HOUSTON -- Lisa Kelly is far from on top of the world.

Her life filled with more drama than any soap opera on television.

“The very first round of chemo, I went into remission,” Kelly said. “I don’t know about this time.”

The first time she was diagnosed with acute leukemia was late 2006. But when physicians in Lake Jackson referred her to the M.D. Anderson Cancer Center for treatment, she said the world-renowned facility refused to accept her limited benefit insurance policy through AARP because it only paid up to $37,000. They would only take her as a self-pay patient.

“They told me, ‘well, you’re going to need about $45,000, and it has to be a cashier’s check,’” she said.

And they needed it before she could even be admitted. So Kelly said she and her husband borrowed against the trust of his recently deceased father. They paid $45,000 up-front and after some initial tests, her doctor wanted her admitted the same day.

But: “He said, ‘the business office needs to talk to you again before you go to admissions,’” Kelly said. “They said they wanted $60,000 more. I’m like, ‘we just gave you $45,000. Do you carry $60,000 in your pocket? We don’t have any more money.”

An override was granted, and Kelly was admitted.

Treatment continued, and she’s the first to tell you the treatment was top-notch.

But Kelly said as she battled for her life, she was also battling with M.D. Anderson’s business office.

“It’s like, ‘you might need to sell your assets to take care of this bill. We’re not a charity hospital,’” she recalled. “I said, I can pay a thousand a month.”

Ultimately, they settled on $2,000 a month, and Kelly retained the services of patient billing advocate Holly Wallack.

“Well, I think it’s just not the way people with life threatening diseases should be treated, especially in this country which is the richest country in the world,” Wallack said.

“As Americans we all should have access to a given level of health care,” M.D. Anderson Dr. Ron Walters said.

Like many hospitals, M.D. Anderson moved to an up-front payment system for uninsured and underinsured patients in 2005 after unpaid bills soared to $52 million dollars — an $18 million dollar jump. 

“It has forced us to look at what we do and how we do it,” Dr. Walters said.

Since the up-front payment system has been in place, M.D. Anderson’s patient revenues have risen 27 percent to $2 billion. Yet during the same time frame, the amount of money allotted for indigent care dropped from $144 million to just under $99 million.

Did we mention M.D. Anderson, which is not for profit and therefore tax exempt, cleared $310 million last year and $317 million the year before?

“It’s hard not to call that a profit,” University of Houston Law and Health Policy Institute professor Patricia Gray said. “For M.D. Anderson and hospitals like M.D. Anderson, it’s going to mean they are likely to get the unwanted attention of lawmakers who want to know why they are not doing more when they have more.”

M.D. Anderson said the reduced indigent care figures don’t account for the doctors and other resources it provides to Harris County’s LBJ Hospital, allowing them to reach patients they otherwise wouldn’t see.

“Balancing the needs of the many with the needs of the few,” Dr. Walters said.

“They are taking care of the poor less and less, and their profits are going up and up,” Wallack said.

But instead of the word profit, M.D. Anderson prefers “net revenue.”

“We are generating more revenues, but the need to pump much of that revenue back into our core mission areas is increasing at similar paces if not more,” Dr. Walters said.

He has a point. The number of Americans diagnosed with cancer was 11.7 million back in 2005. That number is expected to grow to more than 18 million in 2020. 

Seventy-five percent of all cancers are diagnosed in individuals 55 and older — baby boomers, the fastest-growing segment of the U.S. population.

Which means M.D. Anderson has to train more doctors and build more beds. It’s in the process of doubling bed capacity while also promoting prevention and pursuing its ultimate goal: finding a cure for cancer. 

That said: “We don’t like the idea of someone wrestling with disease and money at the same time either,” Dr. Walters said.

Unfortunately, Dr. Walters said the system makes them. It’s a system that allows major insurers to negotiate better deals because they bring more volume, while people like Lisa Kelly pay full markup.

“It would be as if you and I went out to a restaurant and we ordered the same hamburger, and I had to pay twice as much for mine as you paid for yours,” Wallack said. “It’s just not fair.”

“This time I felt like somebody shot me, ran over, dragged me, backed up over me,” Kelly said. “This was a really tough one.”

After a year of remission, Kelly’s leukemia is back with a vengeance. With M.D. Anderson’s help, she qualified for full coverage under special insurance in February of this year.

It doesn’t change the fact that she’s already paid $82,000 in self-pay charges and still owes $137,000 from before. She’s made an offer of 72 cents on the dollar — the same rate, she said, paid by Blue Cross Blue Shield.

“I don’t want a hand out,” she said.

Kelly said it’s not that she doesn’t want to pay; she just wants to pay what’s fair.