Cancer Care, With a Dose of Insurance Bureaucracy

(NYT) – Over the Memorial Day weekend, a 9-year-old Bronx girl named Lauren went grocery shopping with her mom. In an aisle, a man banged into Lauren’s left arm with his cart, tearing away part of a big mole. She bled heavily.
After a trip to the emergency room at Our Lady of Mercy Medical Center, a dermatologist sent the remainder of the mole for biopsy. On June 10, Lauren returned to the hospital with her mother. She had melanoma, a skin cancer rare in children, and very serious at any age.
At the suggestion of the doctor, her mother took Lauren to Memorial Sloan-Kettering Cancer Center. Surgery would be performed to remove the tissue around the mole. On further examination, a specialist also recommended scans on her lungs and liver, and the removal of lymph nodes from her arm, Lauren’s mother said.
Nearly a month later, every syllable of the diagnosis is still electric.
“She doesn’t have a cold that is just going to get better,” said her mother, Amanda.
Even so, no treatment has started. Two dates for surgery have been scheduled, then postponed; on Tuesday, she had a third date, for Friday. None of the delays have anything to do with the urgency of her condition, which is beyond dispute.
So far, Lauren’s care has been stalled by the gnarled bureaucracy that guards the treasure of health care and — possibly — by the charged question of what services the American public should provide to noncitizens, according to her family and the office of United States Senator Charles E. Schumer.
Lauren was born in Ireland. In 2000, when she was just 1 year old, her parents brought her to the United States. All involved overstayed their visas. They are here as — take your linguistic choice — undocumented immigrants or illegal aliens. But at least in New York State, the government decided long before they came that even foreign-born children without proper papers could receive health care.
In 1991, the state created Children’s Health Plus, insurance for kids who did not qualify for ordinary government insurance, either because their families made more than the income limits or because they were in the United States without legal papers. Both the Democrats and the Republicans in Albany agreed that children should not suffer because of decisions made by the adults in their lives.
From age 4, Lauren had regular checkups and childhood shots through Fidelis Care, a managed care company that was set up by the Roman Catholic bishops of New York under contract with the state to provide Child Health Plus insurance. Fidelis says its goal is to provide the “finest quality health care to everyone in New York State who does not have access to health insurance.”
A few days after Lauren’s diagnosis, her mother said, she learned from the insurance company that there was a problem because the child was not a legal resident.
“Around the 14th of June, I got the call that since she did not have any status, her request was being denied,” Amanda said. “I never heard anything about this until she got sick. They said it was a new policy, just out.”
Fidelis said that this was a complete misunderstanding, and that the only issue was getting up-to-date paperwork for Lauren.
“From May 1, 2008, her health insurance has continued without interruption and she has been fully covered during the care and treatment of this recent health issue,” Darla Shattenkirk, a spokeswoman for Fidelis, wrote in an e-mail message. “Children do not need green cards; they can be undocumented and still apply for coverage. There was no issue of documentation or citizenship in this case.”
In fact, the Catholic bishops have been consistent advocates for immigrant services, so it would be hard to imagine that their own insurance company would cut off someone because of immigration status.
But something plainly went wrong. Lauren’s mother, who did not want to be fully identified because of her own legal vulnerability, said she could not untangle the knot.
“I’ve lost count of how many insurance representatives I’ve spoken with, going through the entire story each time,” Amanda said. “I could do it with my eyes closed and my hands tied behind my back.”
THE family took the problem to The Irish Voice, the weekly newspaper, and also sought help from Senator Schumer’s office. An aide to Mr. Schumer said that after calls to the state’s Department of Health, the coverage problem seemed to have been fixed last week.
The operation was scheduled for Wednesday. That changed Monday evening, when they were told that the surgery could not take place at Memorial Sloan-Kettering, which is not part of the Fidelis provider network.
After another round of phone calls on Tuesday, Fidelis agreed that treatment could go ahead as planned.
And Lauren, who is going into fourth grade in September, spent the afternoon with her mother at “Kit Kittredge” — the new “American Girl” movie.

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