A feel good Cancer story about an Insurance Company

[RandyW]

Family beats insurance woes to seek help for ailing collegian

Mary E. O’Leary , Register Topics Editor

-NEW HAVEN — Cristina Cortese has done her part.

The 21-year-old, with the help of family and loyal friends, has suffered through four bouts of chemotherapy, dropping at one point to 83 pounds from its harsh side effects.

Advertisement

She no longer plays wing on the rugby club team, but she has managed to finish her last four courses at Southern Connecticut State University through e-mail correspondence and will graduate Friday.

But whether she survives thymic carcinoma long enough to become a psychologist, rests with a long-shot experimental program at the Cancer Center of America in Philadelphia.

Packed and ready to leave for the facility last week, Lisa Cortese, Cristina’s mother, was crestfallen that the latest set of e-mails and phone calls from the hospital and her insurance company had again dashed their hopes that treatment would be covered.

"We are just devastated," Lisa Cortese said.

But that all changed after inquiries from the press.

One problem was that her insurance company, Blue Cross Blue Shield of Georgia, would pay only for treatment of one specific type of cancer, even if other cancers were found, an arrangement unacceptable to the hospital.

The other was a contract sent from the hospital that put the entire financial burden on the family, while questions remained whether they would accept Blue Cross under any circumstances. To smooth the way, the family has already mortgaged its house to put $250,000 in escrow towards the costs.

"They have both (hospital and insurance company) been jumping through hoops the past two days. So, as of today ... she can go to any facility she would like to go to prolong her life," Lisa Cortese said

Scott Golden, a spokesman for Blue Cross Blue Shield of Georgia, said he believed the family was now satisfied with the insurance coverage.

It’s been an emotional roller-coaster ride for the Tolland family since they got the unexpected news Jan. 4 that Cristina’s thymus was cancerous with lesions spreading to a lung and her liver.

Usually the thymus grows until puberty, at which point it begins to atrophy and turn to fat. In what may be a condition with genetic implications, Cristina’s thymus didn’t atrophy, and doctors say it turned cancerous within the last few years.

Her only symptoms were swollen fingers and fatigue, but given her schedule, being tired seemed normal to her mother.

"She was doing her work-study program, full-time classes and playing rugby. Of course she was tired," said Lisa Cortese.

Cristina’s friends and professors at Southern have rallied around the petite, 5-foot-tall senior with fund-raisers and frequent trips to her home in upstate Connecticut. In addition to playing rugby, Cristine is president of the Psychology Club and participated in the student government.

Several hundred students showed up at a variety show they arranged last week to help the family with medical expenses, which are currently around $20,000 for co-pays and other out-of-pockets costs.

"I have been here for five years, and I have never seen students as involved on this campus as I have around Cristine," said Kate Marsland, professor of psychology and Cristine’s advisor.

Treatments in Philadelphia will now be covered in a 60/40 split, with the insurance company paying 60 percent. That gives the family the option of checking out the Cancer Center of America program, but the financial burden could still quickly balloon for a family with three younger children.

In one of her many fights with the insurance company, Lisa Cortese said Blue Cross would cover only CAT scans for Cristina’s 18-year-old and 16-year-old sisters, but not for her 14-year-old brother, which were necessary to determine if the sibblings had the same problem.

As of Friday, they agreed to check her son and authorized a PET Scan or more detailed image for the 18-year-old girl, who is showing an intact thymus, a red flag, given Cristina’s condition. The PET scan will show the state of the thymus.

Also, for the first time, given the complexities of her situation, Cristine now has a case manager.

"It’s incredible. It’s been nothing to everything. It’s what I wanted from the beginning, instead of a lot of pain and heartache over it. Regardless, it will all work out hopefully in the end and give us some more time with Cristina. Right now, that’s what our goal is," said Lisa Cortese.

Cristina will undergo her last bout of chemotheraphy this week — 14 hours over three days. She worries about the financial and emotional burden on her family, but works to remain positive.

"It’s definitely been a really difficult time for me, but just having the support from my family and friends has made things so much easier, and getting the support from my school has made things so much less stressful for me."

The next battle is transitioning Cristine to Medicaid or Social Security disability medical benefits to keep the insurance going after she graduates and the 18-month insurance extension ends.

Lisa Cortese quit her job as manager of a residential care facility in January to oversee her daughter’s care full time. So, the family is living on the salary of Cristine’s dad, who carries the insurance.

"Emotionally, the first two months, it was difficult to just get out of bed and get dressed, and then we realized we had to do it for Cristina. Otherwise, we would be sitting home mourning and crying 24/7, and we knew we didn’t want that," she said.

The family will make a decision on whether to opt for the Cancer Center of America after consulting with doctors there the last week in May, but they are grateful to have the option.

"I don’t want them to tell me she has six extra months, but she will be in the hospital for four of them. But at least if we go and we hear it, we know we tried. That’s where we have to be at right now. At least it will be in our hands and not in the insurance hands," Lisa Cortese said.

[raneyf]

It is absolutely unbelievable to me the things people have to go through to have a slim chance to live. I'm ashamed that I never realized it until living through it. Now I wonder what happens to people that don't have knowledge or resources to get lawyers and media attention. I'm convinced my insurance company just wants me to hurry up and die. Too bad for them, I'm a little bit contrary!

[RandyW]

I like contrary people!!!!!!!