In the autumn of 2014, a cancerous lump was detected in Bobbie Fleming’s left breast during a routine mammogram at Dartmouth-Hitchcock Medical Center. Shortly thereafter, she underwent surgery and six weeks of radiation treatments at DHMC. Because Fleming, 57, is a disabled Army veteran, her medical bills would be picked by the federal government. “That was a tremendous relief,” she said.

It didn’t matter that DHMC, a private hospital, had provided Fleming’s care. The VA Medical Center in White River Junction frequently sends female veterans to DHMC and other “community partners.”

It makes sense. Instead of  buying expensive equipment to perform mammograms and other procedures, the White River Junction VA often uses nearby private hospitals and clinics to care for 1,400 female veterans to avoid costly duplication of services. (The only New England VA medical center that provides mammograms in-house is in Boston.)

Fleming, a single mother with a teenage daughter, had only recently moved to Hartland from northern California. She was unsure how the VA and DHMC would coordinate her care, but she quickly became a believer in the system.

“The VA was wonderful about it,” she told me. “The medical staff at Dartmouth was the same way.”

Then, a little more than a year ago, DHMC called Fleming to let her know it was time for a post-surgery mammogram. Fleming had the mammogram, and received a clean bill of health.

So far, so good. But as it turned out, the other kind of bills were a problem. DHMC started sending her bills for the mammogram and radiologist’s report, which, at first, she figured was just a bookkeeping mix-up.

But when the bills, which totaled $750, kept coming, Fleming called DHMC to remind the hospital that she was a veteran. The White River Junction VA would pay for the follow-up mammogram, just as it had for her surgery and radiation treatments.

Not this time, DHMC informed her. The VA requires pre-approval for procedures that veterans undergo at DHMC. The mammogram she underwent in March 2015 hadn’t been pre-approved.

Who’s fault was that? I’m not sure. But DHMC certainly wasn’t about to admit a mistake, or rectify it. Fleming was still responsible for the $750 in charges.

“I just don’t have that kind of money laying around,” she told me.

After she disputed the charges, Fleming heard last month from DHMC’s customer service department. Last year, DHMC began outsourcing its customer service department (or maybe, in this case, its disservice department) to a company called Conifer Health Solutions that is headquartered in Frisco, Texas, but has employees in Lebanon.

According to the letter that Fleming received, “Dartmouth-Hitchcock Medical Center does not authorize any treatments with the VA. We rely on the patient to understand and follow the guidelines the VA has for its patients prior to receiving service outside the VA.”

What I don’t understand is why DHMC would have called Fleming to set up an mammogram appointment without having already gotten the VA’s OK.

Fleming drove to DHMC to meet with a customer service representative. “I thought if I spoke to someone in person, I might get somewhere.”

All she got was a putdown.

She said the customer service representative informed her that the unpaid bill was about to be sent to a collection agency. If she was unable to pay, she could fill out a two-page application for financial assistance from DHMC. But before her “financial hardship” could be approved, DHMC wanted to see, among other things, her latest federal tax return and three recent bank statements.

Fleming was hesitant to turn over her private financial information to a customer service representative.

“Ma’am, I’m not the one asking for free health care,” Fleming recalled him saying.

She reminded him that she was veteran and had earned her free care. “I’m sorry,” he said. “It was a poor choice of words.”

Indeed.

Fleming, who grew up in a foster family, joined the Army in 1976 after graduating from high school. She served in the military police at an Army camp in Alabama for three years. She was later diagnosed with Post Traumatic Stress Disorder.

“The military isn’t always kind to females,” she said. “Things happened (40 years ago) that hopefully don’t happen now.”

Fleming left DHMC without filing for financial assistance. Later, she sent me an email outlining her billing story.

I relayed the information to DHMC spokesman Rick Adams. “One of the issues, nationally, in health care is a lack of coordination across providers,” Adams wrote back. “Despite electronic medical records, providers often don’t have effective means of sharing information about patients because their computer systems don’t talk to each other.”

In Fleming’s case, I’m not sure computers are wholly to blame. The time that DHMC invested in sending bills and letters to Fleming could have been better spent on the phone with the VA to straighten out the billing mess.

Last Thursday, I called Joe Anglin, the public affairs officer at the White River Junction VA. He quickly arranged for me to talk with Carey Russ, the women veterans program manager. I explained Fleming’s $750 problem. It was the first Russ had heard about it, but she couldn’t have been more understanding or helpful. It was obvious that a “communication breakdown” had occurred between the VA and DHMC, she said.

“We need to make this right,” Russ said. “We need to pay for this woman’s care.”

Amazing what can happen when people talk to each other instead of leaving it up to computers.

Jim Kenyon can be reached at jkenyon@vnews.com.