Some may know – especially those who have been following my most recent blogs related to a return of Prostate Cancer that I’ve been dealing with – but today was a Red Letter day when it comes to Health Insurance, Health Insurance Companies and how they ethically (oops unethically) deal with their customers. I am not sure how we got here, but where we are when it comes to our health and how that is paid for is so broken it’s quite unbelievable.
WHAT’S THE SCOOP?
Today was a follow up visit with my local doctor. Nothing special and almost a waste of time, but the appointment was scheduled and kept. Routine visit – weight, blood pressure, temperature, and nothing unusual. Today I was to receive the results of my bone scan and CT scan, but since I got a CD with the data ready to send to the Mayo Clinic (which of course I read – not that I’m a doctor, but I can read, and a report that says nothing was found was exactly what I was expecting), which I sent, I knew the outcome before the visit.
Doctor enters the room with a pleasant smile asking me how I am. Now that was a loaded question since I am full of frustration over the way Health Insurance companies deal with their customers (namely me). Of course since I am the one that wants treatment, I personalize their actions. Yes, I know better, but to me it is personal since it is my health. So…I proceed to vent to the doctor.
“Doc, I don’t know how you deal with these insurance companies day in and day out! They are a pain in the ass.”
“You don’t know the half of it,” he responded, “and it’s only getting worse!”
For a few minutes he openly allowed me to vent, then looked at me, removing his glasses and said, “Let me vent a bit.”
Of course with no identifying information shared, my doctor shared with me the most amazing story I’ve heard (and I suspect that this is nothing in comparison to many many more stories like this out there).
“So I have a patient with advanced lung cancer. He’s been a smoker most of his life, so as you can imagine his lungs are pretty damaged. Likewise, he has cancerous lymph nodes in his chest. So I suggested a form of radiation treatment that is more localized to his tumor so that I can spare what little lung he has left. If I use traditional radiation the tissue damage will create substantial problems for this man who needs to salvage as much of his lung as possible.
I submitted my request to his health insurance company. Their reply: DENIED. They wanted me to use the conventional treatment!
I told the person on the phone, because by now I was personally involved, that if it were their lung or even their father in a similar situation, they would want the better treatment. The treatment that would salvage what lung he has left.
They then suggested that I resubmit the request showing the two treatments: (1) more effective treatment and (2) conventional tissue destroying treatment. We did that.
Got the response today: DENIED!
I was incensed and called again for a peer to peer discussion. Not more than 30 minutes ago I was told that the conventional treatment was all that was needed, even though I know that the damage from that will substantially diminish his quality of life and could create more medical costs down the road.
Chuck, they just don’t care!”
HOW DID WE GET HERE?
How did we get to the point that a person checking off a checklist is the determining factor into the kind of health care we receive in the United States of American? Are we really OK with care provided at the lowest common denominator? We we can receive quality treatment but the insurance company will only pay for adequate treatment, is that OK?
SHARE YOUR STORY
You don’t have to name names, but feel free to share your story. Maybe if enough of us get our stories told…SOMEONE WILL LISTEN.
FEEL FREE TO SHARE YOUR STORY OR YOUR COMMENTS.