An Arizona graduate student with advanced colon cancer turned to Twitter when his insurance company stopped covering his medical bills. Surprisingly, the insurance company’s chief executive responded.

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What ensued was a fiery multiday exchange that not only resulted in full coverage of the student’s medical bills, but cast light on gaps in student health care coverage and the complexities of the country’s private insurance system.

The Agenda: Health The rising costs of the U.S. health care system.

Arijit Guha, 31, a New York native who was raised in Ohio, learned he had cancer in February 2011 after developing debilitating stomach pain following a trip to India. During surgery, the doctors found the cancer had spread to his abdominal lining, and they removed most of his colon, leaving him with a colostomy. Since then he has undergone more surgery and chemotherapy or, in his words, been “filleted, disemboweled and then bathed in hot poison.”

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A doctoral student at Arizona State University, Mr. Guha was insured under an Aetna Student Health plan for which he paid $400 a month. The plan initially covered his care, but in February, Mr. Guha’s treatment costs reached the $300,000 cap on the insurance plan, leaving the student with $118,000 in medical bills.

More than a million students are covered through college health plans, according to the federal Department of Health and Human Services. Although the Affordable Care Act does away with coverage caps, the rules are still being phased in and don’t yet apply to all student health plans.

When Aetna began denying his claims, Mr. Guha took his frustrations to Twitter. Using the Twitter handle @Poop_Strong, he posted his first message on July 22.

@Aetna has now denied $118k in claims (in just 5 mos) since kicking me to the curb. Gotta preserve that $2 billion annual profit somehow.

The insurance company responded under the Twitter name @AetnaHealth, and asked Mr. Guha to contact someone there.

@Poop_Strong We care about our members. We want you to be empowered to be healthy and make informed decisions.

But Mr. Guha said the word “empowered” made him angry, and he posted a sarcastic response, invoking the Aetna chief executive, Mark T. Bertolini, whose Twitter account is @mtbert.

That’s so sweet you want me to be empowered. Does @mtbert care to empower me by paying my $118K and counting in bills?

Then a startling thing happened. Mr. Bertolini entered the fray himself on July 26.

We paid hundreds of thousands of $ already. A call is all it takes.

Mr. Guha responded:

Does that mean if I call you, you’ll graciously offer to pay my bills?

The surprising exchange continued, and Mr. Guha challenged Mr. Bertolini to defend Aetna’s student health care plans with limited caps.

@mtbert Do you think it’s morally justifiable to offer a flawed insurance product that doesn’t cover catastrophes?

Mr. Bertolini responded:

@poop_strong Why do you think the premiums were so low? Don’t you look at your policy limits when you buy other insurance (auto)?

The response angered Mr. Guha and his followers, who jumped in. A follower named @Amayo wrote:

@mtbert I’m concerned that you don’t understnad how your industry works. ASU students aren’t given a choice on insurance plans

And @ponderbob sent this message:

@mtbert As a dad, if your kid was in school, got cancer & reached their lifetime cap, what advice would you give him?

The floodgates opened, and Mr. Guha’s friends — and a few people he didn’t know — joined in, aiming barbs at Mr. Bertolini and attacking the insurance industry. “Things got heated pretty quickly,” Mr. Guha acknowledged. “People were taking this pretty personally, especially people who know me.”

After Mr. Bertolini mentioned that the insurance giant’s $2 billion in earnings would cover only 10 percent of the uninsured, a Twitter user named @sean_dougall responded:

@mtbert Nobody’s asking you to cover the uninsured. We’re asking you to cover your members.

In what seemed to be a turning point, Mr. Bertolini noted that he was working to help Mr. Guha.

The system is broken. I’m trying to fix it.

On Friday, Mr. Bertolini called Mr. Guha directly. Aetna agreed to cover the $118,000 in bills. More important, Aetna and the university now will offer a student plan for the 2012-13 academic year with no lifetime cap and a $2 million annual cap that will eventually disappear under the Affordable Care Act. The policy also will cover preventive care for students and won’t deny anyone with a pre-existing condition.

“We wanted to be proactive about meeting students’ needs,” said Dr. Allan Markus, the director of health services at Arizona State and one of Mr. Guha’s doctors. Dr. Markus said that Mr. Guha was the first A.S.U. student he has known who has reached the $300,000 lifetime cap.

So what drove Mr. Bertolini’s involvement? “This was a compelling case,” he said in an e-mail. “This felt like a discussion I should be involved in. I appreciated the conversation, even when it was pointed.”

Mr. Bertolini said he is a regular Twitter user “because I enjoy it.” He added that as chief executive, he believes Twitter is an essential tool for him to interact with his customers. “It is where people are talking about issues that are important to them,” he said. “We must be part of that dialogue if we want to be a viable player.”

“I was pleased we found a resolution, working with the school, to help him,” he said.

Before winning coverage from Aetna, Mr. Guha had initiated a social media fund-raising campaign to help pay his bills. Now he plans to donate the estimated $130,000 he raised to charities that help support cancer patients.

Mr. Guha is currently on a break from biweekly chemotherapy treatments after a successful procedure to remove a lesion on his liver in April. He says he wants to become more involved in health policy activism.

Mr. Guha announced the resolution to his financial problems on Twitter.

“Congrats Twitter hordes! @Aetna has agreed to cover my bills. Every last penny. Thanks, @mtbert, for listening.”

Mr. Guha has nothing but praise for Mr. Bertolini. “In the end, he did the right thing,” he said. “Now the fight moves on to ensuring this never needs to happen for anyone ever again.”

Over the coming weeks, Well will continue to explore the reasons behind our troubled health care system from the perspective of the patient. The series will be part of a larger New York Times project called The Agenda, which will focus on some of the most critical issues that the president and the next Congress will face in the coming months and years. Join the conversation at The Agenda