Chappell family’s insurance battle highlights gaps in healthcare safety net

BURGETTSTOWN, Pa. — The Chappell family is in a race against time as they struggle to secure insurance coverage for Paul Chappell, who was diagnosed with a glioblastoma multiforme (GBM) brain tumor in 2022.

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With his insurance set to lapse on Jan. 1, the family is facing mounting financial pressure.

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“This was in Philadelphia and SSA. And they reached out to us on December 12, and they denied to waive the 5-month grace period. And they basically didn’t give a reason,” said Pam Chappell, Paul’s wife.

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The Philadelphia branch of the Social Security Administration offered the following statement: “Everything’s being done according to regulation, but we are directing them to other agencies that could provide help. There’s nothing outstanding for our agency to do, but we’re looking to connect citizens to other potential resources.”

The SSA added that the only way to waive the remaining 5 months of waiting time would be if Paul had ALS or renal failure.

Pam explored alternative insurance options but encountered further obstacles.

“They told me that I needed to look into the Affordable Care Act, and I did look into those insurances. And when I reached out to the state of Pennsylvania, we did not qualify. So therefore we do not qualify for the tax break,” she said.

The Chappells also do not qualify for Medicaid, as their income from the past 5 years exceeds the eligibility threshold. After a final determination from the Centers for Medicare & Medicaid Services resulted in a denial, the family is now faced with a difficult choice: pay their bills or pay for Paul’s care.

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“I reached out to another insurance and they could get us insurance for $2,660 a month that, with a $2,000 deductible, that would cover Paul’s doctors and Optune. But neither one of us is working, so $2,660 a month for five months is $13,000. So how do they expect us to eat and pay our utilities, cause that’s pretty high,” Pam said.

While community members have shown support, Novocure, the company handling the Optune device for Paul’s treatment, has offered to arrange a payment plan.

“Novocure is who handles the Optune and they had said that they would reach out and do some type of payment plan for us. But it’s $24,700 a month for the Optune. So they have agreed to reach out to us to make some type of payment plan. That I’m not sure what it’s going to be yet,” Pam said.

As the deadline approaches, Pam expressed her frustration with the federal government’s response.

“It all falls back on us. Because the federal government has made it pretty clear that they are not going to help us. They made that very clear. On that phone call December 20, they made it very clear. Totally inhumane. Totally,” she said.

The Center for Medicare Services declined to discuss the specifics of the Chappells’ case due to privacy laws. Attempts to reach the federal Social Security Administration for comment were unsuccessful.