When Vallejo resident Betty Simmons suffered a massive heart attack on May 25, 2004, emergency crews rushed her first to Sutter Solano Medical Center.
The hospital charge: $20,995.
Because of the seriousness of her condition, she was quickly transferred to John Muir Medical Center in Concord, where she spent 13 days as medical experts labored to save her life.
The bill: $531,000.
That covered hospital expenses only. It did not include charges from a host of surgeons, cardiologists, anesthesiologists and other professionals who are not employees of the hospital and thus all bill separately.
The specialists' total: Nearly $150,000.
Simmons, then a 62-year-old technical illustrator, was uninsured and unemployed. She had no way to pay those bills.
She gratefully realizes she is alive today only because of the experts' excellent care. Surgeons put in five stents in two procedures, then implanted a pacemaker-defibrillator. The surgeries required keeping her in a medically induced coma for six days.
"I was told afterwards that most women my age wouldn't live more than two days," she said. "I was touch-and-go for quite awhile."
But after the hospital released her, Simmons found herself in a financial morass that highlights the struggles the uninsured often face.
In addition to the hospital charges, each doctor or medical group billed her separately, independently deciding how to handle their bills, when to send them to a collection agency and which collection agency to use.
At one point while she was recuperating at home, six collection agencies were pursuing her.
"Just for the record, I had never had a bad debt in my life," she said.
"The entire experience was devastating. I was being bombarded with bills. I was trying to recover. I was in pretty bad shape. It was just very stressful."
It became so complicated that a Legal Services attorney who assisted her compiled a large spreadsheet to track all the paperwork.
During the medical crisis, her sister, Mary Lee Simmons, flew from Seattle to help. She quickly became involved in an expensive bureaucratic snag.
Solano County participates in County Medical Services, a state-sponsored program that helps finance medical care for those who cannot afford it. Her sister filled out an application for Simmons and went to John Muir to submit it.
But that was May 28, right before the three-day Memorial Day weekend. The woman who was supposed to accept the application apparently had left early, said Simmons' attorney, Jodie Berger of Legal Services of Northern California.
So Simmons' sister had to wait until June 1 to turn in the application, Berger said. That proved to be a costly delay. State rules permit the County Medical Services Program to pay only expenses dating to the first of the month in which the application is received.
As a result, it would not cover those crucial seven days at John Muir before June 1.
Sutter Solano Medical Center approved her for charity care and wrote off her bill.
John Muir received $260,000 from County Medical Services to cover the June expenses. But the hospital continued to bill her for the remaining $271,000. Sixteen months after her heart attack, John Muir offered Simmons a charity care application for the first time.
Why did the hospital wait more than a year to discuss charity care with her?
"We would not have offered patient assistance until all other financial assistance programs offered were reviewed," said John Muir spokeswoman Laura Kaufman.
At that point, Simmons had sued Solano County over her May hospital bills and declined to apply for charity care while the lawsuit was pending, Kaufman said.
Seventeen months after her heart attack, John Muir wrote off Simmons' unpaid bill as charity care.
Even though she never filled out an application, the hospital assumed that since she qualified for the County Medical Services Program, she would be eligible for charity care, Kaufman said.
But that left a daunting array of bills from doctors and medical groups totaling nearly $150,000.
In the lawsuit against Solano County, Berger argued that the county has an obligation to help cover the health care bills of indigent people who do not qualify for other programs.
They settled the case in August 2006. Solano County agreed to cover her bills and set up a new program for people like Simmons who fall through the cracks. The county also agreed to remind local hospitals they can fax applications around the clock.
"We created a new program because there is this possibility that somebody could have a good reason not to apply (for other programs), such as being in a coma," said Christiana Smith, deputy director of employment and eligibility services for the county.
Simmons finally got her last bill paid off this summer.
She said she does not know how she would have made it through the financial maze without the help of Berger and Legal Services. She hopes the changes resulting from her lawsuit will help other uninsured people avoid a similar quagmire.
"It was easy to see how people could get lost in the shuffle and not have any idea how to get help for themselves."
Contact Sandy Kleffman at 925-943-8249 or firstname.lastname@example.org.