When do you buy a car without inquiring about cost? Probably never. Chances are you carefully research different brands of cars, repair records, gas mileage, safety records, dealer cost (so you know how low you can negotiate)  or you read used car ads for a good deal until your eyes bleed.

When it comes to your health, shopping for the best deal usually does not enter into your equation. If you are told that six weeks of radiation is mandatory following a lumpectomy, you just say: When do I start and where? You don’t say: how much would that be? Usually you pick the facility closest to you and one that is covered by insurance. You do not call around and ask how much others may charge. (They probably won’t even tell you.) Also, you’d like to think that  you chose a radiation oncologist on his skills and a facility based on its equipment, not on price. Most people go to the radiologist recommended by  their oncologist.

The reality is that even with good insurance, you will end up paying between 10-20 percent of the bills yourself. And here is the reality check: My bill for one month of radiation comes to $44,681.00.

This amount does not include the whole six weeks. It does not include the bill for radiation set up, initial consultation with the radiation oncologist nor does it include the cost of a CAT scan.

Of course the total amount of $44,681 is what people pay who don’t have insurance. I will pay a percentage of the adjusted rate negotiated by my insurance company.  If I did not have insurance, could I have asked for “an adjusted rate?’ Probably not. I would have been stuck paying the whole thing.

When your life is in the balance, the price becomes irrelevant. Yet when I write the checks, a few thousand dollars at a time, for my part of the bills, I cannot help but think of people who simply do not have it. I think of people who have to put it on a credit card and pile up high interest rates. I think of people who don’t even have the ability to put it on a credit card because they don’t have them or their available credit would  not cover their medical  bills. Combine this reality with the fact that a woman with breast cancer usually sees her income go down by an average 26 percent. In my case it already looks like my income for the year will be down by close to 40 percent. For one reason I work a lot fewer hours, and when I am at work I am distracted. And I have not even had to have chemo therapy, a major stumbling block in anyone’s work schedule.

In the waiting area, before receiving my mysterious “wire,”  I immediately set eyes on a young woman, at the most 25 years old, too young to be wearing a hideous hospital gown and a plastic ID bracelet at the Magnolia Cancer Center. The middle-aged woman next to her is fully dressed. I feel emotional as a look at them.

The mother, I assume, notices. She, too, have tears well up in her eyes before we both look away, neither of us, obviously, want the girl to see our reaction.

I hope she will escape chemo. But because of her young age, the odds are not in her favor. And what about five years on the estrogen interfering pill Tamoxifen, while her biological clock is ticking? And what about her very survival? The young woman just sits there, quiet and calm,  seemingly unaware of the high stakes.

Three other women, all older, are also in the waiting area.  The women talked freely but quietly among each other.

One is a nurse in the child oncology department of the Magnolia Cancer Center. She quietly says: “Breast cancer may be one in four now. But it is not official yet.”. She is here for her first annual check up after lumpectomy, radiation and chemotherapy. All her hair is back on her head: Thick and dark, streaked with gray, curly. “It used to be straight and thin,” she says,visibly shaken by what she has been through during the past year.

Another woman in the waiting room is a slim, light skinned black woman with a pleasant smile and a dignified demeanor. She sits with her back straight, one leg gracefully crossed over the other, hands in her lap.  She looks serene, only the nervously tapping foot betrays her tension.

Her great-grandmother, her grandmother, her mother and sister all died from breast cancer, she tells us. Ten years ago she herself had a lumpectomy and radiation. Then it was ductal carcinoma in situ. Now, in a routine check up, she is discovered to have lobular carcinoma. She needs a full mastectomy. Her voice is calm, she looks brave, but then again: there is the jiggling leg. I don’t know if she is aware of these scandalous statistics. The numbers below are truly something to scream about at town hall meetings instead of ranting about imaginary “death panels.” How about a certain death trap (unless you have deep pockets): breast cancer without health insurance.

According to the American Cancer Society the gap in death rates from breast cancer between African American and white women has increased substantially. In 1991, death rates among African American women were 18 percent higher compared to white women; by 2004, they were 36 percent higher.

It is amazing how four women in a waiting room can bond so quickly. It reminds me of female bonding during pregnancy. Although back then I sensed more of a competitiveness among expectant mothers in the obstetrician’s waiting room. Who had kept her weight down better? Who was thinking she would handle labor pains better? Whose baby would be the best baby ever? (Mine, of course.) Now we, the breast cancer patients, seem genuinely interest in each others’ stories, seem to care about everyone’s fate. We do not compare.

I am called away before I hear the result of the  oncology nurse’s check up.  But a few minutes later, in the adjacent room, I hear laughter and applause from the waiting area. After one year, the nurse is still cancer free. The room cheers for her as she walks away. (The two first years after surgery are the most likely for recurrence.)

I have no idea what happened to the young woman who waited for surgery with her mother. I still think of her.

The post man sprinkles me with bills. How many have I managed to accumulate, considering I have not yet had my MRI or surgery? Did their computerized billing system over heat? Reluctantly, I open the first white envelope.

“This is not a bill” it reads. Then what is it?

It is a letter from the insurance company informing me that a claim has been filed. The three next envelopes have the same date, June 19^th, but all are for different amounts. What is going on? Ah, one is from the doctor for his time, one is for the laboratory for analyzing my cells, and the third  is for the  use their equipment.

In small print, all the bills confirm claims have been filed with my insurance company. Then in large bold letters, all three bills say: It is your responsibility to pay.

I realize: this is just the beginning of bill-o-mania.

Without as much as a glance at the content, I empty an old ring binder. Voila, a fresh storage facility for my medical bills. I take a yellow marker and high light the date, the “service provider,” the description and the code of what was done, as well as the amount.

This is going to take organizational skills I don’t possess. After all, some days I feel I already have the famous “chemo brain.” Should I need chemo therapy, my mental stamina will hardly improve.

I place my “new” medical ring binder in the book shelf and notice one more white envelope on my desk. It is from the Cobra Services Administration:

We are changing from Blue Cross Blue Shield to Guardian. If you do not respond to us with a check in the amount of $849.23 within ten days from the above date, we assume you do not want continued coverage.

Are they @*&%# kidding me? Why would they assume I don’t want health coverage just as I face my biggest expenses since paying for a university education and buying a house?