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Dealing with difficult health choices

Family grapples with illness, unemployment and insurance premiums

Family grapples with illness, unemployment and insurance premiums

October 18, 2009|By ARNOLD PLATOU

o Health insurance rate hikes: Costs, causes and effects

o Employers, individuals face tough choices on health coverage

CLEAR SPRING -- His wife newly diagnosed with a crippling disease, Jeff Pine was dealing with back pain so severe he had to quit his longtime career as a bricklayer.

And now he was facing another crisis -- health care costs.

The Pines needed health insurance they couldn't afford, yet couldn't afford to go without.

"It just gets to be a nightmare," said Pine, 40. "Thankfully, we had some friends, neighbors and church members that set up a fund and helped us. We're kind of lucky there, blessed that we're around pretty good Christian people."

The Pines are not unlike millions of others challenged with finding health care coverage as the nation's economy has forced many out of work and now limits new job opportunities.

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Handling pain

Jeff Pine, who grew up in the rural Blairs Valley area that still is his home, became a bricklayer after graduating from Clear Spring High School in 1987.

He was on a job site in 1999 when he bent to pick up a covered 5-gallon bucket he thought was nearly empty.

It wasn't.

Others had replaced the bucket with a full one, Pine said, and when he grabbed it, the unexpected strain triggered sharp pain across his back.

In time, a specialist found serious spinal problems and said surgery might be necessary.

After marrying Stephanie in 2001, Pine ignored the pain and kept working.

"I kept on, taking pain pills, and I was probably doing more damage," he said.

The following year, their daughter, Jordan, was born.

Amid the joy soon came a new crisis.

"I never lost swelling in my feet, my hands, from my pregnancy," said Stephanie, 38. "I was just extremely tired. A couple of months into having my daughter, I was put in the hospital. I was severely anemic. I had to get a transfusion."

The condition, which has no known cause and is very hard to diagnose, was diagnosed by her family doctor, Jill Ciccarelli of Williamsport.

"She had these sausage-like, thick fingers and I had only seen it in a textbook and I said, 'Oh, that looks like something I have only seen in my training,'" Ciccarelli said.

She determined Stephanie has scleroderma, a chronic disease that hardens body tissues. The disease, which affects about 300,000 Americans, has no known cure.

The symptoms "vary greatly from individual to individual, and the effects of scleroderma can range from very mild to life-threatening," according to the Scleroderma Foundation, the leading nonprofit supporter of scleroderma research in the United States.

"The seriousness will depend on what parts of the body are affected and the extent to which they are affected," the foundation says on its Web site.

For Stephanie Pine, the disease has caused her stomach to thicken so much that she bleeds internally, Ciccarelli said.

"She can become anemic. She has to have blood transfusions or (the gastroenterologist) has to close off the vessels to stop the bleeding," Ciccarelli said.

She said Stephanie comes to her office for regular monitoring, and frequently goes to The Johns Hopkins and the University of Maryland hospitals in Baltimore for more specialized care.

Looking for insurance

The company for whom Jeff Pine worked paid him up to $17.50 per hour and its health insurance was covering most of the family's medical bills, so he was reluctant to leave.

By 2003, however, a doctor with Maryland's workers' compensation program, which helps people who have been injured on the job, insisted that Pine quit the company and be trained for a different job.

He resigned that summer.

The workers' comp program would pay doctors to treat his back, provide tuition for him to attend classes in computer-aided design drafting and give him $362 a week to support his family.

But his family -- particularly Stephanie -- needed medical insurance, too.

Jeff said he knew he could continue her coverage from the company's insurer through a federal plan called COBRA. He said he was told Stephanie couldn't stay on the plan by herself, that he had to remain on it, too.

That meant the family not only would have to pay $480 per month for insurance for her, but $480 more -- a total of $960 per month -- for his coverage, as well.

That was "outrageous," Pine said. "It wouldn't have left us nothing to live on."

So with federal law giving him 60 days to decide whether to take the COBRA plan, Pine began asking other insurance companies for quotes to cover the whole family.

That's when he ran into the words "pre-existing condition."

"They said they could take me and Jordan, but not Stephanie," he said. "They wouldn't cover Stephanie with scleroderma, and that was the main reason I needed the insurance. She was getting a blood transfusion at least every month. Plus, all the tests. They had to check for kidney damage, lung damage."

He was about to give up trying when he learned he had been given bad advice about the insurance.

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