Katie Dagenais, a spokesperson for M.D. Anderson in Orlando, said when asked that the hospital would not discuss the Giovinazzo case. "However," the hospital said in a statement responding to a request for comment, "with regard to payment of services, M.D. Anderson shares in the community's obligation to provide health care for the truly needy. To continue to fulfill this responsibility to our patients, and in the interest of fairness to all patients, M.D. Anderson must make every effort to obtain payment for services rendered and handles charity care on a case-by-case basis." M.D. Anderson's parent facility in Houston received negative publicity in 2008 when it required $45,000 before continuing care of a cancer patient. It later allowed her to defer payment of an additional $60,000. Money "can't be taken out of the equation," says Wendy Gottsegen, a spokesperson for the Houston center, or the burden becomes so great "we can't do research that will ultimately cure cancer." The parent hospital now discloses the amount it spends on charity care; Anderson in Orlando does not.
As for Sally Giovinazzo, her hysterectomy took 3½ hours and her hospital stay lasted from Wednesday to Friday. In the future, she says, "I won't take my health so nonchalantly and [will] start saving money, because I can't go through this again. It's too stressful. I just got lucky." She doesn't expect that kind of providence twice.
Corrected on 8/4/2010: A previous version of this story included Cedars-Sinai among hospitals requiring payment up front for all nonemergency treatment and elective procedures. The hospital does so only in narrow circumstances: elective cosmetic surgery and foreign patients traveling to the United States for treatment.