Instead, she got sicker after a nine-week stay and surgery to remove her small bowel, half of her stomach, her appendix and part of her pancreas. She asked for the opinion of a specialist at M.D. Anderson Cancer Center, but her health maintenance (HMO) organization wouldn’t pay for it.

After a second hospital stay during which her weight dropped to 69 pounds, she called the Patient Advocate Foundation (PAF). The foundation’s staff began lobbying her insurance company to let her see a specialist, and called the local media for coverage. Their efforts helped get Trainer moved to M.D. Anderson the same day.

"I didn’t have the first clue of what to do,Trainer said. "I [believe I] would have died. I was a long term, high risk for an HMO.

Trainer’s case is just one example of the work that PAF does. Founded in 1996, the organization helps cancer patients deal with issues surrounding their medical coverage. PAF assists in many ways, from negotiating with insurance companies for treatments and payments to helping people without insurance.

"There was no other advocacy program addressing this,said Nancy Davenport-Ennis, founding executive director of the group. "Yet, surveys of patients and medical professionals showed [help with insurance] was needed.

Headquartered in Newport News, Va., PAF accepts cases nationwide through its hotline at 1-800-532-5274. The foundation’s case managers handle about 75 percent of the calls by negotiating directly with insurance providers. The organization also works with more than 70 lawyers who provide work free of charge for PAF’s clients.

The foundation’s work differs from patient advocates affiliated with hospitals or service organizations. The foundation deals only with insurance disputes, because its caseworkers, and lawyers can pursue legal action pertaining to these matters.

"When someone is diagnosed with cancer, arguing with an insurance company over treatments and payments is demoralizing. We will stop the loss of self-esteem, Davenport-Ennis said.

After PAF intervened, Trainer spent two weeks at M.D. Anderson last May, and when she went home, a nurse visited her twice a day. Her weight is back up to 81 pounds. Trainer said that even though PAF is negotiating with her insurance company, who refuses to pay, she still sees a specialist at M.D. Anderson.

"[Nancy] had the resources and the know-how,Trainer added. "If it hadn’t been for her expertise, I would have been in this apartment in my bed and there wouldn’t be anything left of me.

• Case Study: The California Women’s Law Center
• Patient Advocacy Foundation