Financial assistance for sudden health problems

March 11, 2008 1:13 PM

Please help a friend's family with sudden health care issues

Hi all, posting this on behalf of my friend, whose family is going through some tough times at the moment. This is uncharted territory for all parties involved, so I hope to tap the wisdom of the hive mind...

The short question is: Do you know of any medical or financial services that offer assistance to cancer patients without insurance? Also, possible question of malpractice in the extended details below... Family is in Florida.

First, a few facts. Family has no health insurance. Mom is the wage earner in the household. Dad is a veteran, is disabled, but not disabled as a result of military service. He does receive some disability income.

Some months ago, mom was diagnosed with breast cancer.. recently it had progressed to stage 2. Despite their low income and the high cost of treatment, they were able to arrange a payment plan with the doctor/hospital. At this point it is putting a severe financial strain on the family and family members who are helping out, but everything seems ok at this point as she's able to receive the treatment she needs.

This past Friday she went to the doctor to prepare for the chemotherapy treatment to begin in a week's time. Underwent surgery to remove a few nodes on one side, a chemo port was installed on the other side. Later that day, she began complaining of severe migraines, became very dizzy and bedridden. At this point the family became concerned and she was brought to the hospital. She was admitted to the hospital for observation in the early morning hours on Saturday, at which point she lost consciousness. From Saturday through Sunday she received no direct attention from a doctor, family was given very little information as to why mom was not waking up, and was continuously told a 'doctor was on the way' but none ever arrived. So beyond the initial ER doctor who had her admitted for observation, and despite her basically slipping into a coma/losing consciousness, she was never examined. Finally late Sunday/early Monday it was determined she'd need to see a neurologist, and was then moved to another larger hospital in the area.

Upon being given a CT scan by a neurologist at the new hospital, it was determined that she had pressure on the brain, which caused the symptoms that led up to her current condition. They drilled holes to relieve the pressure, but blood came out (if I'm not mistaken, the brain is surrounded by spinal fluid, not blood, so for blood to come out is a bad thing). They then determined that she had a lump of cancerous tissue at the back of her brain, so full-on brain surgery took place to remove some (but not all) of it (not yet sure why only 'some' was removed). This is quite recent (yesterday afternoon) so beyond that I have very little information, other than that the doctors say the procedure went well. They also mentioned that had she not made it to hospital #2 when she did, she would have died that night.

So, all of this is quite a shock to family and friends - not only are they worried about their mom, but how they can possibly afford to pay for this .. so I ask: Do you know of any programs designed to help people in situations like this? I don't know if there's anything that specifically helps cancer victims, or perhaps spouses/family of veterans, something along those lines.

And a secondary question as to whether you think there was questionable treatment at the first hospital... you would think that someone who suddenly loses consciousness for unknown reasons wouldn't have to wait 2 days to be examined by a doctor. I don't know if this approaches the domain of malpractice or if it just the sad state of our health care system. (We're not in a major metro area so this wouldn't be an issue of an overtaxed hospital staff, either.) If anything I question the lack of attention from the hospital may be tied to their lack of insurance. I highly doubt the family would look to sue - it's certainly not on their mind at the moment. But if this would be considered gross negligence I would like them to know this.

Thanks very much for any suggestions you may have... if it would help to have more information, I'll follow up with my friend and post his response..

posted by MarkLark to health & fitness (11 comments total)

Florida is one of the states that extends Medicaid coverage to residents who incur very high medical bills, even if their income or assets are above the usual limits for Medicaid eligibility. This is called the "medically needy" or "spend down" program. Eligibility determinations for Medicaid are done through the county offices of the Florida Department of Children and Families (DCF), so they would be the first point-of-contact to find out whether your friend's mother would be eligible for Medicaid coverage. They have an overview of the Medicaid program as it is run in Florida here, along with a short description of the Medically Needy program. (There's a link to a PDF document at the bottom explaining the program.)

If she can be covered by the Medically Needy program, she may get retroactive eligibility for as far back as 3 months, which potentially means bills incurred in the recent past could be covered.

Good luck and best wishes for her recovery.
posted by iminurmefi at 1:37 PM on March 11, 2008

As a follow up to iminurmefi's reply, I would suggest asking at the hospital where she is currently inpatient if they have staff that can assist with the process of applying for Medicaid. I am not in FL, but do work at a hospital. We have a department dedicated to helping patients apply for Medicaid. Barring that, a social worker may be able to help. That way, her family isn't faced with navigating the process alone.

Best of luck to all.
posted by DrGirlfriend at 1:47 PM on March 11, 2008

As I understand it (disclaimer: I was a Theatre Arts major), malpractice is when a practitioner does something that is not standard practise (that is, not just a wrong decision, but one that is outside the generally accepted range of things that one might do in such a situation) that was the cause of a injury. So this would require that someone along the way failed to do their duty (e.g. maybe the hospital has a policy that the nurse should call for a physician in such a situation and the nurse didn't do it) and that this resulted in your mother's permanent physical condition being worse than it otherwise would have been (if she makes a full and complete recovery in short order then it's hard to say that the mistake caused an injury, harder yet to claim damages).

IANAL, etc. and if you really want to know about malpractice then you should speak to an attorney.
posted by winston at 1:49 PM on March 11, 2008

Thanks, iminurmefi and DrGirlfriend, I'll be sure to pass that on to them.

Winston, thanks.. I wasn't asked to ask that, I kind of threw it in there just because something didn't seem 'right' with the treatment she received (or lack thereof). Maybe it's nothing more than 'poor treatment'.. I really had no idea. Getting litigious isn't on anyone's mind right now.. I just thought I'd see what other people thought of the situation.
posted by MarkLark at 1:56 PM on March 11, 2008

It is not a professional opinion, nor an informed one, but I think that yes, they should look into a lawsuit when they can. When they can do so, they should shop around for a lawyer. (They need to look for a good one. No double jeopardy means a bad lawyer can permanently screw up a chance for recovery.)

Some hospitals evidently have massive discounts for uninsured patients, and help out in other ways: "Uninsured patients receive a 69 percent discount on hospital inpatient charges and a 25 percent discount on outpatient services."

There's Cancercare. A similar question was asked here and a respondent suggested the American Cancer Society; another said that she went to her state's Department of Human Services to ask for medical assistance, and then apply for disability. "When I took these two steps, I was able to get treatment for the cancer with no insurance or money upfront."

You (or they) might want to look through this Google search and this Google search for other results I might've missed with my non-thorough examination.

If they are not too proud, fundraising, either through local solicitation or via the Internet, might help with the bills.
posted by WCityMike at 2:03 PM on March 11, 2008

Another long shot, but probably worth mentioning just in case--if she was diagnosed with breast cancer for free through the Breast and Cervical Cancer Early Detection Program (see state website here), she'd automatically be eligible for Medicaid coverage of her treatment and wouldn't have to apply through the medically needy route. Unfortunately, Florida is one of about 21 states that restricts Medicaid eligibility through that specific program to women who were diagnosed through the program. Might be worth checking on, though--sometimes people get screenings through low-cost clinics and don't realize who is ultimately paying the bill, and in this case it might be an easier route to Medicaid eligibility.
posted by iminurmefi at 2:12 PM on March 11, 2008 [2 favorites has favorites]

You can also try contacting one of the Susan G. Komen affiliates in Florida. They may be able to point you in the right direction for treatment funding/programs for uninsured/under-insured women.
posted by Felicity Rilke at 2:27 PM on March 11, 2008

Also, regarding the poor treatment at the first hospital...they may consider calling the office of the hospital's Patient Advocate (can be as simple as calling the hospitals' main number and asking for the Patient Advocate office). Then they can pass on this feedback. I agree that the staff waited too long to see her, or even to give the family any information.
posted by DrGirlfriend at 2:48 PM on March 11, 2008

1) Definitely, definitely look into emergency Medicaid as others have noted.

2) While I agree that it's somewhat odd and inappropriate for a patient to be hospitalized for 48 hours without seeing a doctor, I wouldn't be surprised if that wasn't the case though for some reason the family got that impression (which in and of itself is suboptimal communication at the least). You'd have to at least look at the medical records to know that, and I'd need a whole lot of additional information before I could say if there was any malpractice. In general terms however, part of the definition of malpractice requires that there was a bad outcome that was preventable with standard of care, and that a healthcare provider deviated from that standard -- that means that for example, if she makes a complete recovery or if this is all related to brain metastasis that was already there in the setting of what may be a terminal cancer (as far as I know a brain lesion would not make breast cancer stage 2 by the way), then it would be a tough case to win. On the other hand for example, if as a result of some sort of documented delay in care, she suffered an otherwise preventable and crippling brain injury, then perhaps there might be a case. This is all abject speculation though at this point. I would consider two things before pushing ahead with legal avenues: get a copy of the records from the first hospital, and see what the neurologists and neurosurgeons at the second hospital think about the case. They have far more insight into the case than we ever would.
posted by drpynchon at 4:08 PM on March 11, 2008 [1 favorite has favorites]

Best thing I can see them doing at this point is getting a good social worker in their corner and staying in their shadow after leaving the hospital until they get help finding assistance. No hospital could survive without the social workers.

I'd say it's outside the realm of normal/appropriate if she went more than 24 hours without being seen by an MD - you'd have to see the chart to know that's truly the case. I can tell you I've been paged plenty of times in the afternoon by a nurse wondering when I'd be in when I was already in that morning. Nonetheless, you should write a letter to the hospital's [hospitalist/internal medicine/oncology/intensivist/family practice] department chairperson letting them know what happened. It's poor communication at the very least.
posted by docpops at 6:57 PM on March 11, 2008

The billing department at the hospital probably has someone who can provide information on financial assistance programs -- call and ask. The hospital has a strong financial incentive to find out and share this information because they would rather be paid by the government or a private charity than not be paid (or be paid slowly) by you. There may also be a guaranteed issue (regardless of health condition) health insurance program in your state. Maybe subsidized for low income, maybe not, but even high monthly premiums will cost less than the bills without insurance. Some programs might require that you be enrolled BEFORE you incur bills for them to pay for those bills (insurance certainly will), so you should get on this ASAP.
posted by Jacqueline at 11:17 PM on March 11, 2008