[lit-ideas] Health insurance -- Judy, Erin?
- From: JimKandJulieB@xxxxxxx
- To: lit-ideas@xxxxxxxxxxxxx
- Date: Sat, 11 Feb 2006 14:49:11 EST
Here's health care in America. Would it be different, would the actions and
outcomes have been different in Canada? Or Europe? (Maybe someone needs to
redefine "necessity").
Julie Krueger
_Man Dies After Insurance Co. Refuses To Cover Treatment - Yahoo! News_
(http://news.yahoo.com/s/kmbc/20060211/lo_kmbc/3257367;_ylt=AgGWfeZ_n0oGdpks3kbuHhc
DW7oF;_ylu=X3oDMTBiMW04NW9mBHNlYwMlJVRPUCUl)
<<Tracy Pierce, 37, lived a full life. He grew up with family and faith. He
went to a Catholic school, got married, had a son, and he even had the car of
his dreams. It was the perfect life.
"He's been strong. He has," his wife, Julie Pierce, said.
Two years ago, Tracy Pierce's life changed dramatically when he was diagnosed
with kidney cancer.
"I have no treatment. Three months has gone by and I haven't had any
treatment," Tracy Pierce told KMBC's Jim Flink in May 2005.
When Flink talked to Tracy Pierce, his cancer was attacking his body. Despite
being fully insured, every treatment his doctors sought for him was denied
by his insurance provider. First-Health Coventry deemed the treatments were
either not a medical necessity or experimental.
"I don't know what else to do but just wait," Tracy Pierce said last May.
As he waited, his doctors appealed again and again, including a 27-page
appeal spelling out that Tracy Pierce would die without care. Coventry
dismissed
each request.
"It's purely economical. You never see an insurance company try to block an
inexpensive test," said William Soper.
Soper leads a group of doctors who filed a lawsuit last year against
insurance providers. This week, Soper went to Jefferson City to lobby
legislators
for change.
"And you know, it's not going to get better anytime soon. It's going to get
worse," said Myra Christopher, who is the president and chief executive
officer of the Center for Practical Bioethics.
Christopher told Flink that change won't happen until there's a change in the
entire medical model.
"I just believe strongly that we need to start being honest about what's
going on here," Christopher said.
What is going on is that some insurance companies deny even routine
treatments because insurance companies treat their patients as costs, not as
clients,
Christopher said.
"Some of these companies are just unethical the way they treat both
subscribers and providers, doctors and hospitals," Soper said.
Two weeks ago, Tracy Pierce talked with Flink again.
"Just holding a lot of anger in," Pierce said.
Cancer ravaged his body, moving from his kidney to his lungs and to his
brain.
"Now, we're just to the point where we're trying to make him comfortable,"
Julie Pierce said.
Even as he was dying, for more than a week, his insurance company denied him
oral morphine, which had been prescribed to reduce his pain.
"That's unacceptable because in this day and age, no one should be in pain,"
Pierce said.
"I just hope we can get something done about it, that's all. We just have to
get something done," Tracy Pierce said.
An hour and a half after Tracy Pierce talked to Flink, he took a nap and
never woke up. His family calls his case death by denial.
"They just wrote a prescription for him to die," Julie Pierce said.
The family is begging for change.
"The reality is the blame-and-shame game isn't going to get us anywhere. We
are all at fault," Christopher said.
Insurance companies, hospitals, doctors, patients and politicians all need to
work together, she said.
"We have to have the moral will. We have to have the intelligence. We have to
have the political leadership to change this," Christopher said.
For Julie Pierce, it was 15 months of watching her husband die slowly,
painfully and helplessly with no chance at lifesaving treatment, Flink
reported.
"My mother always told me to get a good job with insurance. For what? It
hasn't done anything," Julie Pierce said.
Julie Pierce said that she understands that we will all die. What is
expected, she said, is that if you have health insurance, you'll be given every
fighting chance. She said that is not happening.
Leukemia Story
Last fall, 12-year-old Nathan Crabtree was an outgoing child getting ready
for a new school year. But his father says Nathan often played sick to extend
summer vacation by a day or two.
To prove a point, his dad took Nathan to a doctor for test, which showed that
Nathan had an aggressive form of leukemia -- one that needed immediate
treatment.
Flink reported that a hospital room has become Nathan's classroom. He spent
just two days of his sixth-grade year with classmates; mostly, he's been at
Children's Mercy Hospital.
"It's not going away, so they were going to send me to Minnesota," Nathan
said.
Doctors wrote to Nathan's insurance company, urging it to send him to the
nation's foremost research hospital. Nathan's bags were packed, when his
father's insurance company, Coventry, refused to pay for that care, calling it
"experimental."
"You don't have anyone to fight for you," said Lee Crabtree, Nathan's father.
Lee Crabtree said he's desperate.
"I have to go out and find private grants, because for all intents and
purposes, I have to assume I have no medical coverage," Lee Crabtree said.
"I think they expect or depend on people giving up after the first phone
call," said Dr. William Soper, the executive director of Mid-America Medical
Affiliates.
Soper said his group is so upset with insurance companies that it has filed a
lawsuit alleging insurers block patient care.
"We have patients who say, 'I want a complete physical,' and we'll look at
their insurance coverage and we have to say, 'Sorry, but your plan doesn't
cover a complete physical,'" Soper said.
Flink reported that many people don't realize what isn't covered by health
insurance until it is too late.
Lee Crabtree said he has a helpless feeling when he looks at his son and
tries to explain why he can't help him live.
"The feeling of this is beyond words. It makes you feel hollow," Lee Crabtree
said.
Late Friday, KMBC learned that Nathan's mother found out she could apply for
coverage with Blue Cross Blue Shield at her workplace, and so she had
applied. What Coventry spent months denying and calling experimental, Blue
Cross
Blue Shield approved on the first request.
Nathan Crabtree leaves for Minnesota on Sunday morning. >>
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