Reproductive cancer survivor beats disease, but is left with medical debt crisis

Editor's Note: The following is part of a class project originally initiated in the classroom of Ball State University professor Adam Kuban in fall 2021. Kuban continued the project this spring semester, challenging his students to find sustainability efforts in the Muncie area and pitch their ideas to Ron Wilkins, interim editor of The Star Press, Journal & Courier and Pal-Item. This spring, stories related to health care will be featured.

In March 2019, at 20 years old, Marilyn Palomino was diagnosed with a form of cancer typically found in women triple her age.

“My abdomen felt dull and sharp at the same time. I knew something was really wrong,” she said.

Doctors at a Planned Parenthood clinic diagnosed her with Stage 1, low-grade endometrial stromal sarcoma. An ultrasound confirmed she had four large tumors the size of lemons in the lining of her uterus.

Palomino’s diagnosis is atypical of those who more commonly contract the disease.

According to Johns Hopkins Medicine, about 50,000 women are diagnosed in the U.S. each year, primarily between the ages of 50 and 70. Black women are disproportionately affected by uterine cancer, but new research published in “Gynecologic Oncology” suggests Hispanic women are a new target group.

“It was a lot to take in," Palomino said. "I come from an immigrant household. How was I was going to communicate this to my family? They did not have the resources to help me.

“How was I was going to continue school while doing this treatment?”

After her diagnosis, she called off her engagement and stopped attending Indiana Tech.

Instead, her focus was to be cured.

She received a localized form of chemotherapy, which included monthly IV infusions and oral medication to target the cancer cells. Palomino said she experienced immense brain fog and loss of appetite. Her health-care provider informed her the treatment would permanently affect her immune system and fertility.

By the end of this five-month ordeal, her bill for treatment was close to $250,000.

The cost she faced is not uncommon for cancer treatment.

“Approximately one-third of cancer survivors went into debt; 55% incurred obligations of $10,000 or more, according to a 2016 "Health Affairs" study. "Cancer survivors who were younger, had lower incomes and had public health insurance were more likely to go into debt or file for bankruptcy.”

Palomino had student health insurance, but the plan only paid a fraction of the cost.

“I had a hybrid plan, and it was very limited, so I skipped the process entirely,” Palomino said.

She had Indiana Tech’s United Healthcare plan, which covers 100% of the allowed amount for preferred providers. But students who seek preventative care services and prescription drugs out of network must completely pay out of pocket.

And her medication bill, which included her insulin potentiation chemotherapy treatment, had gone to collection.

“Medical debt has socioeconomic factors that contribute to systemic issues," Jacqueline Wiltshire, associate professor at Indiana University in the Fairbanks School of Public Health, said. "Wealth gives you access to health care, and in this country, getting good insurance coverage is tied to employment.”

A Consumer Financial Protection Bureau’s 2020 report found 18.2% of Hoosiers have a $2.2 billion total in collections reflected on credit reports, which ranks 11th of all 50 states. The Indiana median medical debt amount in collections is $748, according to The Urban Institute.

“Something I had to learn along the way was how complicated medical billing is," Palomino said. "One part of the bill is for the lab and the actual medication. The other bill is the rate of the doctor.”

When Palomino moved at the start of the fall semester and sent her mail to a new apartment, she found several letters from a collection agency and a lawyer. She called and was given two options: either pay a specific amount in full or start a $800 per month payment plan immediately.

She could not afford it.

“It is important to let your provider know your financial concerns to help you anticipate the treatment prices," Wiltshire said. "If you feel overwhelmed, reach out to a community-based organization to help navigate through this medical jungle. Self-advocacy is the key component.”

Palomino contacted her scholarship program, the Young Eisner Scholars, for guidance. The program called the agency on her behalf and paid the collection’s debt off in its entirety. They informed her that her scholarship would cover all of her medication going forward.

“This is why, even though there are unfortunate aspects of my situation, I do recognize that I am very blessed, and this is a prime example of that,” she said.

She called the downtown Chicago, Illinois, oncology clinic, which administered her surgery and cancer treatment, to negotiate the cost. She requested an itemized list of services to check for any discrepancies. The health-care provider wrote off some of the debt. The rest she paid with income from multiple jobs.

“I was tired a lot," she said. "I would leave home around 8 a.m., and I wouldn't get back home until 11:30 p.m.”

Palomino refinanced her debt through a private loan with a low annual percentage rate. She made her last payment of $760 in May 2023.

“When I paid it off and in full — oh my God, it was the just most amazing feeling,” Palomino said.

This article originally appeared on Lafayette Journal & Courier: Young reproductive cancer survivor burdened by medical debt crisis