When staying alive means going bankrupt

She was working at a credit union when she was first diagnosed with cancer in 2001. Her employer-paid insurance covered most of her expenses as she underwent surgery and her first round of chemo, which continued well into 2002. She changed jobs later that year, carefully paying her own insurance premiums through a COBRA extended health benefits program until she qualified for the group plan offered by her new employer, a title company in Montecito, an hour down the coast.

But while she was on leave for surgery to repair hernias and a bowel obstruction caused by her first operation, she was laid off. Once more, she used the COBRA process — established by a federal law that lets employees who lose their jobs maintain their health insurance for up to 18 months by paying their own premiums. Again, her insurance paid most of the bills.

Aldrich had landed a new job as a processor for a Lompoc mortgage company when her cancer returned in 2004. Though she didn't have health insurance through her employer and her COBRA benefits had been exhausted, she had continued to buy health insurance, paying $533 a month.

She underwent more surgery and returned to chemotherapy treatments at Santa Barbara Hematology and Oncology, a large medical practice in the area. As the nausea and hair loss subsided in the spring of 2005, she began to receive bills from the practice that eventually totaled more than $15,000.

Where's the $7,000 cap?
Aldrich was stunned, since her policy with Blue Shield of California had a $2,000 annual deductible and a co-payment schedule that was supposed to cap her maximum annual “out-of-pocket” cost at $7,000 when using a “preferred provider,” as Santa Barbara Hematology is.

Cancer's high cost Here are the line-item charges from Santa Barbara Hematology and Oncology for Kathleen Aldrich's final round of chemotherapy over two days in the spring of 2005. Carboplatin and Docotaxel are the main anti-cancer drugs; Neulasta is given to help boost white blood cells destroyed by chemo. April 28 Office visit:             $166.56 Chemo infusion:      $446.72 Chemo infusion:      $104.96 Carboplatin:          $3,867.50 Docotaxel:            $5,726.56 Infusion:                  $240.56 Dexamethanose:       $40.00 Kytril:                       $320.00 Benadryl:                    $4.83 Saline:                       $60.00 April 29 Office visit:               $43.44 Injection:                   $50.00 Neulasta:             $5,700.00 Total:                 $16,771.73 Source: Santa Barbara Hematology's account statement as filed in Santa Barbara County Superior Court.

Still dazed by the chemo, she said, she tried to get the bill corrected, calling both the medical practice and Blue Shield. When nothing seemed to work, she turned to her sister, Mary Beth Fisher, a registered nurse for 35 years who spent the last part of her career in administrative jobs for medical practices, handling plenty of insurance matters.

“I said, ‘I know you can get ahold of someone who can help you get through this mess,’” Fisher told MSNBC.com. In the end, though, she said all they got was the run-around from both the medical practice and Blue Shield. “It was always ‘talk to another person, put your request in through e-mail.’”

Fisher said that in her experience, case workers are available on both sides to help resolve such problems. “I was astounded that she wasn’t offered that kind of assistance or support," she said. "… It really was that nobody would talk to you.”

No help from Blue Shield
Fisher believes the source of the problem was that the oncology practice had been paid more for the same services under Aldrich's  previous insurance policy and did not change its billings to reflect the terms of its contract with Blue Shield, Aldrich’s new carrier. But she said Blue Shield did little to make the change clear to the doctors group.

Blue Shield spokeswoman Elise Anderson said privacy laws prohibited her from even acknowledging that Aldrich is a Blue Shield client, but she was confident the company’s customer service process works well.

Lynn Humphrey, administrator of Santa Barbara Hematology, also declined to discuss Aldrich’s case.

According to the sisters, Santa Barbara Hematology sent Aldrich’s case to a collection agency just a few months after the dispute began and refused to discuss the bill after that, a common practice in collections cases. Then, they say, Aldrich was dismissed as a patient for being “a pain.”

The sudden severing of the relationship with the young doctor whom Aldrich still reveres as the woman who twice saved her life was particularly painful.

“I was so devastated and embarrassed,” she said. “Was I a pain during chemo, the whole time? Am I a piece of crap or what?”

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