Woman Suddenly Loses Medicare Insurance in Middle of Cancer Treatment

One woman was dramatically dropped from her Medicare coverage in the middle of Stage IV cancer treatment, and now others are worried their insurance could disappear without warning.

Pam Ellis, a North Carolinian grandmother, is undergoing treatment for a type of cancer known as MALT lymphoma. She's also battling the Centers for Medicare and Medicaid Services and the Social Security Administration after they dropped her health insurance without an explanation.

The 67-year-old Charlotte resident said she was undergoing treatment for her Stage IV diagnosis when she received word that her Medicare had been terminated.

"It was devastating," her husband told local station WCNC Charlotte. "You think you do everything right and then all of a sudden, Pam doesn't have insurance when she needs it most in her life."

Ellis had been in the middle of disputing a medical bill for $3,000 as well.

"That was the low point when they canceled the insurance," Ellis said. "I kind of had given up when they did that."

Ellis and her husband only found out the news in February, three months after the policy officially ended, and they had to delay the treatment by several weeks as they sorted through the financial situation.

Since the Ellis family's story was reported, many have been questioning how Medicare makes its policy decisions, especially if they erroneously remove coverage in the middle of a lifesaving treatment.

"That we would allow coverage to be denied under those consequences seems to me to be really inappropriate and something we should address at a policy level," U.S. Representative Jeff Jackson told WCNC Charlotte.

"The first step is going to be identifying exactly where the policy failure was and then, if there is a real gap here and I think there probably is, then we start pulling in other legislators and we say, 'Hey, we think this is fundamentally unfair. Can we work together to fill this gap and address this?' If this is happening in one particular congressional office that means it's probably happening all across the country."

According to the Social Security Administration, all Medicare recipients should receive proper notice that their insurance coverage is ending.

"A notice of termination of enrollment for nonpayment of premiums will generally be mailed to the enrollee about 30 days after the end of the grace period," reads the policy. "This 30-day period provides time for processing any premium payments received late in the grace period and avoids incorrect notices that could cause the enrollee needless anxiety."

That's the opposite of what happened to Ellis, they say, but the SSA did reach out and fix the error after the WCNC Charlotte article went live.

Now, Ellis has coverage again and got the $3,000 charge erased due to a processing error.

"Our local office has been in communication with the Ellis's. We do apologize for any delays in addressing and responding to their concerns," SSA Regional Communications Director Patti Patterson told the local publication. "If someone becomes aware of an issue with their Medicare premiums, they should contact SSA immediately and we will take any necessary actions."

Sulagna Misra, a primary care doctor who advocates for price transparency in health care, said she's witnessed a movement across insurance companies nationwide to stop covering people, whether medical, home or vehicle.

"As time goes on more and more cracks within health insurance and the current medical system are showing," Misra told Newsweek. "The patient should ideally have had an option to pause or hold or have enrollment unchanged as this was sorted out."

Misra said doctors are continuing to opt out of Medicare because the Federal Trade Commission has allowed for non-competes to go away and doctors can open their own practices and leave the hospitals they were once a part of. She also said doctors are frustrated by the slow prior authorization processes that can end up delaying lifesaving treatment.

"We need to stop the prior authorization process and respect the physician's decision as many insurance processes truly hinder treatment," Misra said. "Sometimes getting a PA and then getting it appealed can take months and a patient can die during that time."

Those who face a similar situation should call CMS at 1-800-633-4227.

If you lost Medicare coverage unexpectedly and would like to share your story, please reach out to personalfinance@newsweek.com.