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HEALTH INSURANCE CASUALTY OF THE DAY: Andrea Bates - Indianapolis, IN - 10/10/2008

Posted by Colette Washing... on October 9, 2008 - 5:24pm

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Cancer Patient’s Treatment Determined by HMO, Not Doctors

“I am a 49 year old female and am currently being treated for colon cancer, stage 4. I was initially diagnosed last year, February 2007, and have been undergoing chemotherapy ever since,” said Andrea Bates of Indianapolis, Ind.  My initial prognosis was not good, but now is looking very good and I am thankful for that.  I currently have insurance through my husband's employer and have been receiving great care, which again, I'm grateful for.



“I recently inquired about another treatment center, Cancer Treatment Centers of America, which has a lot more available options to treat my cancer that my current hospital does not provide. I was informed that because I have an HMO, I cannot pursue treatment outside my network.  If I had a PPO, insurance would most likely cover the cost of me going to the Cancer Treatment Center of America though.

“Since the insurance I have is through my husband's work, we were only given two options to choose from for insurance for the 2008 year - Advantage HMO or Anthem PPO. For obvious reasons, we had to take the Advantage HMO route because it was more than half as cheap than the Anthem PPO. Why should we have to choose in the first place and why only these two types of insurances?

“But they finally did allow me to go to another hospital to have my final major surgery, and I was grateful for this since this last surgery was the one that probably ended up saving my life. I had 65 percent of my liver removed that had cancer on it.

“I don't know if the insurance company would have eventually allowed me to go to the Cancer Treatment Center of America.  They might have if I would have continued to pursue it, but I guess that's part of the problem - why should I have to justify my intentions of going somewhere else where better treatment is offered that could save my life?

“It simply is not fair that we have to choose between ‘affordable’ healthcare versus ‘not-so-affordable’ healthcare and only being given limited choices of insurance plans to choose from. These choices obviously can make a difference between life and death. I'm sick to death with increasing premiums year after year and receiving less coverage, year after year.”

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Sponsored by the California Nurses Association/National Nurses Organizing Committee

Eighty-two percent of Americans think the U.S. healthcare system should be fundamentally changed or completely rebuilt (Commonwealth Fund, Aug. 7, 2008). America's nurses know that only single-payer, improved and expanded Medicare for all will fix our broken system and the tragedy of our devastated families. HR 676, by U.S. Rep John Conyers, is the most comprehensive, cost effective way to achieve guaranteed healthcare for all.

For more information, or to contact this patient: Liz Jacobs, RN 510/273-2232.

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Cancer Treatment Centers of America

Submitted by Scuzz on October 11, 2008 - 10:46pm.

"Since the insurance I have is through my husband's work, we were only given two options to choose from for insurance for the 2008 year - Advantage HMO or Anthem PPO. For obvious reasons, we had to take the Advantage HMO route because it was more than half as cheap than the Anthem PPO. Why should we have to choose in the first place and why only these two types of insurances?"

Umm...that's what your husband's employer offers. And after that, it's your contract. It's like asking why Verizon only covers half your state. If you didn't like it, you shouldn't have signed up for it to begin with.

Why not ask the tough question?

How much over AWP is Cancer Treatment Centers of America jacking for its drugs?

I know.

Do you?

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Why don't you tell us who your employer is?

Submitted by Donna Smith - S... on October 12, 2008 - 5:01pm.

You strongly dislike medical care providers and seem to know the inner details -- or at least claim to -- of why insurance companies are making what in your opinion are the right decisions every time. Patients are always wrong or at least ignorant in your view. Doctors are always wrong or at least suspect in your view. Insurance companies are always right in your view. Hogwash. This patient even said she was lucky to be getting good treatment yet you still attacked and belittled. That's dishonest and not at all helpful to meaningful discussion. If that's the way insurance companies are paying folks to defend their position, then the position is very weak indeed.

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illuminating

Submitted by Squibcakes on October 13, 2008 - 8:09pm.

You're attributing opinions to Scuzz that weren't said. That's your wrong interpretation. And you haven't exactly claimed anything stated was wrong...

if we all want to choose whatever hospital we want, then obviously it costs more. In this case the cheaper option was chosen. it's like saying i wish i had bought comprehensive coverage for my car, after it got trashed.

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Disclose your ties and then defend them

Submitted by Donna Smith - S... on October 14, 2008 - 3:45am.

It would be helpful to anyone reading your comments -- you and your friend Scuzz -- to have names and your affiliations noted for all to evaluate. Anyone who defends any position or industry without being willing to say who they are and who they work for is not being up front.

Cannot take attacks seriously without disclosure. Sunlight is the best disfectant -- step into the sun.

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Admin's choice

Submitted by Squibcakes on October 14, 2008 - 7:32am.

This site encourages anonymous particpation by design. If that's not acceptible then change it globally - not just for those who you disagree with.

If you can't take me seriously then just ignore me, but my words stand on their own merit.

i've already said what my motives are: personal and economic freedom to choose to participate in charitable efforts, and to ensure that the debate is honest about pros and cons of any given solution.

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Spin

Submitted by Squibcakes on October 14, 2008 - 7:35am.

Scuzz is not my friend - I have no idea who Scuzz is. And 'disclose your ties' makes it sound like i am a person of influence and power and backroom deals...

please - let's lose the drama.

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The drama is the dead fellow citizens

Submitted by Donna Smith - S... on October 14, 2008 - 8:49am.

We cannot lose the drama... people are dying because we are not appreciating the human consequences and truly having the vivid and very real stories told enough.

We may argue about the details, but the reality is stark. At least 22,000 people in this country are dying every year simply because they cannot access care. Yet their stories go largely untold, their names are lost in the din of daily news feeds. If we were losing that many fellow Americans to any other domestic policy or program, it would lead every news cast and be above the fold on every newspaper.

Perhaps because I work with and for RNs, I fail to believe that every healthcare decision should be completely motivated by the financial outcomes. Human beings matter. Life matters.

So, we will continue to tell the real stories of these patients and their families. Many of the deals that decide life and death are being done in those back rooms of the influential and powerful...

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