Woman says she was told her cancer was not good enough for Medicaid

Posted at 1:43 AM, Sep 27, 2012
and last updated 2012-09-27 10:16:53-04

Virginia Beach, Va. - Imagine being told, “We help cancer patients, but just not you.”

One Virginia Beach woman came to NewsChannel 3 for help after she says she was told her cancer wasn't good enough.

“I know if I don’t get treatment, I’m not going to live, I’m not going to have a chance.”

Living through cancer once is tough enough, but after seven years in remission, Vicki Andrus found out she would have to fight lung cancer for a second time.

“Came back, there was a tumor in the exact same location as other tumor, with the exact same cancer.”

So the merry go-round started again including visits to her oncologist, her radiologist, and her surgeon ordering CAT-scans, PET-scans and lung scans. That ended in the decision by doctors to remove her entire right lung.

“I left and my head was totally spinning thinking about all the if’s and buts.”

Including how she was going to pay for it all, because in her job as a teaching assistant, Vicki doesn’t get the benefit of health insurance.

“All my time and energy is not able to be spent on what’s happening to me,” she says. Right now my energy is only spent on all these overwhelming medical bills.”

With $30,000 already racked up before a single round of chemotherapy or surgery, Vicki decided to go to the State of Virginia for help, hoping she would be eligible for Medicaid.

A family member first contacted the city of Suffolk’s social services office. In an online response, an employee said she could apply but that "the only medical category for cancer is breast and cervical cancer."

“Breast cancer and cervical cancer would be a qualifier for Medicaid. How dare they discriminate against all the other cancers there are.”

“Cancer is cancer. I don’t care what kind you have, I don’t care what stage it’s in, and it doesn’t matter.”

Just to make sure, Vicki called her local Medicaid office in Virginia Beach and got the same answer.

Again, they told her to apply anyway, but Vicki felt discouraged that her cancer wasn't good enough for coverage.

“You can’t just pick and choose, this one has breast cancer, we'll take her, this one has ovarian cancer, no, she’s not going to qualify.”

“I really want to know why, get an answer from the State of Virginia about why they can pick and choose”

So Vicki asked NewsChannel 3 to take action.

And the first place we went was the state's department of social services, which administers Medicaid.

They do admit that "breast cancer or cervical cancer is specifically designated as a qualifying medical condition for Medicaid under the breast and cervical cancer treatment act."

But even in that special program, women still have to be considered low-income to get help.

According to the state, if you qualify for full Medicaid coverage, cancer treatments are always paid for, no matter what type of cancer you have.

So why wasn't this explained to Vicki by her local office?

According to the city of Virginia Beach, "state Medicaid policy allows local social service agencies to provide general information only."

They showed NewsChannel 3 a directive which says local offices should "limit verbal and written information…" because "an attempt to be helpful could be futile or lead to incorrect advice."

It seems the local offices went against that very rule in their conversations with Vicki, giving her more information than she needed about breast and cervical cancer, and confusing her in the process.

But the state wouldn't say if Virginia Beach or Suffolk violated social services policy.

In the end, NewsChannel 3 found out that the state was not discriminating against Vicki’s lung cancer, but their answers haven't helped her get any closer to possible coverage.

Vicki applied for Medicaid three weeks ago, and has yet to hear back on whether she qualifies under their disabled category.

“Whatever it takes, I will fight for whatever treatment I can have, because I’m not going to give up.”

“I plan on being around for a long time. I have a lot of grandchildren that I want to see grow up, be a part of their lives.”

Vicki just underwent that surgery to remove the remaining lobes of her right lung.

She is doing well, still recovering at Sentara Norfolk Heart Hospital.

And while she is waiting on an answer for Medicaid eligibility, Sentara has told us that Vicki will receive assistance with her medical bills through their uninsured patient discount program.

It’s available to anyone without insurance, all you need to do is ask.