A Very Good Policy

joshhaileystudios.com

Nicole Marquez with her parents, Larry and Susan, last Halloween, weeks after her fall.

by Ronni Mott
September 9, 2009

When Susan Marquez bought health insurance for her daughter, Nicole, she was thinking about covering Nicole's annual gynecological exams and making sure she could get a flu shot. The Golden Rule plan she bought for $2,256 annually had a $2,500 deductible and a $35 co-pay, which would keep Nicole's out-of-pocket expenses manageable. For a healthy 25-year-old, it's "a very good policy," Susan says.

The Marquezes didn't know that Nicole would test the plan to its $3 million limit. On Aug. 30, 2008, a maintenance worker in Nicole's New York City building found her nearly lifeless, bleeding body crumpled in a heap at the bottom of an airshaft, ribs, pelvis, neck and spine broken. In an event Nicole still doesn't remember, she had apparently fallen or been pushed from the roof, six stories up (link).

Nicole spent a month in neurological intensive care, "about the most expensive place," in a hospital, Susan says. When she was stable enough, the family—with the help of Jackson donors—moved her back to Jackson to the out-of-pocket tune of $15,000. She spent another month at Select Specialty Hospital until she was ready to begin rehab, and then moved to Methodist Rehabilitation Hospital. Susan didn't realize both hospitals were "out of network," on the plan, because administrators in New York had already nixed UMMC for the same reason. "Out of network" essentially means patients need to pick up 80 percent of the costs, instead of 20 percent for "in network" facilities.

"It adds up," Susan says. The plan, which is nearly tapped out, continues to cover some costs, along with Medicaid, as long as Nicole shows improvement. She's beating the odds because she's also doing water therapy and Pilates on her own. After a year, medical bills that Nicole is responsible for are in the neighborhood of $125,000, having already paid over $100,000 through her parents' retirement savings, donations and fund-raising events. And it's not over. She's still unable to work, and Social Security disability pays only about $300 a month. Like millions of other Americans, Nicole may have to declare bankruptcy to deal with the bills.

"We certainly want to try to avoid that," Susan says. "I'm not complaining," she added. "My God, if (Nicole) hadn't had insurance, I can't even imagine."

COMMENTS

100 recent comments »