non-participating providers. This has resulted in Ms. Shapiro being balance billed for her emergency room visit,” Aetna wrote in a statement.

Shapiro said she had heard of other Austin Independent School District employees dealing with high hospital bills. In fact, Shapiro reached out to radio station KUT after hearing the story of Drew Calver, an Austin high school teacher who was balance-billed for nearly $ 109,000 by St. David’s after a heart attack. Calver’s story was part of Kaiser Health News and NPR’s “Bill of the Month” series last year.

In her case, Shapiro said, Aetna told her not to pay what the hospital was charging her. She was told to pay only her deductible ($ 1,275), which she did right away, she said. But St. David’s kept sending her bills for the remaining balance, which was more than $ 5,000.

“I guess I just thought that it was going to go away,” Shapiro said.

But it didn’t. For a public school teacher, $ 5,000 would have been a huge blow to her budget, she said.

Shapiro applied for financial assistance, but St. David’s told her she didn’t qualify. She felt out of options, she said — until a friend told her about the state’s mediation program.

After she contacted the program, a state mediator set up a scheduled call with Aetna and St. David’s. But before it took place, a KUT reporter asked St. David’s for a comment on the situation. Shortly afterward, Shapiro said, St. David’s told her she no longer owed anything.

St. David’s later told KUT that Shapiro had “already satisfied her financial obligation.” It also denied that she was balance-billed to begin with.

Shapiro called the whole experience exhausting. “It’s just very frustrating because this has been very time-consuming,” she said.

More Work To Do

Pogue, of the Center for Public Policy Priorities, has been arguing that the state needs to find more ways to get involved. The current mediation process is pretty good, she said, but not enough people know it’s an option.

“Because first, the instructions for how to do it are on your medical bill and your explanation of benefits — the most indecipherable documents you are going to get,” she said.

And even if people understand they have a right to mediation, they might get scared off by the concept and think they need a lawyer, Pogue added.

When people do use the program, though, it tends to work by saving patients money.

In fiscal year 2018, the initial complaints amounted to $ 9.7 million worth of medical bills, according to the state insurance agency. After mediation, the final charges had been negotiated down to $ 1.3 million.

Mediation is helpful, Pogue said, but it still puts a big burden on the patient, who may be confused. “Why didn’t this happen in the first place?” she said. “How come I had to, while recovering from an emergency, decipher medical bills, fill out paperwork with the state department of insurance, jump through all these hoops, when all that needed to happen was a phone call?”

The ideal solution to surprise medical bills would remove consumers from this confusing web altogether, she said.

States like New York, California and Florida have systems that make things easier for consumers, Pogue said, and Texas should, too.

In 2015, New York became the first state to pass a law aimed at protecting patients from surprise medical bills from out-of-network hospitals. Its Emergency Medical Services and Surprise Bills Law holds consumers harmless if they are treated by an out-of-network doctor at a participating hospital, among other things.

In 2016, Florida lawmakers passed legislation protecting consumers from receiving surprise medical bills “from doctors and hospitals that don’t have a contract with the patient’s insurance plan,” the Miami Herald reported.

And in 2017, California passed a law shielding patients from balance billing. The law kicks in if someone visits an in-network provider, including a hospital, imaging center or lab. Under the law, patients would be responsible only for their in-network share of the cost, even if they’re seen by an out-of-network provider.

In the meantime, Pogue said, more Texans should take advantage of what’s already in place in the state.

The number of people who seek mediation is “tiny compared to the number of people who get surprise bills,” she said, “so there is a ton of work to be done.”

This story is part of a partnership that includes KUT, NPR and Kaiser Health News.

Kaiser Health News

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Curbing surprise medical bills draws rare bipartisan interest

President Trump said taming unexpected bills would be a top priority.
ABC News: Health

SPECIAL NEWS BULLETIN:

http://www.acrx.org -As millions of Americans strive to deal with the economic downturn,loss of jobs,foreclosures,high cost of gas,and the rising cost of prescription drug cost. Charles Myrick ,the President of American Consultants Rx, announced the re-release of the American Consultants Rx community service project which consist of millions of free discount prescription cards being donated to thousands of not for profits,hospitals,schools,churches,etc. in an effort to assist the uninsured,under insured,and seniors deal with the high cost of prescription drugs.-American Consultants Rx -Pharmacy Discount Network News

BEST DEAL UPDATE BY AMERICAN CONSULTANTS RX:

Click today to request your free ACRX discount prescription card and save up to 80% off of your medicine!

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Senate To Vote On Competing Bills To End Government Shutdown

With the partial government shutdown entering its second month, the Senate is scheduled to vote Thursday on competing proposals to re-open the government. Neither bill is expected to receive the 60 needed votes to advance, however, as both sides remain dug in over the issue of a border wall.
RTT – Political News

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Courts say anti-abortion ‘heartbeat bills’ are unconstitutional. So why do they keep coming?

Time and again, when it’s introduced in a state legislature, the bill is touted as the most restrictive in the nation. It’s often referred to as a “heartbeat bill” and seeks to ban abortions at the time when a fetus’ heartbeat can be detected, which can be as early as six weeks into a pregnancy — before many women even know that they are pregnant.


CNN.com – RSS Channel – Health

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1.18.19 Paying bills will increase your credit score; Clark Stinks

Paying bills could now have a direct positive impact on your credit score thanks to Experian; Christa reads listener posts about how Clark has missed the mark in his advice this week. If you have a “Clark Stinks” to share you can leave it here

Learn more about your ad choices. Visit megaphone.fm/adchoices

Watch the video

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Back To School Sale – Get up to 40% OFF stylish footwear at Payless.com

Insured But Still In Debt: 5 Jobs Pulling In $100K A Year No Match For Medical Bills

Robert and Tiffany Cano of San Tan Valley, Ariz., have a new marriage, a new house and a 10-month-old son, Brody, who is delighted by his ability to blow raspberries.

They also have a stack of medical bills that threatens to undermine it all.

In the months since their sturdy, brown-eyed boy was born, the Canos have acquired more than $ 12,000 in medical debt — so much that they need a spreadsheet to track what they owe to hospitals and doctors.

“I’m on these payment arrangements that are killing us,” said Tiffany Cano, 37, who has spent her lunch hours on the phone negotiating payoff plans that now total $ 700 a month. “My husband is working four jobs. I work full time. We’re a hardworking family doing our best and not getting anywhere.”

The pair, who earn nearly $ 100,000 a year, are insured and have had no major illnesses or injuries. Still, the Canos are among the 1 in 4 Americans who report in multiple polls that the high cost of health care is the biggest concern facing their families. And they’re at risk of joining the 62 percent of people who file for bankruptcy tied to medical bills.

“Oh, yes, that worry is always in the back of my mind,” Tiffany said.

The family is part of a struggling group: middle-class folks who have followed the rules and paid for employer-based medical insurance, only to find that soaring health care costs — combined with high deductibles, high copayments and surprise medical bills — leave them vulnerable.

“I thought we’d be covered, and it’s just not enough coverage at all,” she said.

Robert Cano, also 37, had family health insurance for 2018 through his job as a manager at a large-chain retail store, for which he pays nearly $ 500 per month. The plan’s $ 3,000 annual deductible and 40 percent coinsurance fees have added up faster than the Canos anticipated.

First came the nearly $ 4,000 bill from the in-network hospital where Brody was born Jan. 2, followed by separate fees from the anesthesiologist and the doctor who performed the routine delivery. Then, at 2 months, Brody was hospitalized with breathing problems doctors said could be related to allergies or asthma. In May, Tiffany came down with a stomach virus that sent her to the emergency room for drugs to treat nausea and dehydration. In October, the baby developed a bad case of bacterial conjunctivitis, or pinkeye.

“It’s been, like, $ 300 here, $ 700 there,” said Tiffany. “We had a hospital bill for him being sick of, like, $ 1,800.” Unable initially to find a pediatrician she liked, Tiffany has agonized over whether to use the ER when Brody gets sick. When he had pinkeye, she debated whether to take him in, hoping it would get better on its own.

Then he got worse, she said, pulling up a photo on her phone of her son with half-moons of red, puffy flesh under his dark eyes.

“I let him suffer for a day like that,” she said.

The Canos lost their first child, a girl, midway through her pregnancy in 2016. Tiffany acknowledges that experience has left her more anxious than the average first-time mom.

“It gave me so much fear that something would happen to him,” she said.

As for their own health care needs, the couple put themselves lower on the priority list. Tiffany has used a prosthetic limb since childhood, when her lower left leg was amputated because of a birth defect.

She needs a new prosthesis because her body changed during pregnancy, but she can’t see how to afford it.

Tiffany Cano with her son, Brody. Cano was born with birth defects that left her with only three fingers on her right hand and a left leg that had to be amputated below the knee during childhood. Because of physical changes during pregnancy, her five-year-old prosthetic leg no longer fits, but she can’t afford her share of the cost of the new limb.

A model suitable for the busy life of a working mom would easily cost $ 10,000 to $ 15,000, according to Tom Fise, executive director of the American Orthotic & Prosthetic Association.

“I try to push through,” Tiffany said. “I put on that brave face of just walking, but it’s so painful to walk. I have bruises all over my leg. I get blisters all the time.” Lately, she’s been wearing an old prosthesis, one she used in high school, because it’s more comfortable.

The Canos don’t know how exactly they fell into such debt, since they tried hard to make responsible decisions. After meeting three years ago, they knew quickly that they wanted to marry and have a family.

“I waited until I found the right guy,” said Tiffany, who was thrilled when, in 2016, they were able to afford a 2,500-square-foot, two-story home in one of the stucco-and-tile neighborhoods an hour outside Phoenix.

But, taken together, the medical payment plans and premiums are almost as much as their $ 1,300 monthly mortgage. All told, the Canos spend about 15 percent of their annual income on health care, almost three times the average for non-Medicare households in the U.S.

That leaves too little for day care, car payments, gas, food and dozens of other domestic expenses, Tiffany said.

For 17 years, Robert Cano had comprehensive health insurance through his job as a soldier in the Army Reserve and paid little or nothing for medical care. He left the Army in 2017, however, after he learned he would be deployed for an extended time away from his wife and new son.

“I told them, ‘I have to be at home,’” he recalled. The Army insurance ended on Dec. 31, 2017, two days before Brody was born.

That meant moving to his employer’s insurance plan. Like more than 40 percent of 152 million Americans who get health insurance through work, the Canos are enrolled in a plan that demands thousands of dollars before any coverage kicks in.

The couple discovered that they earn too much to qualify for financial assistance from medical providers, or for subsidies if they shifted their insurance to a plan under the federal health insurance exchange. She is a full-time bank compliance officer. He is a full-time store manager.

Tiffany wrote to KHN after seeing stories about sky-high medical bills on TV. Dr. Merrit Quarum, the chief executive of WellRithms, a health care consulting firm, reviewed the family’s medical bills and the responses from their health care providers.

Though Quarum had questions about some of the fees in the itemized bills — $ 4 for a 600-milligram ibuprofen tablet? $ 3,125 to place an epidural? — he found the charges were legitimate under the terms of the contract between the hospital and the Canos’ insurer. Tiffany’s only recourse was to set up the five payment plans she navigates each month.

“I wish I could say it wasn’t so, but it is,” Quarum said.

Robert Cano plays with his 10-month-old son, Brody, before leaving for work on a recent Saturday morning.(Heidi de Marco/KHN)

Robert Cano of San Tan Valley, Ariz., gets ready for work on Oct. 20, 2018. He estimates he works up to 120 hours a week, mostly to cover the extra costs of his family’s health care. In addition to his retail job, he is a substitute teacher and a nighttime security guard, and delivers sandwiches for a fast-food chain.(Heidi de Marco/KHN)

Tiffany Cano feeds 10-month-old Brody on Oct. 20, 2018. She works 40 hours a week at a local bank as a compliance officer, commuting more than 90 minutes each way, while Brody attends a local day care center. Because her husband works so much, she says, she often feels as if she’s raising their son alone.(Heidi de Marco/KHN)

Mostly to pay off that health care debt, Robert has taken several part-time gigs this year — he works as a substitute teacher and a nighttime security guard and delivers sandwiches for a fast-food chain in Scottsdale, 40 miles away, where tips are better. He said he sometimes works up to 120 hours in a week.

“I’m not ashamed or embarrassed, even as old as I am, to deliver sandwiches,” he said, pulling on his retail chain polo shirt before rushing to a Saturday morning shift.

He continued: “I know people, they’d rather get food stamps and feel sorry for themselves. But I’m a fighter. I will not give up. … If I can bring in an extra $ 400 a week or $ 800 a month, she can get what she needs for the baby.”

Often getting home after midnight, he keeps shampoo and shaving cream in his car and naps in parking lots between jobs, relying on Red Bull and aspirin to stay alert.

That means on many nights, when Tiffany picks up Brody from day care after her 90-minute commute, she handles most of the chores at home.

“Sometimes I feel like a single mom because my husband is never around,” she said.

She carefully tracks the family’s medical expenses, trying to juggle them with ordinary outlays that can’t wait — like $ 500 for the brakes that went out on her car this month.

At the rate they’re going, the bills won’t be paid until Brody is 3, Tiffany said. The Canos are getting older and they’d like to have another baby before it’s too late, but, for now, that seems impossible.

For 2019, the couple have decided to switch to a different plan offered through the regional bank where Tiffany works. The premium is higher — $ 650 a month — but the deductible is $ 1,500 with just 10 percent coinsurance.

“It is going to be a lot more per paycheck, which is going to hurt us,” Tiffany said. “But after what just happened, I want to make sure we are prepared in case anything does occur.”

How to fix a health care system that burdens middle-class families so heavily is beyond her, she said.

“The only thing we can do is just keep working,” Tiffany said. “I always wonder: How does everybody else do it?”


KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation.

Kaiser Health News

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