Coverage options available for the uninsured coping with cancer

Oct. 09--HARMONY TWP. -- Despite her fears that she might have breast cancer, Mary Ann Schneider was initially afraid to see a doctor.

She and her husband, Larry, had been without health insurance since he retired early because of health issues. The couple planned to enroll in COBRA, which allows former employees to retain their work insurance for a fee. However, they didn't realize it would cost them $800 a month.

Instead, they decided to go without until she turned 65, when Medicare would take care of her.

"I was never sick. The only time I was in the hospital was three times to have three kids. Never broke a bone," said Schneider, who's now 67. "So I figured we can manage for a year or so. Because we couldn't afford $800 on his Social Security and I just lost my job ... we decided to go without insurance."

But a few months before her 65th birthday, she noticed her breast was swollen and sore around the nipple. Her mother, grandmother and aunt all lost their lives to breast cancer, so it was something that quickly came to mind.

Schneider consulted her sister-in-law, a nurse, who referred her to Adagio Health in Center Township to get a free mammogram. After her appointment there, they contacted her a few days later, telling Schneider they needed to run more thorough, diagnostic tests.

She stressed that she didn't have health insurance, but that didn't matter.

"They helped me. I'll tell you what, I don't know what I would've done without Adagio," Schneider said.

Through Adagio, she obtained Medicaid coverage that would last until Medicare took over. They also scheduled doctor's appointments on her behalf at Magee Women's Hospital of UPMC in Pittsburgh.

Her fears were soon confirmed: Schneider had breast cancer in her milk duct. She had a mastectomy and lymph node removal covered by Medicaid, but didn't need any chemotherapy or radiation treatments.

According to U.S. Census data, 6.4 percent of Pennsylvanians were uninsured in 2015, the lowest rate since the Affordable Care Act took effect in 2010.

The rate of uninsured Pennsylvanians in 2014 was at 8.5 percent; in 2013, 9.7 percent.

Medicaid expansion played a role in providing additional coverage to those who would otherwise be uninsured. As of June 2016, 2.8 million residents statewide had Medicaid coverage, and 682,000 additional Pennsylvanians became newly eligible after the expansion took effect last year, according to healthinsurance.org.

Much to Schneider's relief, there are resources available for patients with cancer that cannot afford health care, let alone being able to pay out of pocket for costly chemotherapy, radiation, surgeries and doctor's visits that often become routine after a cancer diagnosis.

Adagio Health

Adagio Health, which has offices throughout western Pennsylvania, offers screening and preventative health programs for women. Over the past year, approximately 200 women in Beaver County have utilized Adagio's cancer screening programs.

They offer three screening programs with various income requirements and other eligibility guidelines, providing mammograms, Pap tests, diagnostic tests and biopsies, among other cancer treatment needs.

"We do see a big need," said Lindsey Chappel, a nurse practitioner at Adagio's Center Township office. "Even with the health-care changes, a lot of people still don't have health insurance."

While Adagio serves people with and without insurance, it most often sees women who might have been putting off seeing a doctor because of lack of coverage. Early detection is key for best outcomes.

"More often than not, most of the time these women have a problem that gets the ball rolling," she said.

In addition to cancer screenings, Adagio provides OB-GYN services, birth control, STD testing and prenatal care.

Emotional and ancillary coverage

Heritage Valley Women's Health Center in Center Township provides referrals for numerous services, which are available to everyone, including uninsured patients.

In addition to referring patients to Adagio Health for cancer treatment, other services are sometimes necessary, too.

For instance, the Center Civic Women's Club provides wigs or breast prosthetics for any Beaver County woman in need. The Beaver County Cancer and Heart Association also provides breast prosthetics for women at a discounted rate.

Another program, called Pathways, which is through the Homemaker-Home Health Aide Service of Beaver County, provides housekeeping services like vacuuming, dusting, washing laundry, preparing meals and providing personal care for those going through cancer treatment.

Those services go beyond the scope of the cancer treatments themselves.

"Some people have a ton of family support. Other people need total support from these services, rides, and you know, it's not all financial," said Beverly Feragotti, manager, radiology operations at the Women's Health Center. "There's quite a bit of emotional support required, as well."

Charity care

Nonprofit hospitals are required by the Internal Revenue Service to provide charitable care for patients who might not otherwise be able to afford it. This mandate went into effect in 2012 after the Affordable Care Act was established.

Heritage Valley Health System provided $6.1 million in charity care between July 2015 and June 2016, which is about 1.4 percent of the organization's net revenue.

"We treat the patient. We don't treat the insurance card," said Bryan Randall, chief financial officer at Heritage Valley. "I think that's very important because our business is really the health and well-being of all the members in the communities we serve, so our goal first is to treat you for whatever you need treated for, and then we take care of business on a secondary basis."

Those who apply for charity care funding at Heritage Valley can be completely covered if their income is up to 300 percent of the federal poverty guideline, which is $35,640 for an individual and $72,900 for a family of four. Partial coverage is provided for people who make up to 450 percent of the federal poverty guideline.

However, even more of Heritage Valley's net revenue went to bad debt. Heritage Valley had roughly $19 million in unpaid medical services during the past fiscal year.

Some of those unpaid balances could account for individuals who would qualify for charity care assistance.

"Bad debt when you look at it, it's really comprised of two things: patients who have the means to pay who don't (and those who) probably would qualify for charity care if they would just complete the application," Randall said.

It's a service that Schneider's husband ended up having to utilize while he was uninsured. He qualified for charity care at a Pittsburgh hospital when he had meningitis the same year she had cancer.

On top of their health issues, their longtime Ambridge home burned in a fire. They moved to Harmony Township last year.

Health insurance wasn't too stressful for much of her life. For many years, Schneider's longtime employer, Sewickley Country Inn, had provided insurance at no cost.

"My whole family was covered, and I paid nothing. I mean, literally, paid nothing. My husband worked at Hussey Copper for 25 years and he paid nothing in the beginning on his insurance," she said. "So we had two insurances, our whole families were covered, and we paid nothing. And then to go from that, you know? You don't realize how much everything costs."

Things have improved since her cancer diagnosis. Mary Ann and Larry are healthy and insured.

"We just had our 45th wedding anniversary," Schneider said. "And our kids all pitched in and bought us a trip. We went to Punta Cana for our 45th. We're happy, we're healthy, we're alive right now."

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