When Insurance Creates Obstacles to Your Cancer Treatment
Julio Soto-Vega and his wife Maria retired to Florida in his mid-60s, about seven years ago. He had worked hard and was ready for some warmth and relaxation. The couple left behind the cold Chicago winters and some beloved family. Like most retirees, they relied on Medicare for the bulk of their medical insurance coverage, but supplemented it with an HMO policy that was available on the public market. Life was good.
All of that changed last year when Mr. Soto-Vega began experiencing some concerning symptoms including weight loss and abdominal pain. The pain got worse and his weight continued to drop, so Mr. Soto-Vega sought medical care from his doctor. For months, the doctors treated him for gastritis, then peptic ulcer, but Mr. Soto-Vega showed no improvement. The couple grew more worried and continued to seek medical intervention.
Primary doctors referred out to specialists, but the couple struggled finding a specialist that would accept their insurance. Tests were ordered, but insurance would deny them or send for review. Eventually, after a CT was ordered and approved, the couple learned that Mr. Soto-Vega had a “malignant mass” in his abdomen, but further testing would be needed to determine a diagnosis and any necessary treatment.
Again, the couple’s insurance denied, declined, and “sent for review” any attempt to learn more about this painful and mysterious mass that they now knew was malignant. Off-the-record, a doctor suggested they return to the Chicago area where they would have access to better medical care, or at least have more options to choose from. Maria Soto-Vega was justifiably frustrated, “It didn’t seem to matter that it was urgent, or even that they knew there was a malignant mass. Insurance should be able to help, but our insurance was not helping us at all.”
The Soto-Vegas followed that informal advice, returning to Illinois and living with their daughter while they worked to connect with medical care that could help provide more answers than they got in Florida. Unfortunately, the obstacles to receiving a diagnosis came right along with them.
Settled in with their daughter, the Soto-Vegas worked to both re-establish residency in their home state of Illinois while finding a doctor who could treat the unnamed malignant mass that was causing Mr. Soto-Vega so much pain and discomfort. This is a challenging task under any circumstance, but establishing residency during the time of COVID-19 shutdowns and quarantines has added additional layers of complication, not to mention while experiencing debilitating pain, making waiting in lines in public offices all but impossible.
After several trips to the ER and more wrangling with insurance policies from two separate states, Mr. Soto-Vega was eventually diagnosed with pancreatic cancer. It was during one of these ER visits that Mr. Soto-Vega was referred to Dr. Srilata Gundala of Hope & Healing Cancer Services.
Dr. Gundala was the only doctor the Soto-Vegas found who was willing to work with them during the month they had no insurance coverage at all. Their Florida policy had been cancelled, but the Illinois policy was not scheduled to start until the first of the next month, several weeks away. Dr. Gundala agreed to begin providing care during the month in between the Florida policy ending and the Illinois policy starting, an offer that enabled Mr. Soto-Vega to start his much-needed treatment without postponing it even longer.
Hope & Healing Cancer Services, with clinics located in Hinsdale and Lombard, Illinois, was founded by Dr. Gundala in 2018. Being an independent provider enables the clinic to have flexibility in treating patients like Julio Soto-Vega. “Insurance should never be the obstacle that keeps patients from getting the care they need to treat their cancer. Mr. Soto-Vega needed care then and there, not three or four weeks later. I am glad we were able to work with Mr. Soto-Vega and start providing the care he needed when he needed it.”
Mr. Soto-Vega is grateful, “I have a good doctor I trust. She helps me a lot and I appreciate her. It was a big challenge to come from Florida to Chicago, but now I have a doctor I am comfortable with, great nurses, and a good place to get care.”
You can learn more about pancreatic cancer HERE and the benefits of independent providers HERE.
Written By: Sheila Quirke, MSW
Reviewed By: Srilata Gundala, MD
