I am angry! Just how did we get here? WHO MADE THE HEALTH INSURANCE COMPANIES GOD?
There is one test offered at one place – FDA approved – that could help drive an effective treatment for my recurrent prostate cancer and, no surprise, the insurance company said – NO! This is not an experimental test, it’s offered at the prestigious Mayo Clinic – and yet, the insurance company believes it’s not valuable. WHAT? One test that has the potential of focusing treatment to cure a problem and minimize costly side effects and somehow BC/BS of South Carolina thinks it’s not WORTH IT. Who made these people GOD?
For those who have been following this series, you by now know that I have a recurrence of prostate cancer. Where, well, that’s the question. Again, fortunately it was caught early as evidenced by a slowly rising PSA. Early is great, but that doesn’t minimize the importance of selecting the best treatment to eradicate the cancer and preserve quality of life. I don’t care to die early from prostate cancer and equally, I desire to have a normal quality of life not hampered by too aggressive a treatment. Both desires seem to me to be reasonable!
Enter the insurance company – in this case Blue Cross/Blue Shield of South Carolina. At one level I am confident that they are doing their job as they see it. But are they acting ethically? Again, from their perspective my guess is they would say – Yes. But is their perspective of profitability the perspective that yields the best results? Perhaps that “rabbit trail” of an ethics discussion should be best saved for later. For now, who made them God when it comes to my health?
THE JOURNEY GETS COMPLICATED
CT scan completed! Bone scan completed! Both – as expected – showed nothing. To be clear both tests were a waste of time and BC/BS money, but they were “required” in order to get the one thing I need – a Choline C-11 Pet Scan from the Mayo clinic done. As a point of reference, the CT or Bone scan won’t detect prostate cancer until it’s fairly well progressed. Mine is recurrent cancer and as evidenced by my PSA of 1.1 it is not well progressed – YEA – so those scans are worthless (but a prerequisite to the C-11 scan).
Scans done, so now I work with the Mayo Clinic to gain insurance company “pre-approval”. Yuck. First who says what should happen to my body – the insurance company of my doctor? Apparently, it’s a mind numbing insurance company that is more concerned with their financial outlay than my health. However, I have no choice but to play the game. The folks at the Mayo Clinic are great, but when I tell them my insurance company is BC/BS of SC, they respond with a dull, “Oh”. They then proceed to tell me that “Southern” insurance companies are tough to deal with, but they will do their best.
Days later, I get a call from Rochester, MN – home of the Mayo Clinic – the gentleman on the other line shares as kindly as he can, that “National Imaging” the folks BC/BS of South Carolina use to pre-approve imaging services has DENIED my scan – saying that PET scans don’t work.
PET scans don’t work. Well, perhaps that’s true for the average ordinary PET scan. But this is a highly specialized PET scan that is incredible at detecting recurrent prostate cancer in the very early stages. BINGO – just what I need. But some numb nuts at National Imagining likely has never heard of a Choline C-11 PET scan and just give me, what I’m sure tens of thousands have heard – a big resounding NO!
IT’S MY LIFE AND HEALTH and WHO CONTROLS IT?
The Insurance Company – plain and simple! It’s wrong and evidence of a system broken!
An example – remove the emotion I feel from this discussion – let’s look at a different situation.
I went to the BC/BS store front in Greenville, SC to inquire about insurance effective January 1, 2014 since my current coverage will expire. (Nothing like facing a medical challenge knowing that in less than two months you won’t have coverage). So I ask for the Platinum plan. “We don’t offer that,” I was told by the BC/BS agent. “Ok, then quote me the Gold plan,” I responded.
The Gold Plan price was calculated with a brief explanation. Then I asked the following question: “Let’s say I had a brain tumor and the best treatment was at MD Anderson in Houston, TX. How much would my insurance pay toward my treatment?”
“Nothing! They are not in our network.”
At this point my mind is racing for my next question. “So let me get this, the only thing my insurance would cover is treatment by Dr. Bumfuck here in SC (no offense to SC physicians, but MD Anderson vs SC – I’d take Anderson!) otherwise 100% is out of pocket?”
“Yes, that’s right. And, we just added the Greenville Hospital System. Slowly we’re adding more to the network.” (at the time of our meeting only one hospital system was in the network, thereby meaning that if my local doctor was affiliated with the one not in the network, I would be forced to change doctors or pay out of pocket)
“Wow,” I responded, “so under this new plan I’m stuck with who you select for my medical care or I have nothing?”
THE BEGINNING IS THE END
Who made the Insurance Companies God?
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