Uninsured couple struggles after medical emergency

Melissa Sefcik gives her husband, Michael, a hug after getting home from work. Michael Sefcik did not have health insurance in mid-December when he had a stroke, but luckily he qualified for Medicaid, which retroactively covered his hospital bills.

Melissa Sefcik keeps her husband’s mounting medical bills in a two-pocket purple folder — and she’s nearly running out of room.

There’s the $1,078 bill for one night Michael Sefcik spent at Trident Medical Center after he suffered a stroke in December and another one, $2,374, for two subsequent nights at Medical University Hospital. There are a handful of others — $940 for a short emergency room stay; $150 for an echocardiogram to take pictures of his heart; $365 for X-rays; $239.32 for few minutes with a Trident neurologist, who Melissa only remembers saying, “Yes, there’s been some damage to his brain. I’m going to call MUSC to see if they can take him.”

All told, 41-year-old Michael Sefcik spent 15 days in two hospitals. He had no health insurance.

“Young people just don’t think about needing it,” said Melissa Sefcik, 35, who lives in Summerville with her husband. “We didn’t. We never thought about it.”

She doesn’t know how much all these medical bills will ultimately cost — they keep coming in the mail — but the couple recently received a financial lifesaver.

Because Michael Sefcik hadn’t worked on a construction site for more than a month before he collapsed on the living room floor on Dec. 15, and because the couple shares a 17-year-old son and had no savings, they received a letter in mid-January explaining he temporarily qualifies for a Medicaid policy, which will retroactively cover his medical bills back to Dec. 1.

That’s especially good news, considering hundreds of thousands of adults in this state, especially the ones who hold low-paying jobs and have no children, can’t get Medicaid.

Eligibility rules for the low-income health insurance program in South Carolina are relatively strict and conservative state leaders have refused to loosen those rules with federal funds available through the Affordable Care Act.

Nevertheless, Obamacare now requires most adults to prove that they have health insurance — through their employer, through a government-subsidized plan, or through some private policy — and time to sign up for an insurance plan on HealthCare.gov is running out.

“The deadline to sign up for coverage is just a few weeks away,” said Sylvia M. Burwell, secretary of the U.S. Department of Health and Human Services, in a recent press release. “We still have a lot of work to do before Feb. 15, but are encouraged by the strong interest we’ve seen so far.”

Since insurance enrollment opened on HealthCare.gov on Nov. 15, more than 7 million people in the United States and more than 170,000 in South Carolina have bought or renewed a plan. Open enrollment closes on Feb. 15.

Most South Carolina residents who don’t have health insurance in 2015 will be fined hundreds of dollars next year if they can’t prove they purchased a policy.

The Sefciks now have to submit additional paperwork in order to retain Michael’s Medicaid coverage. Eventually, Melissa said they can pay for a policy through her new employer.

“Insurance might not seem like something you need, but then look what can happen,” she said. “He was perfectly healthy. All he did was smoke. And it’s changed our lives.”

Reach Lauren Sausser at 937-5598.