Ariella Vaccarino is a typical working singer. A lyric coloratura, she has an impressive international résumé, works as a cantorial soprano, and teaches voice lessons in her Southern California home. And, like most classical singers, she knows exactly what it’s like to be uninsured.
“I always paid for private insurance,” she explains, “and then my husband was on a great film with dreamy insurance so I switched. When his job ended I tried to get private insurance on my own again and was denied repeatedly.”
The reason, potential insurers cited, was hand tremors—an overexaggerated definition for some minimal shaking in Vaccarino’s hands due to her years of piano playing. After several stressful letters and back-and-forths, her insurance company’s fears of a nervous system disorder were assuaged, and not a moment too soon: “I found out I was pregnant six days after I was approved.”
Insurance is one of the hot topics of this election year. It is one of the three key platforms of an AARP, Business Roundtable, SEIU, and NFIB collaborative effort, Divided We Fail. Without backing any one party or candidate, Divided We Fail has called for a bipartisan solution to the national healthcare crisis. Regardless of who takes office next year, however, the change will not be instant.
Vaccarino’s story has a happy ending, but it still left her scarred and “completely fearful” of ever having to change or leave her current plan. Her loss of insurance could leave her among the estimated 47 million Americans (15.8 percent of the population) who are uninsured. Of those 47 million an estimated 300,000 are artists.
It’s a professional Catch-22: Singers must be in good health to get performance work, and must get performance work to cover the costs of a healthy lifestyle. Superstar singers—such as Rolando Villazón, Natalie Dessay, and the stars of the Met’s revival of Tristan und Isolde earlier this year (a production more ill-fated than the title lovers), Ben Heppner, and Deborah Voigt—have all dealt with health problems brought on by their physically and emotionally taxing profession.
Singers who aren’t “bookending” their Covent Garden and La Scala performances with Rolex endorsements and CD signings also have health risks, and usually without the means to afford the best medical care. Rebekkah Hilgraves, a soprano in the Knoxville, Tenn. area, currently chooses to remain uninsured because “my health is good enough that I pay far less going for medical visits without insurance,” she says.
Yet even singers who try to remain in the best of health—Hilgraves practices herbal medicine, studies yoga, and works from home to avoid seasonal illnesses—may be overlooking serious, and seriously undetectable, illnesses that could have an impact on both their health and career.
Putting off insurance until she finally took a day job for the benefits, soprano Gwendolyn Alu neglected her annual checkups for years to avoid the costs.
“As soon as I was covered I discovered that I had stage-one cervical cancer,” she says. Alu’s new insurer denied her coverage—the insurance company decided it was a pre-existing condition. “I still owe money for it,” she says.
Young singers, particularly those who are recent graduates and looking to establish themselves, often feel pressured to take 9-to-5 jobs to supplement their income and to secure basic benefits.
“I just don’t have the time or energy to practice as much as I feel I should,” one singer, who doubles as a receptionist, posted to an online opera forum. “My teacher thinks I need to find a part-time job instead, but I know I’m unlikely to find one that offers health care. I have GERD and am on prescription medication. With no insurance, it is about $200 a month.”
Even for a singer in the best of health, burnout can take its toll—and for singers fortunate enough to have an insurance plan, providers may deny essential services and medications. Dr. H. Steven Sims, a trained baritone, otolaryngologist, and director of the Chicago Institute for Voice Care, treats insured singers of all genres, and bends as many rules as possible to treat uninsured singers, as well. Often, his biggest insurance challenges are with those who have coverage.
“Videostrobe exams are really the best way to diagnose laryngeal problems, but I don’t think everyone knows this,” he explains. “I often see patients who were seen by someone else, told there was no cancer, and advised to ‘try to rest your voice or maybe have some therapy.’ Of course, the therapy wasn’t arranged and the patients did not get a recommendation for a therapist.
“I’ve also had female patients with tremors and other neurological disorders who were told that they were just stressed, so I think the shallow understanding of voice disorders is part of the problem,” says Dr. Sims. Big-league providers almost uniformly deny speech pathology and vocal therapy. “Hoarseness is often seen as a nuisance rather than an impairment,” he explains, “so I spend a lot of time fighting insurance companies to get them to cover services that singers need.”
Sadly, Dr. Sims’ situation is unique: he runs a niche practice in a state institution. Even sadder, while he is able to make drastic cost reductions to accommodate the uninsured, particularly students, he can bend only so far.
“One of the most protracted fights I had involved a student in the San Francisco Bay area who was a [large insurance provider] client. She was studying voice at a university here in Chicago and lost her voice. She came to see me and we were able to successfully treat her, and her performances went well. However, [the insurance company] argued that seeing me as an emergency treating physician was not justified. They did not believe there was such a thing as a vocal emergency and initially refused to pay for services, claiming that the student should have flown back to California to see a physician in the network.
“Because her father is an attorney, we eventually prevailed, but the battle exhausted the patient, me, and her father. We struggled for about eight to nine months before they finally conceded. The sad reality is that I can’t invest that much time in every patient because the companies request letters, and documentation, and phone calls, and reams of information.”
Such situations can infuse a young singer with the perfect amount of pathos to sing any mad scene from the canon—but they also make it harder to tackle a Lucia or an Orlando. With singing hovering toward the bottom of the list of lucrative careers, many performers are driven into other industries, either as a preventative measure or in the wake of a medical emergency. For some, such as Rebekkah Hilgraves, the mere anxiety of being uninsured (“Is that a tickle in my throat?” “What if I sprain my ankle on this set?”) is enough to make them sick.
The situation may seem bleak. Dr. Sims believes that even with a universal health plan singers may still have to fight for essential care that seems frivolous to others—but singers can have some hope. Insurance providers and insurance-related non-profits geared specifically towards the self-employed or people in the performing arts have begun to crop up. Atlantis Health Plan and Fractured Atlas, both based in New York City, are two such programs.
Barbara Pitts, an account executive for Atlantis, specializes in insuring artists and estimates that one third of her more than 300 clients are creative people. Pitts doesn’t recall personally enrolling an opera or classical singer, but she considers them a natural fit for one of the two plans on offer. In addition to being less likely to be denied coverage, clients with Atlantis get personal treatment from their account executive, including a rigorous review of medical records to determine what coverage is best.
“I’ll come to you, and sit down with you, and do the paperwork with you, and make sure you get the coverage that’s right for you,” Pitts says.
The more arts-focused Fractured Atlas offers similar healthcare benefits, in addition to funding, education, and other benefits. Moreover, in conjunction with Aetna, Fractured Atlas has been able to extend its coverage past the New York City area (one drawback to Atlantis) into 29 states and the District of Columbia. Unlike Atlantis, however, Fractured Atlas is not an insurance provider; it simply provides artists with access to more affordable plans. It is still, as many artists agree, better than nothing, and Fractured Atlas’s blog provides keen insight into healthcare developments.
Singers who are members of AGMA or any other unions—including the New York-based Freelancers Union, which is free to join—have insurance options available through their unions.
Most importantly, if you are lucky enough to be insured already, hold onto your coverage. Even firms like Atlantis must abide by pre-existing exclusions, meaning if you have gone without insurance for more than 63 days, your new insurance may rule your claim as a pre-existing condition and refuse to cover your fees.
“You can accrue months of credible coverage,” says Pitts, “but you won’t be able to get treatment for anything deemed pre-existing for the first 11 months.” As any singer knows, 11 months can be 11 months too long for many throat problems.
If you are currently uninsured and cannot afford a plan at the moment, don’t worry. Millions of Americans every day take preventative steps to ward off illness and injury and find ways to get the medical attention they need for a reasonable price. Many singers swear by Emergen-C, Airborne, Effer-C, or one of the slew of immunity-boosting drinks, to prevent common colds and infections. Keep a few packets on hand while traveling—planes, trains, and buses are some of the easiest places to pick up other people’s germs. Also, be sure to keep up on vitamins, be aware of any seasonal, food, or medical allergies you may have, and maintain a healthy lifestyle. These precautions may seem to be no-brainers, but they follow the old, common-sense adage that an ounce of prevention is worth a pound of cure.
For medications, the recent $4 generic prescriptions concept has swept through Target, Wal-Mart, and BJ’s Wholesale Club. Several other major retailers in the United States offer similar discounts (including free antibiotics in some stores). A complete list is available at
www.ncsl.org.
Keep up on regular doctors’ appointments—a simple physical can detect various issues before they become catastrophic. Across the country, many clinics offer care on a sliding scale that will match with your budget. The same goes for dental checkups and some specialists, including ENTs. A basic Google search lists the sliding scale for free clinics, dental offices, and specialists in your area. Be prepared and create a list for quick reference when an emergency hits.
