It’s Not Just One Test

By Vidur Tangri 

United States of America – a land of freedom and opportunity. These opportunities and a prospect of securing a better future for their children led my parents to immigrate to the States in 2003. Coming from a cultural background where health insurance is looked upon more as a luxury than a necessity, food and housing were the top priorities for our family. Since my parents are well into their 50s, working long hours every day definitely took a toll on their health but they refused to visit a doctor. Finally after six years, we were able to convince my parents to visit a doctor. On their first visit the doctor diagnosed them with diabetes and hypertension, prescribing them metformin and aspirin. The bills for lab work and the doctor’s visit were quickly adding up. Without insurance, even the basic lab tests such as HgbA1C testing and urinalysis were very expensive. The medical bill for the visit and lab work came out to $1000. Paying for the bill and the monthly prescriptions out of pocket definitely made my parents think twice about going to the physician.

My dad did not visit the doctor again until November 2013, when he had intermittent but painful rectal bleeding for over a month. He was getting weaker by the day and finally made a trip to his primary care physician, Dr. Balasubramanian. Understanding our lack of health insurance, Dr. Balasubramanian personally called and referred my father to his longtime friend, urologist Dr. Kim. Dr. Kim instantly ordered a colonoscopy and stopped aspirin.

Without insurance, the procedure alone was going to cost $1500 so we were referred to the Colorectal Cancer Screening program of Harford County Health Department. This cancer prevention program covers diagnostic procedures for county residents over the age of 50. Thankfully, the health care workers at the health department were very understanding of the situation and were able to arrange for the colonoscopy procedure fees to be covered. The colonoscopy revealed the presence of external hemorrhoids. Following up with the urologist, Dr. Kim recommended a topical application of several different medications but to no relief. With complaints of persistent distress and discomfort, Dr. Kim planned to perform a hemorrhoidectomy. Standing at the crossroads of a financial situation and extreme pain, my father agreed to have the hemorrhoids removed surgically.

Following the surgery, there was an obvious difference in my dad. It was great to see him so energetic and back to his smiling self, but the $4000 medical bill was definitely received with a frown. Following the surgery, we continue to receive numerous calls from the doctor’s office asking to pay the outstanding bill, but my parents don’t have the financial stability to pay it off. In the last two years, my parents have worked laboriously while trying to save every penny, but to no avail. The bill was recently referred to a collection agency, and they have continued the same trend of calls. The agency provides a 3-month installment plan, but keeping up with the payments has been very tough especially while supporting me through medical school.

As I watch my parents continue to struggle with the medical expenses, I wonder, had my dad not been negatively affected by the costs of health care during his initial visit, if he would have continued to see the doctor and the hemorrhoids could have been controlled without surgery. As I progress through medical school and onto residency, I will definitely appreciate my patient’s struggle with paying for medical tests ordered as they may lead them to forgo other tests and treatments that may be more beneficial.