It was the last time I’d be seeing Chris. She came in to see me for follow-up of her asthma which had been getting worse recently. She also mentioned in passing that she was having some problems sleeping. Everything about the visit had seemed routine until I mentioned something about insurances not wanting to pay for a particular medication. Then she told me her story.

The national company she worked for had changed their insurance carrier to one that offered less coverage and since that was the only insurance they offered, employees either had to take it or leave it. It was an insurance our group practice did not take. Since she and her husband, a newly diagnosed diabetic, both came to us, both had to find another provider. She was most concerned however, about her young son who had a great relationship with his pediatrician and she didn’t want him to lose that. So she kept being seen by us and now had a $600+ bill. She couldn’t continue to see us.

It was then that her eyes welled up with tears. Now I should tell you that Chris has always been an upbeat patient – even when she’s sick she maintains her sense of humor. So the tears caught me by surprise. The reason for the visit – asthma – dissolved into the background. I probed further.

Turns out she’d been really caught in the bank crunch. They had taken a variable rate mortgage on their house and when the market tanked, their variable rate became feverish. Unable to keep up with the new payments, they lost their home. To make matters worse, they also had their car repossessed. 

Both she and her husband worked but she was worried about losing her job which was tied into the building sector. The pay wasn’t great, the hours were terrible and they had laid off some people the week before. Everyone was frightened their job was next. Now on top of it, their insurance coverage had changed and they had to pay more out of pocket for less coverage.

No wonder she couldn’t sleep.

I loaded her up with samples to treat her asthma. Ideally, I would have had her back to see if further adjustments needed to be made to her asthma med but more importantly, I would have spent time talking and listening to her about how her underlying anxiety was impacting her health.

It’s obvious but it’s worth saying: healing involves a willingness to listen, to provide the space for people to come forth with their stories. But it doesn’t happen in a vacuum. It happens in the rapport patients and providers build with each other. It’s a mutual trust that develops over time.

She and her family will eventually find another provider but I hope she finds that quickly.

It’s disheartening for both patients and providers that the time spent in developing these relationships can change when companies select different insurance carriers. In some cases, this is done yearly. All the work put into developing relationships between patients/providers can’t occur with frequent changes.

It’s time for a single-payor health care system.