Six weeks later, with a mass the size of a lemon in her right breast and a new pain under her arm, Smith went to the emergency room at Greater Baltimore Medical Center in Towson on a Saturday night in March. She got no treatment and was told to call a doctor Monday.
She did and somehow got an appointment that day with a doctor at St. Joseph Medical Center. The nurses quickly sized up the situation. Before the week was out, she had a biopsy, a diagnosis of cancer and a promise they would help, despite her financial situation.
Still, the money issue didn't go away. Handed a half-dozen prescriptions for diagnostic tests needed to determine the course of treatment and the extent of the cancer, she kept running into snags. She kept breaking out the American Express card. Hundreds here, $1,700 there. When it came time to get an MRI, she waited for an hour and a half and was told they didn't take AMEX.
"If you don't have medical insurance, you get bounced around," she said. Smith said she is certain she would have a much better prognosis if only she had health insurance. Her cancer might have spread too far.
Smith's medical needs are now being handled. She got care through the state Department of Health and Mental Hygeine's Breast and Cervical Cancer Diagnostic and Treatment Program. Because she and her husband are separated after nine years of marriage, she qualified for that program and for Medicaid, the state-federal health insurance plan for the poor.
"What's sad is that if my husband and I weren't separated, I wouldn't have qualified," she said. "I probably would have just been in limbo."
The state-funded program has a budget of $14 million and sees 4,200 low-income women a year. "We never turn people away" who qualify, said Donna Gugel, director of DHMH's center for cancer surveillance and control.
But the program isn't known to everybody. Gugel said it has a Web site and providers know about it, but acknowledges that a woman having access problems might never hear about it. "Her case illustrates that it's hard," she said.
A bill that would have established a program to provide a year of coverage to any Maryland resident newly diagnosed with cancer earning less than 300 percent of the federal poverty level ($63,000 a year for a family of four) failed to get out of a committee in the Maryland House of Delegates this year.
