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DEL.ICIO.USMedical 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?
Comments
By Beccaann
June 8, 2006 07:12 AM | Link to this
Wish I could do something for the Silises. I have had my own problems with this is a minor way. After a car accident, I am still paying on deductables and explaining to credit card companies why I can’t pay them the full about again this month. I don’t know if you can ever catch up. I have actually taken on a second job to help pay off the bills. Did I have insurance? I certainly did, but they only pay so much.
Rick, has anyone set up a medical bank account for this child?
By deegee
June 8, 2006 08:16 AM | Link to this
This is truly a heartbreaker for any parent. Who couldn’t look into the eyes of a sick child and not promise to go to any lengths to make them well? It’s never easy to make quality of life decisions but it has to be unbearable with a newborn.
Unfortunately I think that this well-meaning family is suffering due to crackdowns on the Medicaid system due to abuse. Many recipients receive free medical care when they could easily afford to pay. I would like to see case workers means test and investigate people making Medicaid claims. I think that just the threat of investigation would thwart some of the abuse. If it isn’t already a practice, all people that are using gov’t assisted health care should pay at least 25% up front for non life-threatening incidents. At least we would get something from them. I would think that the private HMOs like Kaiser would be able to offer some level of health insurance at an affordable price to those families that need just the basics. Then we could free up resources to assist families living under the circumstances described above.
Social Security is not really the answer because the system is not designed like an investment club. You pay in so that someone else gets a benefit. You hope that when you retire someone else will be around to pay your benefit.
By Karen
June 8, 2006 09:32 AM | Link to this
This is truly sad. I know where you are coming from. I am in the same situation. I have diabetes but I can’t get health coverage because I have diabetes. All my medical bills have to be paid by me out of pocket. Social Security is a joke. You work all your life and monies are taken out and when you need it it is not available.
I look at GASPER the whale getting all that medical attention for free, and I have to pay $200-$300.00 per doctor’s visit plus insulin charges out of pocket.
I will keep Jacob in my prayers. Hang in there!
By nikki
June 8, 2006 10:11 AM | Link to this
I know where they are coming from. My mother-in-law, who has nothing, lived on Social Security and very little of that because past employers did not pay it, needs to be in nursing home and is temporarily. The problem is that she doesn’t have and can’t afford supplemental insurance, hence, nursing homes don’t want her and she is on waiting list for group home. I have filed with Medicaid and awaiting a decision. Medicaid is a joke. Have had 3 caseworkers in couple of months. Can’t get anyone on the phone, voice mail full, faxes are ignored, all we get are cryptic, generic letters. All of the things mentioned here are decent, hard working, American citizens, in need, who get nothing, I repeat nothing, but crap from their government. I am so frustrated I could scream. My mother in law lived with us prior to needing this care, we can’t afford any better, we can’t understand any of this. What does an elder do if they have no one to help with all this?
By Bruce Wilcox
June 8, 2006 10:37 AM | Link to this
A National Health Care System is the only answer. Let us join all the other industrial nations of the world. An independent research group hired by Congress to keep the politics out of it found that the majority of Americans support the idea of National Health Care.
The groups findings were just released this week so it should be easy to find on the web.
The added benefit it would keep the price of health care under control.
By deegee
June 8, 2006 11:03 AM | Link to this
I like the concept of national health care but am afraid of what managing and execution of the plan would look like, i.e., madicare Part D prescription drug plan. I would vote for it as long as people are expected to pay a reasonable co-pay up front like my HMO requires. I hate to see a system in place where healthy people end up paying via taxes, while people that abuse themselves pay nothing.
By lynn
June 8, 2006 12:56 PM | Link to this
Once again, thank the amigos & slackers living off of our hard earned paychecks every week by abusing our system…but most of all thank our government who allows it.
By nikki
June 8, 2006 01:10 PM | Link to this
@lynn - You don’t know whether all are slackers or not. You will not know until you are put in a desperate situation and have trouble yourselves. I blame all of us for letting our government get out of control. PS - If I ever need government assistance, I’ll make sure they don’t use the portion you pay, okay?
By lynn
June 8, 2006 01:19 PM | Link to this
Nikki, I would appreciate you not stealing my hard earned over taxed dollars but it sounds like you already are!
By lynn
June 8, 2006 01:23 PM | Link to this
Also, FYI, One of my dearest friends who has worked for over 30 years recently fell into a situation where she was out of her long term job, lost her house & her health went to hell too. She applied everywhere in search of some type of assistance with her RX’s, employment etc. and was told NO by every agency. Had she been a minority I’m sure she could have got help.
By Nicole
June 8, 2006 02:32 PM | Link to this
It is a sad day when we take public forums and use them to express our own prejudicial views…what’s even sadder is the whole concept of what Rick was really speaking of and expressing in his article was lost on one twisted view. Nevertheless, I would like to say I wish the Silis’ well and I pray they will be able to find the care and monies they need for their son. If anyone saw the movie in which Denzel Washington played a father in desperate need of medical attention for his son and the “HMO” would not cover the cost, this kind of brings to reality the Healthcare System we know today. There was a time when government employees were offered the “best” rates, services and insurances around. Not anymore, they now rank amongst one of the worst. I tend to agree with those who have expressed frustration that it is sad when an animal can get the necessary care they need for “free” (which is really at the cost of taxpayers), yet we have individuals who work everyday, and have worked for a number of years (in my case since I was 14 - I’m now 34 so you do the math), and are still unable to afford the cost of healthcare benefits for themselves and their families. I agree with Mrs. Silis, since she worked for so many years, why can’t she receive her Social Security now and allow it to go towards the care of her children? Common sense would say “that’s a good idea”, but then again we are dealing with a government that does not use common sense. I wish them well, and I pray for the best for them.
By nikki
June 8, 2006 02:46 PM | Link to this
@lynn - I have worked since I was 18 and I am now 56. No lapse of employment. So i dare say i’m not using any of your freakin money. Listen to what I am saying you self righteous nut. With the attitude you have, undoubtedly your “worth it” list is very short. Why don’t you get some help for your schizoprenic side before you hurt somebody.
By lynn
June 8, 2006 02:58 PM | Link to this
LOL Nikki, it’s obvious from every post you have made on the various blogs today that your prozac needs refilling! I’ve read others comments to you and everyone agrees your lost in your own world. At such a ripe age, your still so dumb!
By nikki
June 8, 2006 03:01 PM | Link to this
You know, I will forgive you. Bless your heart, you can’t help the way you are. Perhaps me and some of my “amigo” friends could help you somehow.
By lynn
June 8, 2006 03:18 PM | Link to this
That would be great, my horse barn needs a good cleaning.
By nikki
June 8, 2006 03:36 PM | Link to this
It is sad when society has no compassion. IED is rampant and nobody cares about anyone else but themselves. I certainly hope this family gets the help they need and anyone else in dire straits. I used to be “hardnosed” but several events in life gave me a different perspective.
By Brad
June 8, 2006 04:40 PM | Link to this
Being in the healthcare field, I have seen the vicious cycle that medical bills and insurance create amongst themselves, and the patient is the loser in all of this. We have gotten to a point where technology has outpaced the ability to pay for services and it is only going to get worse. I work with medically fragile kids and I am thankful that I work at a place where they treat children regardless of ability to pay, because the families have high bills. I could talk about this till I am blue in the face, but I do not need to write a book here about health care. Good luck to the Silises and to you Mr Badie in your attempts at changing an industry that has created its own problems.
By ELLE
June 8, 2006 05:13 PM | Link to this
@Lynn: “Had she been a minority I’m sure she could have got help.”
Is there a program in Social Security that asks “ARE YOU A MINORITY?” prior to paying out a claim?
-OR-Are you being a “BIGOT”?
I am certainly sorry for this family. There are so many families like them. I don’t know the answer, but it is heart breaking.
We have someone who was an “OLYMPIC” hopeful. Her name is Marin Morrison. You can check out her story… www.marinlove.com
She is a young swimmer formerly of Collins Hill H.S. in Gwinnett County Georgia. This kid was a strong Olympic hopeful… I used to watch her swim 2.5 hours daily 6 days a week.
She was diagnosed with a brain tumor on February 23, 2005.
Once again here is someone in need of medical care from a “2-parent” family. The bills are catastrophic. We have fundraisers at a lot of swim meets. We donate the money to her family. Additionally, we pray for her prior to many of the meets.
The fundraising occurs at just about all County schools with swim teams. I am proud of these young adults!
Kids needing costly medical care are tough on their parents, and even harder on siblings! They require lots of care, and costly medication and therapy.
I don’t know what the answer is… but there has to be some viable solution! This could happen to any of us!
Attacking other races or ethnicities… serves no purpose. It is just mean spirited banter!
I will continue to pray for people like the Silises and the Morrisons… and other families devastated by catastrophic illnesses.
By Jonathan Blake
June 8, 2006 06:59 PM | Link to this
It is a complete misrepresentation of the voters in Kevin Kenerly’s district for him to be wined and dined by the developers (George Thorndyke, Mr. Jenkins,etc…) shown in the Las Vegas video on WSB-TV .com. For him to use the Disney World excuse and to be staying in a $1,000.00 a night suite is a slap in the face of every taxpayer who pays his salary.This should be brought to the attention of everyone with a Gwinnett County address. The $500,000.00 commission he made on the sale of the old Macy’s @ Gwinnett Place shouls also be a conflict of interest(If not blatantly illegal) If this is swept under the rug it is a complete failure of the press in this election. I am not a big fan of any of the canidates but this smells fishy as my dear departed mother used to say. Feel free to contact me for any further comments. Concerned citizen, Jonathan Blake jonathanhblake@bellsouth.net
By Michael H. Smith
June 11, 2006 09:43 PM | Link to this
Reading these AJC blogs is like taking a crash course in human psychology. The back and forth commentary, though at times is somewhat entertaining, it often detracts from dealing with the real human issues at hand.
Universally accessible affordable healthcare for every individual “U.S. citizen” in this country is long over due. Going back to the founding document of this country, which neither qualified nor quantified our inalienable rights virtually necessitates it, wherein and among these are found assurances of life, liberty and the pursuit of happiness.
Now my good conservative ilk does have a bit of, how do we say, an air of duplicity amongst the ranks when it comes down to “protecting life”? Oh yeah we do trumpet pro-life issues don’t we now, but only when it comes to abortion as defined by ending the life of the un-borne fetus? Then in turn say, to hell with the life of the living! They were probably slackers, made bad choices, just needed education so they got what they deserved anyway. Blaaaaaaaah….
Every so-called “compassionate conservative” (you know the Bushites) and the indeed conservatives elected to office in this country needs to spend about a month in the ICU wards and the rehab centers of hospitals across this country to get in touch with reality. The real human story portrayed in this blog of one tragedy, is simply one abortion played out millions of times over in this nation where entire families have had their lives terminated - aborted - by an inadequate healthcare system that serves a few very well but just doesn’t give one good damn about the overwhelming rest.
“Let the watchwords of all our people be the old familiar watchwords of honesty, decency, fair-dealing, and commonsense.”… “We must treat each man on his worth and merits as a man. We must see that each is given a square deal, because he is entitled to no more and should receive no less.” “The welfare of each of us is dependent fundamentally upon the welfare of all of us.”
Theodore Roosevelt
New York State Fair, Syracuse, September 7, 1903
By katie
June 19, 2006 08:21 AM | Link to this
when babies are born and are unhealthy, why not allow them to die then? How much money should be spent on a life? Everyone keeps blaming the illegals but they aren’t the real problem. It’s whites and blacks on welfare that drain our system. Those that have children but can’t afford them and shouldn’t have had them to begin with. It’s a hard, tough world and all the money in the world shouldn’t be spent to keep one alive. I feel bad for this child but come on, how much tax payer money should be spent?
By Michael H. Smith
June 19, 2006 11:36 AM | Link to this
No disrespect intended katie but have you ever had to pull the plug on someone you love?
I only blame the illegals for the crimes they commit and whatever problems they actually create; nothing more, nothing less. However, no U.S. taxpayer in the least manner of speaking should be obligated to give any healthcare whatsoever to an illegal alien other than humanitarian aid. And that just long enough to send them the heck back home where their native government or family can pick up their healthcare costs and treatment.
But you’re right. All the money in the world can’t cure everyone of everything. In my blame accessing, the present system is most culpable. Two particular problems exist with healthcare funding in this country. One is the government, the other places the rest of the cost burdens on businesses.
In truth though, the healthcare costs eventually come back for we the consumer/individuals to pay. So I boldly suggest we can do better than what we have now and get more bang for our healthcare buck.