Brenda Serrano is a cancer survivor. She has been treated successfully for non-Hodgkin's lymphoma. She was lucky: not only did the doctor catch the blood cancer in time, but her husband was in a job that provided the family with health insurance. They had to pay 10% of all the bills, but they managed.
Now, however, the cancer is in remission but there is a new threat to her health. Her husband, a software engineer, lost his job last year. He found another within a couple of months, but without insurance. For a year they paid into the government's Cobra scheme to keep their existing policy going, but this summer they will have to look for a new one, and the chances are that, because Serrano will be deemed to have a pre-existing condition, it will not cover cancer.
Serrano, 45, who came from Puerto Rico more than two decades ago, is facing a health insurance black hole. She is one of those hoping the Affordable Care Act will not be thrown out by the supreme court this month, because if it survives, from next year it will stop insurance companies denying health coverage to people with pre-existing conditions.
She has no idea how much she has paid out already for treatment. Like most people, she is confused by the sheer quantity and variety of bills that arrive. But she estimates that they are spending at least $25,000 a year on health at the moment.
That includes the $1500 a month they now pay in insurance premiums, the first $900 of bills that they must pay and then the 10% of the cost of all the ongoing tests and treatment she must have.
"I went to the doctor because I had a lump on my neck, who sent me to a specialist and they gave me a biopsy," says Serrano who lives in Altamonte Springs, Florida. "There are bills for the first doctor, then the specialist, then the biopsy and anaesthesiologist and the person who wakes you up. You receive all these bills and you are not even treated yet.
Then you get the results and they send you to an oncologist. The first one was very nice. I cried because I thought I was going to die and my family would suffer."
But she has survived many things in her life, she says, and got through the investigations and chemotherapy. The longer-term damage appears to be to the family finances. "I used to tell them if this cancer doesn't kill me, then these bills will," she says.
Even now, with health insurance, she struggles to pay. "I need a Pet scan every three months. It costs over $3000, so I pay $350 each time. I pay what I can. When I get into debt collection, I try to pay those first, but I can't keep up.
"If I don't pay the bills, they start sending paper and then they start calling. It is not a human being calling but a voice on a machine. It says if you are this person, please press one – of not, press three. They say it is personal business and give you the number of the bill. I have to call them to see if we can make an arrangement. Sometimes I can make some sort of payment. It is harder with the collection agency than the hospital."
