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Uninsured heart patients find different payment paths

October 19, 2009|By HEATHER KEELS

o Employers, individuals face tough choices on health coverage

HAGERSTOWN -- Randy Heavner Sr. runs his own landscaping company. Elton Horst works part time as a janitor.

Both looked into buying their own health insurance, weighed their risks and decided it was too expensive.

Neither counted on having his heart malfunction.

Their stories show the spectrum of assistance that is available for Americans who find themselves in the nightmare situation of needing lifesaving care without any health insurance to help pay for it, and their differing perspectives on health care reform highlight the deeply rooted feelings that split even those who would be affected most by reform.

'I would have died'

Heavner, 52, of Clear Spring, said that with his family of eight children, he and his wife would have had to pay about $1,200 per month for health insurance. There was no way they could afford that, he said.

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The family got by for almost 20 years with Heavner and his wife visiting the Community Free Clinic of Washington County, which serves uninsured patients for free, and their children covered by a state medical assistance program for children of low-income families.

That arrangement met their needs until a few years ago, when Heavner started feeling short of breath and tired all the time. In 2007, he brought up his symptoms at a visit to the clinic, and the staff sent him to Washington County Hospital for some tests.

"They found out my aorta valve was severely shut down and I really had, literally, days or months to live," Heavner said.

The condition apparently was a birth defect that had gone unnoticed. Doctors said Heavner needed his aortic valve replaced, but when he found out the surgery would cost more than $120,000, he refused to have the work done.

"I wasn't going to put my kids and family in this financial crisis that I knew we could never pay," he said. "I would have died if it wasn't for Dr. Dan McDougal."

McDougal, a Community Free Clinic doctor, found a surgeon at Johns Hopkins who agreed to do the surgery for free, Heavner said. There would be other bills associated with the hospital stay, but McDougal said he would try to get those waived, too.

Heavner had the surgery in February 2008. Today, he takes a blood-thinning drug to reduce the risk of developing a blood clot due to the artificial valve, and he has his blood checked regularly, but otherwise leads a normal life, he said.

Heavner recently recorded a tribute to McDougal, who has Lou Gehrig's disease, that was played at a fundraising event honoring the doctor.

"I thanked him for helping me and my family out," he said.

'Pretty much blindsided'

Horst, 63, of Hagerstown, said he was a competitive runner for 45 years. At 60, he was running 5K races at a seven-minute mile pace. So when he was laid off from a local furniture company and got a part-time job with Antietam Pediatric and Adolescent Care, he decided to take his chances without health insurance.

"I've been healthy all my life and had been very athletic and had made the assumption, which was probably very naive, that my YMCA membership was my health insurance," Horst said.

In August 2008, Horst was on a machine at the YMCA when he noticed his heart was beating irregularly and decided to get it checked out.

He went to Washington County Hospital, where an echocardiogram showed he had mitral valve prolapse, a condition in which blood pumped from the heart's left atrium into the left ventricle sometimes is able to leak backward. In severe cases, the condition can lead to heart failure, Horst said.

"This just pretty much blindsided me," he said.

Horst said he eventually will need surgery to correct the problem, but for now, he is eating a healthier diet, going easy on the exercise and trying to stay out of the hospital until he turns 65 and qualifies for Medicare.

That strategy has succeeded so far, except for one incident in February, when Horst collapsed in his apartment. He was taken to the emergency room, where his heart stopped for 17 seconds, he said.

Doctors said the problem probably was brought on by the beta blocker Horst had been prescribed for the heart condition. Beta blockers lower blood pressure, and Horst already had low blood pressure, he said.

Each hospital visit -- the first when he was diagnosed and the second in February -- was only one night, but the bills for the hospital stay alone were more than $2,000 each. Separate bills for the doctors who treated him and for the ambulance ride brought his total for the two visits to almost $8,000.

Horst applied for the hospital's financial assistance program, which provides discounts based on federal guidelines related to income, assets and household size. He qualified for a 20-percent discount.

By making payments totaling about $250 a month, Horst said he has been "slowly gnawing away" at the bills, but the debt still looms.

"I say some people pay on house mortgages, I'm paying on health bills," he said.

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