One day, my mother suddenly was unable to finish her sentences. She was admitted to the local hospital, where a CT and MRI revealed multiple lesions. Ultimately, she was diagnosed with a glioblastoma. The neurosurgeon told us she was too old to operate on and recommended hospice, adding that she was unlikely to live more than six months. At another hospital, she was offered radiation, chemotherapy, and infusions, as her firm wish was to live as long as she could.
Because her illness left her with difficulty walking, dressing, feeding herself, and speaking, she was sent to a rehabilitation facility after hospitalization. From there, she needed daily transportation for radiation treatment at a cost of $1,448, none of it covered by insurance. The rehabilitation itself cost $7,123, because Medicare pays only 80 percent after 20 days and private supplement plans don’t cover rehabilitation at all.
A complex billing maze compounded efforts to pay for care. Inpatient care was “in network” with her plan, but her outpatient facility was not. Months later, I was told that her plan had its own cancer resource program I could enroll her in that would cover all costs Medicare didn’t, but only retroactively for one month, and after advocacy, it was made retroactive to the beginning of the year. Each organization insisted the other was responsible for not informing me of this sooner. My mother’s out-of-pocket expenses for that year came to over $38,000.
One of my brothers did not cope well with our mother’s illness. He became physically aggressive, grabbing me and punching staff at his residence. He refused to attend his day program for months, sometimes went a week without washing or changing his clothes, and spent his days in a recliner or in bed. To manage his behavioral problems, he needed applied behavior analysis (ABA), and in New York, private insurance is required to fund this.
The agency that was to provide his therapy requested prior authorization for an assessment. It was denied; the psychiatrist who rejected it suggested his problems might stem from dementia, though he had no symptoms of dementia. There were appeals for both the assessment and then appeals for the therapy itself. Ultimately, his care was not authorized until several months later.
The claims were their own ordeal. The behavioral health company managing his benefits first refused to release any information on the claims I submitted, for a number of spurious reasons. Multiple forms were said to be lost and had to be resubmitted. They have found reasons to reject claims for frivolous reasons, and once, by their own admission, their own mistake, and I had to resubmit them. To date, I’ve spent over $13,000 on his treatment. My first reimbursement finally arrived for $4,844 plus $24.94 in interest for delayed payments. They then rejected another claim by the same mistake as before, and a representative informed me a computer system handles the initial claims and that is why it was wrongly rejected again, and only by my request, an actual human being will reprocess the claim correctly.
My daughter has had similar frustrations. New York is funding a Massachusetts program because they do not have anything suitable in New York. She once had an eye infection. When we tried to fill an antibiotic eye drop at a local pharmacy, I presented her Medicaid card, but was told that New York State Medicaid won’t pay for prescriptions filled out of state. This is common: Students at her program who live in New York and have only Medicaid must make a round trip of at least seven hours just to see a doctor.
According to a 2025 national survey by Physicians for a National Health Program (PNHP) of 1,207 practicing physicians, 45 percent often or always felt unable to provide the best possible care, 47 percent often or always felt unable to provide optimal care due to inadequate time, and 44 percent reported being unable to deliver medically necessary treatment because of insurance barriers. Furthermore, medical debt has increased tremendously. “From 2010-2024, Virginia hospitals and medical providers sought to collect $1.4 billion in medical debt by bringing 1.15 million lawsuits against patients, constituting 27.1 percent of all the state’s debt collection actions in District Court.”
These sorts of coverage battles between multiple systems simply would not occur under a national single-payer health plan, and could greatly simplify access to care for everyone. This would improve outcomes for those who cannot afford to lay out funds while cutting costs. Without high out-of-pocket costs, the finances of low- and middle-income families would improve, which would decrease family stress, improve caregivers’ health, and also boost the economy. Single-payer health care is a public health necessity.
Ilana Slaff-Galatan is a psychiatrist.
