A good friend of mine has, for the past few months, suffered one of the worst chronic coughs I’ve ever heard. It started with a cold, and it’s never gone away or gotten better. But it has gotten worse. About three weeks ago, when she traveled from Salinas to San Diego to visit her father, her sister said something that made her laugh. The laughing turned into coughing and my friend coughed so hard that the world spun before her eyes, she slumped to the ground and her heart, for a brief moment, stopped.


The lifeguards at the beach they were visiting called an ambulance (cost, $200 for every mile to the hospital) and took her to the emergency room (the bill just arrived, and surprisingly, it was only about $3,000). I don’t think that includes the doctors’ charges (add maybe another $1,500 for that), and I don’t think it includes the IV medications they gave her (steroids to reduce the inflammation in her lungs, and something “soothing” to calm down her panic) so add maybe another $1,000 to that. The quick diagnosis was asthma, with a side of slightly enlarged heart. But getting down to the real cause may cost more money than she can afford.


My friend has a job. Two jobs, in fact: She is a full-time caregiver to her grandmother, who suffers from dementia and a host of chronic medical conditions, and she works about 30 hours a week as a personal assistant to a pair of self-employed working parents. The caregiver gig is unpaid – grandma has just a little too much in savings to qualify for a state-funded caregiver, but not actually enough savings to hire one for real. And the assistant job doesn’t offer benefits.


While she was in the E.R., a financial aid counselor came in to talk about her options. After running some numbers, the counselor told her that based on her income, she probably could qualify for the CalFresh program (more commonly known as food stamps) and MediCal. And that’s when my friend, who’s struggled for a long time without taking a dime from the state or federal government, really needed something soothing in her IV. 


“It that really what my life has come to?” she asked.


And that’s one uninsured patient, on one day, with one set of circumstances. She’ll pay the hospital and doctors everything she owes – she’s already working out a payment plan with the hospital’s finance department – because that’s how she is. And on the other side of the coin, hospitals all over the state are struggling to keep their doors open, as they meet a perfect storm of uninsured patients like my friend, insurance companies squeezing their balance sheets and cutbacks in the state budget.


Natividad Medical Center CEO Harry Weis announced this week that Anthem Blue Cross, which insures about 4,000 Natividad patients, had cancelled its contract for inpatient and outpatient services. For hospital stays or ER visits, it means Anthem has no agreement in place with Natividad.


The cuts took place on Dec. 31. Natividad physicians, who are contract employees, won’t be impacted. But if a patient needs a test, or a hospital visit, they most certainly will.


Weis has been in California since 2000 and seen Anthem play hardball with hospitals in the past, but this recent round with Natividad has them taking a tougher position than ever before. The same thing happened with Community Hospital of the Monterey Peninsula in 2010: The hospital reached a 2-year agreement with Anthem after protracted negotiations. 


“Our last negotiations with them were in 2007… we had reverse philanthropy with them where we were subsidizing a for-profit company. We weren’t even breaking even,” Weis says. “Then in 2011, they decided it had been long enough and they were looking for significant reductions, more than a third in the next three years.”


Weis calls it a “harsh gesture business transaction” on Anthem’s part, and says the hospital is now looking for ways to keep the faith with its customers.


“We may look for ways to reduce their out-of-pocket,” Weis says. What that looks like exactly is still in process, but Weis says he expects to work more closely with the businesses that pay the premiums.


“This kind of decision by Anthem could be positive in that it propels us to create other relationships between those who pay for the premiums and those who provide care,” Weis says. “We have to be here for the tough times, and be steady and predictable for our patients.”


Next week: a look at Salinas Valley Memorial and its hunt for someone to help love it into fiscal certainty, and how the state is losing tens of millions of healthcare dollars through its chronic inability to get its act together. 


MARY DUAN is the Weekly’s editor. Reach her at mary@mcweekly.com and follow her at twitter.com/maryrduan.