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Thursday, June 8, 2006
Medical bills leave family scrimping
The Atlanta Journal-Constitution
Rutledge — Jacob had maxed out his medical insurance by the time he was 2 1/2 years old. One million dollars — just in therapy and hospital stays. “By the time he was 3, we figured he’d spend at cumulative of two years in the hospital,” his mom, Gail Silis, said.
Jacob was born nine years ago with a bad heart. Among other abnormalities, his arteries were reversed. His aorta, as well as blood vessels leading to his lungs, were too narrow.
He received a heart transplant on Memorial Day 2000. So far, its been a success. Still, he still needs constant medical care to make sure his body isn’t rejecting the organ.
In March, the Silises of Lawrenceville were the recipients of bad news. The family learned that monetary assistance provided through Medicaid had been denied. For the past six years, Jacob’s bill had been paid through the Katie Beckett Program. It pays exorbitant medical bills for those who can’t afford to — if certain criteria are met.
The Silises are middle class, but of the rank-and-file nature. Money’s tight. There’s not enough wiggle room to accommodate the kind of care Jacob demands — occupational as well as physical therapy, echocardiograms, extensive lab work, this, that and the other. And that doesn’t even take into account unexpected medical emergencies like pneumonia and infections.
Ironically, the Silises are partly to blame for their situation. Guess you can be too good at parenting.
I met Vince and Gail three years ago at Camp Braveheart, an annual camp for cardiac kids held in Rutledge. Gail serves as the director of arts and crafts. Vince, when his job as a computer programmer permits, volunteers, too.
When it comes to taking care of Jacob, one of two sons, its a tag-team effort. They dispense and monitor the effects of powerful medications that keep Jacob’s heart ticking and buoy his immune system. When he’s sick, she acts as nurse as much as possible.
“I’d rather keep him at home if I can,” Gail said.
And because of that, Jacob hasn’t chocked up enough hospital stays, scares and near misses to merit the need for continuous care.
Still, that doesn’t negate the fact that Jacob needs specialized attention Mom and Dad can’t provide. Or pay for, like therapy. Then there are the unforeseen expenses that can pop up any minute, any day.
“Before my children, I worked from the age of 17 until I was 37, so I’ve paid into the system,” Gail said. “My husband has paid into the system. I know Social Security won’t be around when I’m older, so why can’t I get what I’ve paid into the system and let it go to my child?”
“It makes me feel like I’m begging.”
Jacob’s pediatrician, Lise Baudean of Lawrenceville Pediatrics, has written a letter for the Silises to support their claim. She’s even stopped charging. “That’s kind of embarrassing,” Silis said.
The parents have stopped weekly therapy because they can’t afford it. They plan to appeal the denial of their claim but hold scant hope for a better outcome. Silis told me a joke that’s well-known within the organ-transplant community. If you maintain a stable home and have two parents, the best way to get premium medical care is to get a divorce.
It’s the only time she laughed during a nearly hourlong interview. The rest of the time she talked between tears.
Funny how medicine has advanced to the point that we can live years with another person’s organs.
What good is it, though, if the medical network to maintain that life is too expensive?
