Your Money or Your Life - KLTV.com - Tyler, Longview, Jacksonville |ETX News

02/06/03

Your Money or Your Life

   "I've been through what most people would never imagine," says Samantha Renzer, a leukemia patient.

   For Samantha Renzer and her parents, life changed when her doctor said the word "leukemia".

   "I was scared. I was very scared," says Samantha Renzer, a leukemia patient.

   "I just buckled. Absolutely buckled," says Alan Renzer, Samantha's father.

   Chemotherapy didn't work. Samantha was prepped for a bone marrow transplant. That's when Alan Renzer was told there was no more insurance money. The family's plan had a million dollar per-person cap. And in just seven months, Samantha had hit it.

   "It never occurred to me that we would ever come close to the cap," says Alan Renzer, Samantha's father.

   Instead of focusing on his little girl's life or death treatment, Alan was burdened with other questions.

   "Did you know that you are responsible now for all the payments? What are you going to do about it," Alan Renzer asks? That's a question thousands of Americans struggle with each year. There are three kinds of insurance caps; Lifetime, annual, and limits on specific treatment such as mental health.

   Most people never realize they have a cap until faced with a devastating diagnosis.

   "American consumers are often confronted not only with the battle of their life with the disease but, at the same time, a battle with their insurance company," says Nancy Davenport-Ennis, President, the Patient Advocate Foundation.

   Nancy Davenport-Ennis of the Patient Advocate Foundation helps families bargain with their insurance company to extend coverage. Failing that. Some states have special funds called "risk pools" for patients without insurance. If that doesn't work, you're left to bargain with your doctors.

   "So if you hit the cap within your health plan policy, your options are fairly limited," says Nancy Davenport-Ennis.

   "Does it happen very often? No," says Jeff Feliciano, Feliciano Financial group. "Can it happen? Yes."

   This agency has been in business almost 20 years and I think our biggest claim is somewhere in the neighborhood of 800,000." Jeff Feliciano, at the Feliciano Financial Group, sells health insurance to East Texans. Feliciano says it's important for you to know the limitations and risks of your policy.

   "I don't think people really pay attention to what their maximums are," says Jeff Feliciano, Feliciano Financial Group. "A lot of policies have what's called a lifetime maximum and they have an aggregate maximum. What an aggregate maximum is where they pay occurrence. Sometimes it can be less than what your lifetime occurrence is."

   Doctor Donald Young says caps keep premiums low. "Only a small number of employers choose to have them, and they do so to keep insurance affordable for their workers," says Donald A. Young, Health Insurance Association of America.

   Doctor Young believes many companies are actually turning away from caps. But that's not what experts, including the Patient Advocate Foundation are finding.

   "What we're beginning to see is that more and more plans are moving to lower caps, and to annual caps," says Davenport-Ennis.

   The Renzers have now enrolled in a special program to help families stranded without insurance. But Samantha's about to hit her second cap. And, at 13, she wonders why it's so hard for family's lie hers to get the help they need.

   "I don't know who I'm going to turn to for insurance for the rest of my life," says Samantha.

   Any caps should be clearly spelled out in your health insurance policy. If you find your health insurance plan has a lifetime limit, supplemental insurance is available. It kicks in once you reach the cap. Past sessions on congress have considered legislation on insurance caps, but none has passed yet.

  Dana Dixon, reporting.

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