Artists without health insurance: screwed. Artists with health insurance: also screwed, probably.

It’s not that getting health insurance is hard, says Alex Maiolo, who helps run the Health Insurance Navigation Tool (HINT) program, which partnered with the D.C.-based Future of Music Coalition in 2005 to help artists understand the world of managed care. But securing good, affordable health insurance can be nearly impossible.

“If you write down that you’re a musician, they won’t say, ‘Oh God, this person is a terrible risk,’” says Maiolo. “They don’t really care about what you do for a living. They care about how you live your life. And that can be a problem if you don’t pay your bills on time, if you’re not rich, or if you’re living like Keith Richards.”

Maiolo, who’s a Chapel Hill, N.C., insurance agent by day and a bassist in Violet Vector and the Lovely Lovelies by night, has helped hundreds of musicians with their health-insurance woes through the HINT program. Still, he says, “the obstacle that artists have is that they can’t afford this stuff.” Here, three tales from the front lines of art and medicine.

AMANDA KLEINMAN

Ailment: Broken ankle
Covered: Emergency-room visit, full-leg cast
Not Covered: Durable medical equipment, physical therapy, lost show revenue

As organist for psych-rock outfit the Apes, Amanda Kleinman, 34, tours the country three months out of the year. That’s 90 days that Kleinman tries not to get hurt. “Unless I am about to die, I just don’t go to the doctor,” she says. But avoiding injury can be hard to do while stumbling around unconscious in a strange attic.

After falling asleep in the attic of Babes in Toyland drummer Lori ­Barbero, who had put the Apes up after their Minneapolis, Minn., show on March 19, “I suddenly became very dizzy,” says Kleinman. “I have low blood pressure, too, and at 4:30 in the morning I vaguely remember waking up,” she recalls. “I also kind of sleepwalk.”

So it wasn’t until later that Kleinman pieced together what happened next. She stumbled to the bathroom, which was occupied by Apes bassist Erick Jackson; when he let her in, she collapsed, breaking her ankle. “I was conscious enough to know that I had done something really bad,” she says. “I’ve done this before, fainting while sleepwalking. I broke a toe doing that last year.”

“The ER was a whole other catastrophe,” she says. After landing at Minneapolis’ Hennepin County Medical Center, she found herself at the end of a line of untreated patients. Getting to their next gig in Chicago looked unlikely. “The last four shows were the only ones that would have given us any profit, because we had just gotten
a new transmission for the van,” says Kleinman.

Jackson suggested they hit the road and find her a cane and painkillers. But Kleinman had a better idea: She turned on the waterworks, forcing out enough tears to get to see a doctor, who told her she’d have to get her leg pinned and surgically fixed on-site. But because Kleinman’s insurance wouldn’t cover the procedure outside the D.C. area, she was outfitted with a temporary cast and crutches, and left to finish the tour without surgery. They missed the Chicago gig—and the $150 they would’ve received for it.

For the remaining three dates, Kleinman says, “playing was a disaster. I’ve never sat down during a show. I had to tell everybody, ‘Lift this, put that cord there,’” she says. Now, Kleinman’s almost $800 in the hole for medical equipment not covered by her plan, including crutches and her current fix-up, an air cast. She ended up forgoing surgery, and the recommended physical therapy proved too costly: Instead, Kleinman was given a list of exercises and therapy bands to use on her own. “I just have to hope I’m doing it right,” she says. “I have no idea.”

That $800—atop Kleinman’s monthly insurance premium of $270, about a third of her monthly income—is a problem. “I came home with a profit of 100 bucks for five weeks on the road. I thought maybe I could start paying off a little bit of credit-card debt,” says Kleinman. “I’ve been doing this for 10 years, and I wouldn’t say I’m a professional musician, because I’m not playing bar mitzvahs every weekend. It’s not a life that offers any kind of security.”

SUNIL FREEMAN

Ailment: Ankylosing spondylitis
Covered: Three hip surgeries and physical therapy
Not Covered: Consistently competent care

Sunil Freeman, the 53-year-old assistant director of the Bethesda Writer’s Center, has suffered from ankylosing spondylitis—a form of arthritis affecting his back, neck, hips, and knees—since he was 18 years old. At 21, he underwent surgery to replace both of his hips. Freeman’s condition is constantly painful; in 1997, it became excruciating. Freeman recalled the experience in an essay published in WordWrights! in 2001: “To walk I use crutches, press my left toe to the floor and drag my foot forward about a half-inch. I do that three or four times, very slowly. Then I raise my right foot and move forward a bit, lean harder on my crutches, and push my left toe into the floor and drag.”

Because of Freeman’s condition, “yeah, it’s probably good that I have health insurance,” he says. That “probably” comes thanks to an experience about a decade ago where his provider, he says, “screwed up.” Freeman says his doctors held off on investigating his condition for as long as possible, even eschewing an X-ray. When Freeman insisted on one, his doctors found that his femur had separated completely from its socket. “Well, that’s why it hurt so bad,” says Freeman.

“They knew I’d had a hip replacement 20 years before, so that should have been the first thought in their mind, that the joint had worn out,” he says. After undergoing another hip-replacement surgery in 2001 at the hands of “a great surgeon given a very difficult operation,” Freeman was told that, because of the extreme damage suffered to his hip, he could no longer walk at length. Receiving physical therapy coverage, though, was a battle. “For a time I wasn’t sure they were going to even authorize the rehab,” he says. “The fact that even the doctors didn’t know what the company would authorize was troubling.” Freeman is now covered through the Writer’s Center by a different provider—one he describes as “competent.”

ADRIAN PARSONS

Ailment: Self-circumcision
Covered: Emergency-room visit, epidural shots
Not Covered: The head of his penis, anymore

If you choose to circumcise yourself in public, fear not the cost—just acquire some temporary cash, a little technique, and a really sharp knife.

When performance artist Adrian Parsons, 25, performed his own foreskin removal last April at the Warehouse, he had a friend in a car ready to rush him to the George Washington University Hospital. What he didn’t have was his wallet: He forgot to carry along an updated insurance card. “I had a totally different card on me, which was, in fact, expired,” says Parsons.

As a result, Parsons ponied up $520 out-of-pocket, but his DIY approach saved him some cash. “Circumcision, when done normally on adults, is performed under anesthesia,” he says. “Since I did it myself, off the cuff, they gave me an epidural instead of putting me under, so it was cheaper.”

Parsons avoided some additional hassle by using a sharp knife and cutting carefully—five incisions. Though Parsons says the three epidural shots to the base of his penis were “unbearably painful,” the bill, at least, didn’t hurt: Parsons’ individual plan reimbursed him. “The fact that the injury was self-inflicted basically never came up,” says Parsons. “I don’t think that’s in their triage questions when they ask about circumcision.”

Parsons figures having a friend alongside helped him come off as a little more sensible. “When I told them it was self-inflicted, they were worried I had been trying to hurt myself,” he says. After he and the friend explained that the procedure was performance art, “they did ask how many people were going to come in with circumcised penises. I think they thought it might be a mass circumcision situation,” he says.