WNC program helps secure life-saving operation for Charlotte man
James and Brenda Porcello are thankful for many things this fall, and near the top of that list is Jan Plummer, of Waynesville, a Mountain Projects employee who was among those who helped save James’ life just a few months ago.
Plummer helped make an intricate and expensive surgery possible, just when the family thought they might lose hope.
The Porcellos live in Charlotte and have family in Waynesville. Earlier this year, James discovered he’d developed liver disease, despite a health history that wouldn’t seem to suggest risk. Initial symptoms had been dismissed by his healthcare providers, and he wasn’t diagnosed until much later, when his symptoms had become worse. At that point, his life was in danger and the situation deteriorated quickly.
“I guess in that instance, the healthcare industry failed me,” said James. “I wish I’d known enough about liver health early on to say, ‘wait a minute now, I want this checked.’”
By late August Portello needed a liver transplant, fast.
Vetted by a team of doctors at one of the few hospitals in North Carolina that performs the surgery, he was established as a good candidate, and the operation seemed fast-tracked — until the hospital had a look at the couple’s health insurance. The Porcellos were members of a cost-sharing program. It had served them well in the past, but the hospital found it unacceptable for an operation of this magnitude.
No standard health insurance, they told him, no operation.
Brenda Porcello was stunned.
“I couldn’t believe they would just turn him down outright,” she said.
But the couple had come to their second marriage with four kids each, and one of their sons, Niki, along with a friend, mounted an email-writing campaign in hopes of finding a solution. Word made its way around and reached Jacquie Buttles, an insurance analyst for the North Carolina Department of Insurance. Buttles knew that James’ only solution was with the Healthcare Marketplace, which doesn’t allow pre-existing conditions to prevent coverage. And she knew who to call.
“Jan Plummer at Mountain Projects and I have been program partners for a decade,” Jacquie said. “I thought we should talk this case through to see what options were available for this patient.”
Plummer manages Mountain Projects’ Certified Application Counseling program, known publicly as “GetCoveredWNC”. This grant-funded initiative offers free information about health insurance options and health care resources, and helps clients navigate paperwork and secure insurance through the Healthcare Marketplace.
Through many years of combined experience, Buttles and Plummer have learned client processes and large agency needs, and they put their heads together to carve out a complicated path forward for James Porcello.
“It’s a shame, but this is the reality of the healthcare industry these days,” Buttles said.
The two had to hurry, as there were only days left in August, and Porcello would need a policy that began Sept. 1. He was hospitalized, and his health was in rapid decline.
“It rarely comes to a life-or-death situation,” said Plummer. “Our counselors help sign people up for health insurance. We specialize in knowing the law, the ins and outs of insurance plans, opportunities for discounts and possible tax credits based on income. But to put that knowledge into practice with someone’s life on the line is a different story.”
The Porcellos couldn’t qualify for a Healthcare.gov plan from a financial standpoint, but Plummer and Buttles knew there were subsidies related to the Inflation Reduction Act and the American Rescue Plan Act that provided help for customers in higher income brackets, and also capped the premium at 8.5%.
First, James would have to apply for Medicaid. This was a formality, because Plummer and Buttles knew he couldn’t qualify, but it was a necessary formality. Working the phones, they pushed his Medicaid application through to rejection in record time and were ready to move forward with his Healthcare Marketplace application.
They quickly worked around Porcello’s late enrollment, found a policy, signed him up, and celebration seemed in order. But then they faced one last unexpected hurdle: the policy came back with an Oct. 1 active date – a month too late to help.
Frantically, they sliced more red tape, identified a paperwork mistake, and finally a policy was in place. Days later, Porcello was in surgery.
“A team of doctors flew to Pittsburgh on a private jet, picked up the liver, and flew it back,” said James.
Porcello’s liver transplant took place at Atrium Health in Charlotte, and he came through with flying colors. He’s made a fast recovery, with lots of strong family support. The insurance Jan and Jacquie arranged covered the costs of surgery, medications and follow up.
“I am feeling very blessed to have a second chance at life,” says James. “Being as close to death as I was makes me so thankful for every minute I have with my family and friends. I look forward to the upcoming holidays with the optimism of a child on Christmas Eve.”
Plummer and Buttles know the intricacies of health insurance, but rarely do they have the opportunity to help save a life. “This story makes my heart sing,” said Jan “We counselors know this work is important, but don’t always have such an amazing story to tell. I’m so happy that Jacquie called and we could work with this family.”
With years of experience with Medicare and health insurance, Buttles has developed many relationships with insurance carriers and the network of nonprofit assisters. She is well known locally as a skilled expert, but rarely finds herself in situations like the Porcellos’.
“My department at NCDOI often asks me to assist in complicated health insurance issues and I use my knowledge of insurance law and my community connections to try and put the puzzle pieces together to come to a successful resolution for the patient,” she said.
“We were both incredibly happy to play a part in this story,” Buttles continued. “However, there were so many people involved — the family, the doctors, the hospital staff and others. It doesn’t get much better than this feeling for the Porcello family.”
“I am so grateful for everyone involved in my treatment and recovery,” James said. “From the angels who helped me get insurance when I needed it so, to the skillful doctors who did an amazing job with the transplant and the nurses who took care of me when I couldn’t care for myself and my family who was there every minute to support and help me even when it meant sacrificing their time and finances. My heart is filled with gratitude as I go forward in life, not taking anything for granted again.“
Get Covered WNC is a program of Mountain Projects Community Action Agency. For more information about affordable insurance coverage, contact Mountain Projects Healthcare Assistors at 828-452-1447 or visit getcoveredwnc.org.
Donate to the organization’s annual holiday Emergency Fund campaign at mountainprojects.org.