Uninsured, and facing cancer surgery

GRAPEVILLE, Pa. - Back in April, Mary Gannon, 54, was taking a shower when she felt the lump in her groin.

Mary earns $11 an hour in a doctor's office as a medical assistant. She's a temp worker, without health insurance.

The doctor she works for, Valerie Pricener, looked at her lump, didn't like what she saw, and wrote a prescription for a CT scan. That cost Mary $350. It showed a lump the size of a quarter.

The doctor sent Mary right upstairs to surgeon Mark A. Zelkovic, and he removed the lump in May. That cost Mary $3,000.

The biopsy came back May 27 - cancer.

Follicular lymphoma.

Mary's husband had died four years earlier of brain and lung cancer. It wasn't diagnosed until Stage 4, the most serious, and he died five months later. That's all she could think about.

How extensive was her cancer? Was it anywhere else in her body?

That day, after she learned the biopsy results, Mary called the Excela Health-Mountain View Diagnostic Testing Center to schedule a PET scan.

This full-body scan was recommended by the surgeon to learn whether she had lumps or tumors anywhere else in her body, and to stage the degree of any cancer.

The information was crucial to planning her care.

The woman who answered the phone, Mary said, told her she wouldn't schedule the $3,000 PET scan unless Mary had insurance. The woman told Mary to apply for medical assistance from the state.

Mary cursed a few fine words under her breath.

Then she asked the surgeon's staff to make the appointment for the PET scan.

Another call. Same result.

"Apparently there were some issues with them," Zelkovic said of the Mountain View diagnostic center. "Unless [patients] have insurance, they have a hard time scheduling them. For whatever reason, that's their policy."

A spokesman for Excela Health, Robin Jennings, said the woman answering the phone likely offered to help Mary apply for charity care. The center requires an uninsured patient to apply for medical assistance and get denied - a process that can take weeks or longer.

Excela waits for the denial letter from medical assistance before offering charity care, Jennings said, to prevent against fraud.

"Even though patients may or may not hear it in a way that feels good to them, I believe our registrars are patient advocates and are giving them the best information and best resources they can," she said.

After being refused the scan, Mary Gannon did apply for medical assistance.

And she waited.

Mary lives in a mobile home in this rural town between Jeannette and Greensburg, about 30 miles east of Pittsburgh. She moved there after her husband died, when she could no longer afford their house. An aunt owned the mobile home and allowed Mary to move in with her three dogs.

Driving to work from the mobile home became a 75-minute grind at rush hour. So Mary left the job where she worked for 11 years as a medical assistant - with insurance - and took the temp job near her new home.

For the first time in 20 years, she wouldn't have health insurance, but she figured, "I'm not going to get sick."

In June, Mary heard from the county assistance office, which handled her medical-assistance application.

Denied.

Mary had no understanding of why she was denied.

She continued to work, wait and fret.

"It's scary, not knowing what stage it's in," Mary said on July 18, referring to any cancer. Angered by the delay, Mary said, "It's like I just sit and wait to see what's going to happen next."

"I have two older boys, and it's driving them batty also. I told them I don't want to die. I want to get this stuff taken care of. I have little grandkids. They're just babies . . . "

As she waited, Mary did a couple of proactive things.

Her uncle, who had insurance issues a year ago, gave her the name of Erin Guay, with the Pennsylvania Health Law Project.

Guay is a paralegal with the Health Law Project, a nonprofit organization that helps poor Pennsylvanians get coverage and care.

She went to work trying to get Mary medical assistance.

In addition, Mary's oncologist, J. Franklin Viverette, filled out an application for her to get charity care at University of Pittsburgh Medical Center (UPMC), with which he is affiliated. The oncologist told Mary he couldn't begin treating her until he knew the results of the PET scan.

Mary kept working, paying small amounts on the money she owed, which had reached almost $4,000.

She spent June and July searching every day for more lumps, eight weeks wondering how in America - with medical technology available - she couldn't get tested.

On July 27, a letter arrived from the UPMC system: "Dear Mary . . . This letter is to inform you that your recent Financial Assistance application has been approved. . . . You are eligible for a 100 percent discount."

A health-care version of Monopoly's get-out-of-jail-free card, the letter gave her free care at UPMC hospitals and cancer centers for a year.

Mary had the scan in early August.

She also learned a few days later that she was now also eligible for medical assistance, through a welfare program called Healthy Horizons.

On Aug. 7, Mary met with her oncologist, Viverette, to get the results of the PET scan.

Better than she dreamed.

No other malignant lymph nodes. No cancer found at all.

She didn't need chemo, just radiation around her groin to kill lingering cells from the node that had been removed. Radiation began after Labor Day.

Mary likes to go camping in a little trailer her husband bought up near Erie. She takes her dogs, and her grandkids. She can now dream of many more weekends at her favorite spot.

But she won't soon forget her anxiety and stress.

"What would have happened if I did have cancer in other places?" she asked. "And it had spread?

"The waiting is like Russian roulette."