Rebecca Bloom
Rebecca Bloom is the author of When Women Get Sick. She has three decades of experience working as a patient advocate helping women with cancer navigate their healthcare, workplace, and finances.
Rebecca Bloom, the author of When Women Get Sick, has spent her career navigating the very systems that are the most frustrating to women who are sick: insurance markets, hospital bureaucracies, and workplace benefits programs. First, Bloom worked as a lawyer focused on employee benefits, and then for nearly three decades, she worked as a patient advocate at Bay Area Cancer Connections, where she helped vulnerable women navigate their healthcare, workplace, and finances.
While Bloom's approach is deeply sensitive and understanding, her perspective is clear-eyed and strategic. Her book contains so much honesty about this unfair system–and it is incredibly practical about how to deal with it. It doles out specific advice about how to choose health care plans, how to actually dispute incorrect bills, how to talk to people in charge of your coverage, who to speak to about your healthcare and benefits–and foremost, how to delegate. (Bloom thinks everyone who is in a major medical crisis should appoint a trusted loved one to be in charge of navigating their paperwork, appointments, and coverage.)
In our interview below, Bloom advises about when to push, and how to protect yourself in a system that often counts on you giving up.
Q:
First, what experience did you draw from to write this book?
A:
I think about this work as both professional and personal. Professionally, I was trained as a lawyer in employee benefits, which is basically how people find support and access benefits they’ve earned, both through work and through government systems. And personally, I was hit with breast cancer in my family—first my mother, then my sister, and with my own long and complicated previvor journey. That began in my mid-thirties with a baseline mammogram that required a lumpectomy to rule out cancer, alongside years of screening, stress, and raising children.
At the same time, I began working as a health advocate [for Bay Area Cancer Connections], sharing what I had learned with thousands of women over more than twenty-five years. When I started to see shifts in women’s health—an explosion of investment on one hand, and a loss of privacy and choice on the other—it felt like an imperfect storm. The timing felt right to bring this material forward and reach more women when they need it.
Q:
In your years of work, what’s your advice for the base level of health insurance that everyone should pursue? What specific things should they look for?
A:
It’s hard to be proactive before you have a diagnosis, but the reality is that we all have a challenge coming at some point. You need to know you’re plugged into the best possible safety net should something arise, especially because diagnoses—particularly for younger women—can take time.
Before buying insurance, you should think about what care you would want, not just what coverage you can afford. Identify your medical home base in advance: where would you want to be treated, which system or doctors do you trust? Then work backward to find the right policy. People often choose the cheapest plan on the marketplace and later discover it doesn’t cover the hospital or cancer center they need. Medical systems (hospitals) [often] know which plans they favor and which contracts may be dropped, and that information is available if you ask early.
Q:
Who is the best person to speak with at the hospital to give health coverage advice? Or general hospital bureaucracy advice?
A:
I would not start with billing. They are often trained to say ‘no’ and rely on rigid scripts. Instead, I call and ask for the person who runs the front office or manages access. At a women’s health center, that is often the person answering the phone or the office manager. Ask who understands how the system works with insurance. It’s usually not the doctor.
Q:
And what if your insurer stops covering your doctor?
A:
You should look into continuity of care. If you’re in the middle of treatment, a doctor can help request that your insurer continue coverage until that course of care is completed. Doctors can also help with denials and appeals. Many people don’t realize that support is available, and they don’t ask—but they should.
Q:
One of your primary pieces of advice is, after you’re diagnosed, to nominate one person or a few people to do your paperwork: to handle bill disputes, make appointments, make sure your tests, procedures, and medications are covered. For this caregiver figure, or the person calling for themselves: what are your tips for not losing your mind while on hold?
A:
I've probably spent thousands of hours of my life on hold–and also when I finally talk to people, it’s talking to people who are trained to tell me ‘no’ and close the door when I'm just trying to kick the door open.
First of all, honestly, I always do something else while I'm on hold. If you listen to the same music and messages–’your call is important to us’–you’ll lose your mind. So multitask. Journal, work, stay productive. Don’t let being on hold freeze your life. Feeling like just a number is part of the design, and staying active helps you resist that.
Q:
Then when you get through to the right person–at the hospital or at your health insurance, or even with your workplace benefits–what’s the tone of voice you aim to strike to be the most effective?
A:
Tone is about kindness and confidence. Screaming at someone who doesn’t have the power to decide won’t help. The goal is to create a partnership with the person on the phone, just as with doctors and nurses. You’re working together to solve a problem inside a broken system. Be empathetic and pleasant, but also purposeful and confident. The human actors inside this system are often the ones who save one another.
Q:
What’s your advice for disputing an incorrect bill?
A:
Never assume a bill is correct. Common problems include billing the wrong insurance or coding errors. You can call the doctor’s office to verify codes and ask for resubmission if something doesn’t make sense. Billing offices can be frustrating, but if you know a bill is wrong, it’s worth calling and clearly stating that it needs to be corrected before more bills are sent.
The system is designed to throw up roadblocks. An incorrect bill is often just the opening move. Many charges are sent out to see whether you’ll pay rather than go through the rigamarole. You have to line up your ducks and pursue it, understanding that some of these bills are sent out to dare you not to push back.
Q:
This is something you mention in your book, but tell us a bit about medical billing scams. What do those look like?
A:
They often happen because of data breaches. What happens is, you’ll get a letter from your hospital that says ‘oh, we're so sorry we had a data breach,’ and you're like, ‘I don't know what that means. What am I supposed to do with that? Thanks for telling me?’ But that means scammers can have your address, [history of] procedures, and insurance history. I’ve seen fake bills that used real hospital logos, correct P.O. boxes, and convincing details—but with mismatched zip codes, fake phone numbers, or addresses that led to unrelated locations. These scams prey on fear, especially among people who worry about losing coverage. That’s why scrutiny matters.
Q:
Switching gears to navigating the workplace. It’s unfortunate but not uncommon that a workplace could force out someone undergoing treatment and taking medical leave. You have a couple chapters where you lay out frameworks for thinking about whether to pursue legal action, even if their employers might be acting illegally. Can you lay out your advice?
A:
The first question is: Do they want to be there? Do they want to stay at this? I just had somebody yesterday that I was talking to about this very issue. She said, ‘I've always been a successful manager, but since my cancer, all of a sudden I'm being written up as not meeting the goals. And I feel like that's a first step towards something cynical down the road.’ And I said, ‘Okay–that's possible, but let's look at how you can maximize getting paid and feeling secure and being insured while you're on your health journey. That's job one. And then later on, down the line, we look at what's left, and we decide: Do you want to ascend there? Do you want to go somewhere else? How can you leverage all of the people and relationships that you have built?’
For these decisions, it depends on many variables: the size of the company, the person’s role, available alternatives, and whether they even want to stay. The first priority is maximizing security–like pay, benefits, insurance–during treatment. That’s job one. Later, you can decide what comes next. Don’t get distracted by potential drama or lawsuits. Focus on what you actually need right now.
Q:
You write about one woman successfully navigating this. Rather than being forced into a lesser position after coming back from treatment, she puts in writing that she’s absolutely ready to keep her original role and doesn’t see any reason why she would be moved, given her skills and readiness. Tell us more about that advice to point out your awareness of potential discrimination, as you write, as “a shield and not as a sword.”
A:
Companies don’t want bad optics. They don’t want stories about pushing out a woman who survived cancer. While they often know how far they can go without triggering a lawsuit, they care deeply about reputation–especially now. Rather than escalating immediately, it’s often more effective to recognize imperfect behavior and push toward a practical solution that aligns with what both sides want.
Q:
So, if your general advice is to avoid the legal route and instead navigate this internally–where should people get outside advice, if it’s not from a lawyer?
A:
Most situations don’t require a lawyer. Many law schools have clinics where students trained by leading experts offer free advice. And you know, there's that old adage: you know what they say about free advice, it's worth what you pay for it. But I think in this instance, it's worth way more than what you pay for it, because these third-year students are learning from the leaders in the field. They really know the law. [And if you know you only want to escalate with a lawyer as a last resort, the law students also aren’t in a position to get any work out of this interaction.]
Then there are disease-specific organizations that often have knowledgeable staff who can answer questions; this was my position. I think Triage Cancer is one of the most wonderful organizations ever, and the Patient Advocate Foundation is also phenomenal.
Q:
And let’s say someone wants to stay at their workplace, but also get the support they need: what’s your advice for talking to your human resources department?
A:
It all comes down to being willing to talk about why you care about the common goals [between you and your workplace]. Instead of saying ‘I need this’– not that I discourage people from saying what they need, I don’t–but I encourage people to really frame the goals as common goals. You know: I want to get back in fighting shape as fast as I can, so that I can keep moving towards all the stuff we're trying to achieve together. Here's what I would love to have your partnership on in order to get there.
