In late March 2010, Young's condition worsened the longer he went looking for a way to pay for treatment.
“I couldn't sleep,” he said. “I couldn't lay down because of the pain.”
Young's close friend and singing colleague Doug Purcell became frustrated.
“I felt incredibly helpless,” Purcell said. “I was to the point of being in tears. I was really angry that this is the way the system works.”
At Beth Israel, hospital officials do try to work with patients who struggle to pay through their charity care process, said Michelle Leone, senior vice president for revenue cycle operations and managed care for Continuum Health Partners, which oversees the hospital.
Leone, who would not speak specifically about Young's case, said the hospital's financial department will help pay for patients with incomes up to about $44,000, or 400 percent above the federal poverty level. Patients who receive emergency care and have no ability to pay will not be denied.
Patients unable to pay for scheduled appointments at the hospital have to work out a charity care plan before being treated. These services include chemotherapy and radiation. The hospital will determine if the patient will pay nothing or a portion of the cost. If the patient still struggles to pay, the hospital will put the patient under a payment plan usually over two years.
“We look at each case individually,” Leone said.
Although the hospital can agree to cover costs for a patient, there is no guarantee that the doctors in charge of the case will go forward if the patient can't afford it. The hospital then is tasked with finding another doctor, Leone said.
“Doctors are not obligated” to treat patients who can't pay, she said. “We try to match patients with the right access to find a surgeon or doctor who can take care of them.”
For Young, he turned to outside resources. Unmarried and with no children, Young's closest family members were his parents, who lived in Georgia. A year before Young's diagnosis, his father, David, had suffered life-threatening injuries from a car accident. He recovered and received a settlement for $13,000. He signed over the check to his son.
Young started treatments that same week.
“If it weren't for that, I don't think I could have lasted one more week,” Young said.
As Young started chemotherapy, he wondered how he would come up with the remaining $10,000 in expenses. He worried about how he would pay for his rent and utilities. He couldn't work and he had exhausted the little resources he had.
The stress of the chemotherapy and radiation quickly took a toll. Eating was a constant struggle. At 6-foot-1, Young usually weighed 180 pounds. He dropped 40 pounds during his treatments.
Young would hesitate to see a doctor when he was feeling particularly ill. His friend Purcell and his husband shared Young's worry about added costs for more medical visits outside his routine treatments.
“With John, it was always an issue of how sick are you feeling? Do we have to take you to the emergency room or can we get through this?” Purcell said.
On one evening that August, Purcell visited Young to do his laundry and house cleaning. Young's immune system had weakened greatly and he felt fatigued. But the pair feared another hospital bill.
Purcell left his Hell's Kitchen home the next day to attend a singing festival in upstate New York where he was expected to perform. On his way, he received a call from his husband that Young had worsened.
“John sounded completely out of it. He was actually getting delirious,” Purcell said. “If we didn't have to worry about the finances, I would've taken him to the hospital the night before.”
Purcell and his husband had spread the word of Young's situation to friends and colleagues. Most were fellow singers in New York who worked as freelancers and went without health insurance, too.
“People wanted to help, but they didn't have one place to go,” Purcell said.
So the couple put together a website called YoungFightingCancer.com and organized a nonprofit organization with the same name. They determined that Young shouldn't receive the donations directly because it would hurt his chances to re-apply for Medicaid as the donations could be viewed as a source of income. Instead, Purcell and his husband would directly pay for his rent and other bills, including the remaining balance Young owed for his treatments through the money raised.
One donor, Nacole Palmer, is a classical and opera singer. She said she was inspired to help because she has been uninsured in the past.
She heard about Young's circumstances as a fellow member of the Trinity choir. Palmer, who also worked as a freelancer with a limited income, donated nearly $100. Motivated to do more, Palmer organized a benefit concert at the Trinity church where roughly $17,000 was raised.
“We do this because we love the music. But there's a cost to that,” said Palmer, who now lives in Connecticut. “I was really touched by his plight. I imagined myself in his shoes.”
The website collected $28,000 in donations.
“Otherwise I just do not know what would have happened,” Purcell said. “We were worried he would have to stop treatments halfway through.”
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