Being a patient is getting harder in a strained and complex US health care system

Tamika Davis couldn’t nap on her couch during cancer treatment. She kept worrying one of her toddlers would wander over and pull out the needle delivering chemotherapy.

Friends and family watched her kids when they could during her treatment last year for colon cancer. But Davis had gaps with no help because she couldn’t afford child care and didn’t know where to look for assistance.

“I did not have the strength nor the energy to try to navigate these things myself,” the San Antonio, Texas, resident said.

Patients are not getting enough help dealing with a healthcare system that is growing increasingly complex, according to researchers and other experts in care delivery. They say more frequent insurance complications, doctor and drug shortages, and a lack of communication all make life harder for people with serious or chronic illnesses.

“Just about anything you can think of, it’s now harder to get it done, basically,” said Elisabeth Schuler, founder and president of Patient Navigator, a business that helps people get through the system.

More care providers and employers are offering help guiding people, a practice the federal Medicare program has started to cover. But that assistance has limits.

Patients with serious or chronic illnesses face a web of challenges. They include:

— Coordinating doctor appointments and tests, often while working or undergoing treatment.

— Dealing with coverage denials or care delays due to insurer pre-approval requirements.

— Figuring out how to fill a prescription if they can’t get coverage or their medication lands on a growing list of drugs in shortage.

— Acting as a go-between for doctors and specialists who don't talk to each other.

— Paying medical bills and getting help with rent or utilities. That assistance has been harder to find since the COVID-19 pandemic, according to Beth Scott of the non-profit Patient Advocate Foundation.

All of this can be compounded for patients who don't speak English or have no experience navigating the health care system, noted Gladys Arias, a policy principal with the American Cancer Society Cancer Action Network.

Davis, the San Antonio cancer patient, said she was in the hospital when she asked for help finding community resources.

She said a case manager set a book of available resources on her bedside table and did nothing else. Davis, a nursing professor, found the book confusing. The programs it detailed had different qualifications based on things like income or diagnosis. The 44-year-old wound up losing her car and leaving her home after care bills piled up.

“I feel like there was some type of help out there for me,” she said. “I just didn’t know where to look.”

Ali DiGiacomo said she wishes that she learned in college how to deal with insurance companies. She often has to do that while coping with side effects from rheumatoid arthritis treatments.

The 30-year-old personal trainer said she’s spent years trying to get a diagnosis for bouts of intense chest pain, which doctors think may be tied to her condition. That requires imaging tests that insurers often decline to cover.

“Dealing with them with brain fog and fatigue and being in pain is just like the cherry on top,” DiGiacomo said.

DiGiacomo said her formulary, or list of covered drugs, has changed three times. That can force her to hunt for a place that carries the newly covered drug, which puts her behind on her medication schedule.

She figures she talks to her insurer at least four times a month.

“I have to hype myself up,” she said. “Then you talk to a million different people. I wish I just had like one person that helped me deal with all this.”

Care delays due to insurer pre-approval requirements have grown more common, many experts say. More plans also have made it challenging to get coverage outside their networks of doctors and hospitals.

A typical appeal for a denial can easily involve 20 to 30 phone calls between the patient, the insurer and the doctor’s office, said Scott, director of case management for Patient Advocate Foundation, which helps people with chronic or debilitating illnesses.

She said some patients give up.

“Sometimes you are sick, and you don’t want to fight it anymore,” she said.

Case managers at hospitals are often overworked, which limits how much help they can provide, noted Schuler, who became a patient advocate about 20 years ago after her 2-year-old daughter went through cancer treatment.

Overall, help for patients is “very patchy everywhere,” according to Harvard Medical School researcher Michael Anne Kyle.

“I think we have a lot of Band-Aids that are necessary,” she said.

Many cancer centers offer patient navigators who can help coordinate appointments, get answers to coverage questions, find rides to the doctor and provide other support. Some insurers provide similar assistance.

And more employers are offering navigation or advocacy help for people on their insurance plans, according to the benefits consultant Mercer.

But these services still aren’t widespread. Alzheimer’s disease patients and their caregivers lack consistent access to such help, said Sam Fazio, a senior director with the non-profit Alzheimer’s Association.

“People are having trouble finding their way,” he said.

Making the system better for patients requires big change, said Dr. Victor Montori, a Mayo Clinic researcher who studies care delivery.

He said the system must focus more on minimally disruptive medicine, which makes care fit into patient lives. That means things like cutting unnecessary paperwork and surveys, making appointments more flexible and giving patients more time with doctors.

He noted that the burden that falls on patients is not just the time and effort they spend navigating the system. It’s also what they give up to do that.

“If you waste people’s time on silly things, you are being unkind to (their) main purpose, which is to live,” he said. “We have to stop thinking of the patient as a part time employee of the healthcare system that we don’t get to pay.”

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Tamika Davis, right, poses with three of her children, from left, Shanara, 3, Matthew, 11, and Lionel Jr., 2, at MLK Park in San Antonio, Thursday, May 30, 2024. Davis said friends and family watched her kids for most of her doctor visits during treatment last year for colon cancer. But she couldn't afford additional childcare, and she didn't know where to look for assistance. (AP Photo/Eric Gay)

Tamika Davis, right, walks through MLK Park with three of her children, from left, Shanara, 3, Matthew, 11, and Lionel Jr., 2, in San Antonio, Thursday, May 30, 2024. Davis said friends and family watched her kids for most of her doctor visits during treatment last year for colon cancer. But she couldn't afford additional childcare, and she didn't know where to look for assistance. (AP Photo/Eric Gay)

Tamika Davis, right, spends time with her children Lionel Jr., left, and Matthew, 11, at MLK Park in San Antonio, Thursday, May 30, 2024. Davis said friends and family watched her kids for most of her doctor visits during treatment last year for colon cancer. But she couldn't afford additional childcare, and she didn't know where to look for assistance. (AP Photo/Eric Gay)

Tamika Davis, right, spends time with her daughter, Shanara, 3, at MLK Park in San Antonio, Thursday, May 30, 2024. Davis said friends and family watched her kids for most of her doctor visits during treatment last year for colon cancer. But she couldn't afford additional childcare, and she didn't know where to look for assistance. (AP Photo/Eric Gay)

Tamika Davis, right, spends time with her daughter, Shanara, 3, at MLK Park in San Antonio, Thursday, May 30, 2024. Davis said friends and family watched her kids for most of her doctor visits during treatment last year for colon cancer. But she couldn't afford additional childcare, and she didn't know where to look for assistance. (AP Photo/Eric Gay)

Tamika Davis, right, spends time with her daughter, Shanara, 3, at MLK Park in San Antonio, Thursday, May 30, 2024. Davis said friends and family watched her kids for most of her doctor visits during treatment last year for colon cancer. But she couldn't afford additional childcare, and she didn't know where to look for assistance. (AP Photo/Eric Gay)

Tamika Davis, right, spends time with her children, Lionel Jr., 2, centers and Shanara, 3, left at MLK Park in San Antonio, Thursday, May 30, 2024. Davis said friends and family watched her kids for most of her doctor visits during treatment last year for colon cancer. But she couldn't afford additional childcare, and she didn't know where to look for assistance. (AP Photo/Eric Gay)

Tamika Davis, right, walks through MLK Park with three of her children, from left, Shanara, 3, Matthew, 11, and Lionel Jr., 2, in San Antonio, Thursday, May 30, 2024. As a cancer patient, she said a case manager set a book of available resources on her bedside table and did nothing else. Davis, a nursing professor, found the book confusing. (AP Photo/Eric Gay)

Tamika Davis, right, poses with three of her children, from left, Shanara, 3, Matthew, 11, and Lionel Jr., 2, at MLK Park in San Antonio, Thursday, May 30, 2024. Davis said friends and family watched her kids for most of her doctor visits during treatment last year for colon cancer. But she couldn't afford additional childcare, and she didn't know where to look for assistance. (AP Photo/Eric Gay)

TORONTO (AP) — Xavier Edwards had the first three-triple game in the majors since 2014, Jonah Bride homered twice and the Miami Marlins set a season high in runs by routing the Toronto Blue Jays 15-5 on Friday night.

Edwards hit a sharp grounder down the right-field line for a triple in the second inning, got another three-bagger in the fourth on a fly ball to the gap in right-center and hit a line drive in the seventh that one-hopped the wall in right for his third triple. He became the first Marlins player with three triples in a game and finished 4 for 6 with four RBIs and two runs scored.

Midway through the game, the Marlins announced that manager Skip Schumaker would miss the final two games because of a family medical issue. Bench coach Luis Urueta will lead the team this weekend.

Marlins outfielder Griffin Conine homered against the team that drafted him in 2018 and drove in three runs.

Bride hit a two-run homer in the first inning and added a solo blast in the eighth, his 11th of the season, in the first multi-homer game of his career.

Jake Burger had three hits and drove in a pair of runs, and Jesús Sánchez scored three times as the Marlins racked up 17 hits, including one against position player Tyler Heineman in the ninth inning.

Adam Oller (2-4) came in 0-3 with a 6.43 ERA in four September starts but snapped his losing streak by allowing four runs and eight hits in five innings. Oller walked two and struck out three.

The Marlins didn’t arrive at their Toronto hotel until 5:30 a.m. EDT following a 13-inning win at Minnesota on Thursday night, but they didn’t show any signs of fatigue against the Blue Jays.

Sánchez opened the scoring with an RBI double off José Berríos in the first and Bride followed with a drive to left.

Edwards' two-run triple in the second made it 5-0, and Sánchez scored on a wild pitch in the third.

Berríos (16-11) allowed six runs and six hits in three innings in his final start of the season, as many runs as he’d allowed in his previous five starts combined. The right-hander lost his second straight start after winning the previous seven.

Burger hit an RBI single against Easton Lucas in the fourth and Conine added a two-out, two-run bloop single.

Conine chased Lucas with a leadoff homer in the seventh, his third.

Ernie Clement homered for Toronto, his 12th. The Blue Jays dropped to 7-15 in September.

Vladimir Guerrero Jr. went 2 for 4 with an RBI. He has 199 hits.

TRAINER’S ROOM

Miami: Placed RHP Declan Cronin (left knee) on the 15-day injured list and activated RHP Mike Baumann from the paternity list.

UP NEXT

RHP Yariel Rodríguez (1-7, 4.41 ERA) is scheduled to start for the Blue Jays on Saturday. The Marlins had not named a starter.

AP MLB: https://apnews.com/hub/mlb

Toronto Blue Jays pitcher Jose Berrios walks back to the dugout during third-inning baseball game action against the Miami Marlins in Toronto, Friday, Sept. 27, 2024. (Chris Young/The Canadian Press via AP)

Toronto Blue Jays' Bo Bichette, center, stands in the dugout during third-inning baseball game action against the Miami Marlins in Toronto, Friday, Sept. 27, 2024. (Chris Young/The Canadian Press via AP)

Toronto Blue Jays pitcher Jose Berrios, center, talks over video with catcher Alejandro Kirk, right, during second-inning baseball game action against the Miami Marlins in Toronto, Friday, Sept. 27, 2024. (Chris Young/The Canadian Press via AP)

Toronto Blue Jays' Vladimir Guerrero Jr., right, reacts after being struck by a foul ball as Miami Marlins catcher Nick Fortes, left, looks on during fifth-inning baseball game action in Toronto, Friday, Sept. 27, 2024. (Chris Young/The Canadian Press via AP)

Toronto Blue Jays manager John Schneider watches from the dugout as his team takes on the Miami Marlins in baseball game action in Toronto, Friday, Sept. 27, 2024. (Chris Young/The Canadian Press via AP)

Toronto Blue Jays' Vladimir Guerrero Jr. hits a sacrifice fly, scoring Jonatan Clase, during sixth-inning baseball game action against the Miami Marlins in Toronto, Friday, Sept. 27, 2024. (Chris Young/The Canadian Press via AP)

Miami Marlins' Jake Burger hits an RBI single during fourth-inning baseball game action against the Toronto Blue Jays in Toronto, Friday, Sept. 27, 2024. (Chris Young/The Canadian Press via AP)

Miami Marlins' Griffin Conine breaks his bat on a two-run single during fourth-inning baseball game action against the Toronto Blue Jays in Toronto, Friday, Sept. 27, 2024. (Chris Young/The Canadian Press via AP)

Miami Marlins' Xavier Edwards (63) hits a two-run triple against the Toronto Blue Jays during second inning interleague MLB baseball action in Toronto, Friday, Sept. 27, 2024. (Chris Young/The Canadian Press via AP)