Cathy Kerns has multiple sclerosis. The drugs she takes are lifesaving, she says, but they cost more than $5,000 a month — and she must make a 20 percent co-payment. Her specialized physical therapy costs $600 per half-hour — and she pays 20 percent of that.
"If I call and plead with the insurance company that I need more therapy so I can walk, they say, 'Sorry, it isn't in the policy,' " she says.
"I'm paying more than $30,000 a year out of pocket. I'm running through my savings."
Kerns, 60, who is retired and lives in Orlando, represents hidden millions in America's healthcare crisis. She has insurance — but she is underinsured.
In that category she joins a California woman who was bitten by a rattlesnake, ran up a $73,000 hospital bill for medicine and an overnight stay, and learned her insurance would pay only $3,000 of it. And a Miami woman whose policy won't cover her diabetes because it was a preexisting condition.
The underinsured include the working poor whose employers don't provide full coverage, people who lose their jobs and their employer-subsidized insurance, and those who fail to understand the fine print in policy contracts and end up with less coverage than they expected.
No government agency keeps an official count of the underinsured. A 2007 survey by the Commonwealth Fund, a New York-based nonprofit that studies healthcare issues, estimates 25 million Americans are underinsured, up from 16 million in 2003. It defined "underinsured" as those with insurance who pay more than 10 percent of their income on medical expenses.
Underinsurance closely tracks the economy, experts say.
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