INN Blog

More Posts
 

Hope, faith and prayer: Santa Cruz County woman finds insurance in fight against cancer [Santa Cruz Sentinel, Calif.]

By Jondi Gumz, Santa Cruz Sentinel, Calif.
McClatchy-Tribune Information Services

Dec. 29--SANTA CRUZ -- When Eva Lopez was told the bumps in her breast might mean cancer, she was shaken.

"You feel like you're going to die," she said, recalling when her father was diagnosed with cancer, she and her siblings told doctors not to tell him what he was treated for, worried he would give up on life.

Lopez, 54, married with two children, had always been healthy.

Neither she nor her husband Jorge had health insurance.

It wasn't offered at her husband's workplace and it wasn't something she thought she needed running a home day care.

For more than 10 years, she had built a successful business, and was caring for children from 14 families.

The Santa Cruz County resident wondered if she would be able to get treatment without insurance.

She was here legally, she had savings and enough money to pay her bills, but not enough to pay for cancer treatment.

Would she have to close her business and go to Mexico in search of a doctor?

What would her families do without her?

For a week, she couldn't sleep.

But it turned out she was not alone.

She had a friend who had survived cancer.

She also had the good fortune to live where the largest group of doctors saw the need to educate Latinas about breast cancer and where United Way staff recognized a program created under the Affordable Care Act for people without health insurance would make a difference in their lives.

And she prayed to

God.

Asking a friend

She called her friend Martha Adams.

Social Security changes you need to know now.

"Do you know someone who will see me?" she asked.

Adams saw the value of health insurance after having her uterus removed to prevent cancer from spreading. She knew someone at Dominican Hospital to ask. She reported back to her friend, "You can do it here."

Lopez met the doctor. She explained that she had "balls" in her breast for five years and when she slept on her side, it hurt. The X-rays didn't find anything but an ultrasound exposed the cancer looking like little pieces of rice.

She got the news on her birthday, Aug. 22.

Her daughter Yolanda, 27, accompanied her "so she would have someone to lean on."

When her daughter broke into tears, Eva knew it was cancer.

The translator told her not to worry, that it was early stage, doctors could operate and chances of survival were good.

Next came more tests.

When she spoke with the surgeon, he warned it would be expensive, "mucho dinero."

She said she couldn't afford to pay the bill all at once, and offered to pay half up front and the rest over time.

Since the cancer was slow moving, the surgery could wait until she got insurance, the doctor said.

But where would she get insurance?

Adams, who runs a home day care, had a suggestion.

Several months back, she had gotten a call from Carla Gomez, outreach worker for the Healthy Breast Campaign, a program started by the Palo Alto Medical Foundation to provide free screenings and other services to women with cancer.

Gomez asked her to take care of a boy whose mother was a field worker from Davenport in treatment for cancer. The Palo Alto Medical Foundation would pay, she said.

"A free program," said Adams. "I was amazed to hear that."

She suggested her friend call Gomez.

DOCTORS REACH OUT

The Healthy Breast Campaign came out of a conversation between Dr. Larry DeGhetaldi of the Palo Alto Medical Foundation, and Dr. Jose Chibras, then at Salud Para La Gente, the nonprofit network of community health clinics.

Chibras said he could tap state funds to cover the cost of mammograms but there was nothing to help Latino women going without insurance to deal with abnormal test results and follow-up care if needed.

Social Security changes you need to know now.

That meant cancer was often diagnosed later than earlier, resulting in worse outcomes.

DeGhetaldi got a $150,000 grant from Avon to hire a Spanish-speaking outreach worker to talk to women and calm their fears about screening and treatment.

The grant was enough to cover the cost of screenings, diagnostics afterward, treatment, transportation and child care for one year.

Gomez, 49, a graduate of Watsonville High School and Vassar College, a sister school to the Ivy League universities, discovered the job posting online.

At the time she was a social worker at Watsonville Community Hospital but needed more hours to make ends meet. Working on a per-day basis, she didn't qualify for health coverage.

"I totally understand people who don't have insurance," she said.

This job was temporary with no benefits, but she applied because "it seemed like a perfect fit."

The interview went so well "they ended up offering me benefits," she said.

DeGhetaldi describes her as an angel.

"She's the kindest person," he said. "She's been a navigator for people in the safety net. She's there to hold their hand."

When the grant funds ran out a year ago, deGhetaldi realized Gomez was too valuable to let go.

"We're going to keep her," he said.

UNITED WAY STEPS UP

Lopez had attended a presentation at La Manzana Center in Watsonville for day care providers where Gomez talked about breast cancer.

She called Gomez and asked for advice.

She learned her income as a day care operator meant she did not qualify for MediCal, the state health care program free to people living in poverty.

However, Gomez thought she might be eligible for California's new Pre-Existing Condition Insurance Program.

"It's part of 'Obamacare,'" Gomez said, sending her to speak with Alicia Fernandez, health outreach supervisor at United Way of Santa Cruz County.

The insurance program started in 2011, giving Californians with a medical condition a place to buy insurance if they are citizens or legally in the U.S.

"The premiums are reasonable for somebody in the middle," Gomez said.

Social Security changes you need to know now.

In Santa Cruz County, it costs $406 a month for someone age 50-54 to get insurance.

For Eva Lopez, this was a lifesaver.

Since the Pre-Existing Condition Insurance Program was created, it has enrolled 15,300 Californians, 8 percent being Latinos and just 200 in Santa Cruz County.

The most common diagnosis is cancer, according to LifeHealthPro, a website for health insurance advisers.

When United Way staff heard a presentation about the program earlier this year, it realized it could meet the needs of families with income who were going without insurance.

Fernandez, who works at United Way in Capitola, got training and was certified by the insurance program in July. It's her job to make sure when someone takes time to fill out forms and provide information about income, she can advise them which program is the right fit.

"We screen to see what they qualify for, so they get the right program the first time," said Fernandez.

Lopez made an appointment for Sept. 4.

The answer was yes, she did qualify, allowing her to enroll as of Oct. 1, just in time for her surgery on Oct. 3 with Dr. Matthew Hansman.

The insurance covered 85 percent of the cost, and Lopez paid the rest.

VIRGIN OFFERS COMFORT

A week and half before her surgery, Lopez had a dream.

She was talking with her older sister Carla, who lives in Watsonville, when a light appeared in the sky and shone down. It was the Virgin of Guadalupe, an apparition associated with miracles since 1531.

"Tell her you have cancer," her sister said.

So Lopez told the Virgin of her cancer, adding, "I don't want to die."

The Virgin told her not to worry, that she would have the surgery and be fine, When Lopez heard that, she hugged the Virgin, feeling her warmth.

"Exactly the way she said, it happened," said Lopez.

Her friend Martha said the dream "gave her peace ... Peace and strength to fight it."

Next Lopez prayed for God to help her doctors.

When she shared that with the physicians, they told her to keep on praying.

Her mastectomy was successful and she's undergoing radiation.

Initially it seemed her insurance might force her to drive to Salinas, but she's been able to undergo the daily five-minute treatment at Santa Cruz Radiation Oncology.

"She's blessed," her daughter said.

When Eva Lopez voted in November, she cast her ballot for Obama, explaining that if not for him, she would have had to close her business.

Morning and night, she prays.

Follow Sentinel reporter Jondi Gumz on Twitter at Twitter.com/jondigumz

At a glance

EDUCATING WOMEN

The women contacted by Palo Alto Medication Foundation since January 2011:

Category number

Outreach and education 6,000

Appointments with primary care physician at Salud Para la Gente 200

Breast diagnostic procedures and surgeries 58

Receiving services after breast cancer diagnosis 7

Source: Carla Gomez, Palo Alto Medical Foundation

By the numbers

UNINSURED?

If you have a pre-existing medical condition and you are a U.S. citizen or lawful resident and you've been without insurance for at least six month, you may qualify for a new health insurance program offered through the state of California. The PreExisting Condition Insurance Plan covers doctor visits, preventive services, prescription drugs, mental health services, labs and X-rays, hospital services and pregnancy care.

The monthly premiums:

Age amount

0-18 $118

19-29 $162

30-34 $234

35-39 $261

40-44 $289

45-49 $329

50-54 $406

55-59 $487

60 and older $530

For information, Call Alicia Fernandez at 465-2209 or go to www.pcip.ca.gov

SOURCE: Michael Mahoney, GoHealth.com

At a glance

OTHER Coverage OPTIONS

If you don't qualify for the PreExisting Condition Insurance Plan, what can you do? Here are suggestions from Michael Mahoney of GoHealth.com.

Federally funded high-risk pools: Many states including California have created high-risk pools as an option for those who have been denied health insurance coverage because of a pre-existing condition. Using funds granted under the ACA in 2010, states subsidize premiums for these plans. In California, it's Major Risk Medical Insurance Program at www.mrmip.ca.gov.

COBRA: This is short for Consolidated Omnibus Budget Reconciliation Act. If you recently lost or left a job where you had group health insurance coverage, COBRA is a viable option for those with pre-existing conditions. While you will be paying much more for the same exact coverage you had while you were working, COBRA lasts a maximum of 18 months.

Short-term health insurance: This is coverage for one month to a year. Since the life of the plan is so short, some short term plans are more lenient when it comes to pre-existing conditions.

Individual coverage: Just assume that because you are turned down by one health insurance provider does not mean you will be rejected by every provider. Different companies may have different rules regarding what is considered an uninsurable condition. Examples of conditions that may fall into that 'gray area' are mild depression, controlled high blood pressure and allergies. Talk to a licensed health insurance agent to make sure you have exhausted every option.

SOURCE: Michael Mahoney, GoHealth.com

___

(c)2012 the Santa Cruz Sentinel (Scotts Valley, Calif.)

Visit the Santa Cruz Sentinel (Scotts Valley, Calif.) at www.santacruzsentinel.com

Distributed by MCT Information Services

Wordcount: 1847



USER COMMENTS:

comments powered by Disqus

  More Newswires

More Newswires >>
  Most Popular Newswires

More Popular Newswires >>
Hot Off the Wires  Hot off the Wires

More Hot News >>

insider icon Denotes premium content. Learn more about becoming an Insider here.
Social Security changes you need to know now.