Fighting cancer on her own: Local patient in limbo after Sutter Medical Group drops Medi-Cal

Deborah Zambo is fighting one of the deadliest forms of cancers. Thanks to a recent insurance shakeup, she feels like she’s fighting it alone.

Zambo is one of 10,000 Sutter Medical Group patients who recently learned her doctors will no longer take their insurance, Medi-Cal Anthem Blue Cross. For Zambo, that meant suddenly switching her primary care physician, her surgeon and her radiologist in the middle of her battle with colorectal cancer.

When Sutter’s medical director announced the change in August, he did it with a patina of optimism, saying the patients getting turned away might actually receive better care at community health clinics scattered across Sacramento and Placer counties.

Now, after spending hours on the phone to get prescriptions, waiting weeks to schedule basic appointments and having no way to follow up on her radiological work, Zambo says she thinks Sutter Medical Group’s prediction was anything but accurate.

“Ever since this happened, I feel like I’ve just been falling through the cracks,” Zambo said.

Sutter Medical Group maintains that transferring its Medi-Cal patients with Anthem Blue Cross to community health clinics was the right move, due to special funding those clinics have, including from the Affordable Care Act.

Prior to October, Zambo was a Medi-Cal patient generally happy with her care. She says the team at Sutter’s Elk Grove Primary Care helped catch her cancer early, and that her surgeon likely saved her life by removing a large tumor. Zambo also has nothing but praise for the Sutter radiologist who guided her through chemotherapy, and she believes her oncologist is “the very best at what she does.” But the level of confidence Zambo had in her doctors just made the news from Sutter Medical Group more jarring.

In an August interview with the Sacramento Bee, Sutter’s director of primary care, Dr. Ken Ashley, said that the Medi-Cal patients who were being dropped would get better services for optometry, dental work and behavioral medicine at the region’s community clinics. “I’m OK with our partners helping take care of these patients,” Ashley was quoted as saying.

For Zambo, the confirmation that she was among those being pushed to Sutter’s “partners” came weeks later, when she received a notice from Anthem. Zambo then started getting phone calls from various doctors’ offices telling her they could no longer treat her.

Technically, Sutter Medical Group offers a “continuum of care” option that Anthem’s Medi-Cal patients can apply for to try to keep their doctors. Zambo says she’s mainly gotten nowhere with that process—or at least what she understands of the process. She’s now lost access to all of her physicians except her oncologist, who she’s fighting to keep under Sutter’s continuum of care option.

“It’s so confusing,” Zambo said.

Like thousands of others with Medi-Cal Anthem Blue Cross, Zambo was referred to a community health clinic for all of her other needs. She started seeking treatment at Health and Life Organization Inc.’s Sacramento Community Clinics. According to Zambo, patient congestion at the clinic meant it took three weeks to get an appointment; the staff didn’t return phone calls in a timely manner; the lab referral process was perplexing; and she’s even had problems getting prescriptions filled.

“Life was simple with Sutter,” she reminisced. “No more.”

Sacramento Community Healh Clinic did not respond to a phone call or email for comment.

Zambo has filed complaints about her situation with both Anthem Blue Cross and Sutter Health. This week, Ashley told SN&R that Sutter still believes it made the right move.

“It takes some time to get a new patient established with a completely new health system, and it can be frustrating,” Ashley acknowledged. “Overall, I feel like this was the best thing for this community of patients.”

Anthem Blue Cross did not provide a comment for this story by press time.

Zambo says she wasn’t necessarily expecting Sutter or Anthem to take responsibility for the way her health care eroded. But Medi-Cal—the state program tasked with helping California’s low-income residents, senior citizens and people with disabilities—is a different story. Zambo says she’s been able to find no clear avenue for even bringing her situation to the attention of state officials at Medi-Cal. And that makes her wonder how many other local patients with serious conditions are in the same boat.

“You just can’t get through to Medi-Cal, and that’s my biggest frustration,” Zambo said. “My cancer is something I have to stay on top of, and some days I have a lot of residual pain from the surgery. I certainly didn’t need this added stress—it’s been hell on earth.”