Not covered is not acceptable.

The summer recess for Congress is nearing its end and it will be time for those we elected to do what needs doing on health care, or respond to hysteria driven by industry and right wing rumors.

Chemotherapy? Denied.

Chemotherapy? Denied.

I found a story on CNN that illustrates the need for reform very clearly. The video describes the efforts of Dr. Nick Spirtos, who opened a chemotherapy clinic in his office after the county hospital equivalent closed due to budget cuts. Spirtos provides chemotherapy treatment free to those in need through a combination of pro-bono work by him and his partners and financial donations.

What is most striking to me is the story of the patient interviewed, Christina Aguilar.

Aguilar is in treatment for ovarian cancer. She worked, she had health insurance. She did everything right, except have good health insurance. The kind that pays for chemotherapy for cancer treatment.

Death Panels? Wake up darlin, weve had em for years.

Death Panels? Wake up darlin', we've had 'em for years.

Her insurance doesn’t cover chemotherapy? Honestly?

As a nation, we have got to ask ourselves if that is even close to being ethical. To me, the answer is clear. I think it has to be, for anyone who allows themselves thought as opposed to being a vessel for Limbaugh and Beck to fill to the rim. This woman is asking for chemotherapy, not botox. She’s asking for life, not elective treatment.

Pro-lifers, are you listening?

Probably not. Let’s keep moving.

I hear so much about how different things should be taken out of the Federal Government’s hands and pushed to the state and local level. They’ll get done there. I can tell you from my experience in other matters, it doesn’t. Christina can tell you that in the case of health care, it apparently doesn’t either. The county hospital chemotherapy center that was her safety net was closed due to state budget cuts.

We hear a lot about the numbers of folks who are “satisfied with their health insurance”. We know very little about the level at which they’ve accessed it. Perhaps Christina Aguilar would have been one of those folks a few years ago. Perhaps someone whose exposure to the system consists of taking a child to the Doctor and dropping a $20 co-pay on the counter would be.

I wonder what Christina’s satisfaction level with her insurance is after being told chemotherapy isn’t covered?

I do know what mine is following the bills I got after my son was born. I do know what it is after insurance refused to pay for the anesthetic doctors wanted my wife to have in a necessary surgery because of the likelihood she’d have a life threatening reaction to the one they would pay for.

I don’t know if satisfaction means satisfaction with knowledge. I can’t imagine it does.

I don’t know if my health insurance covers chemotherapy. I’m afraid to look. I pray I don’t need to know.

What do you really know about your insurance? Perhaps more critically, what do those screaming people  really know about theirs?



Filed under Healthcare, Uncategorized

15 responses to “Not covered is not acceptable.

  1. Change is hard, isn’t it? Must be harder for some who automatically think it bodes ill. What happens when you’re not curious and able to imagine great things?

    The Essay

    A 10 year old girl recites her essay on the future to her teacher. Then to a principle, then a doctor and finally a psychiatrist. Her parents are very concerned.

  2. Are the stories true about the rules changing once you’re ill? Even if you knew about your insurance would you be faced with the small print that allows changes as they see necessary? Have you looked at the yearly and lifetime max benefit on your insurance policy? How much medical care would be available before you max out the benefit?

    The hardest part of this conversation for me to understand is how anyone can be against helping someone in need. When I hear about how everyone should be taking care of themselves, and I know there are many who have planned well, paid for insurance, saved, made payments on time and then find out financial ruin is one serious illness away even after doing all they were supposed to do to take care of themselves.

    Have you talked to the people who think “tax” is such a dirty word they can’t see that they are paying the insurance company instead? It’s been proven insurance rates increase when medical costs rise. Further proven medical costs rise when people who can’t pay get treatment in emergency rooms. These “tax” obsessed are fine with whoever they’re paying as long as it isn’t “tax”? Even if they acknowledge the fact they’re already paying, it seems OK since it isn’t “tax.” How does this make sense?

    People who aren’t indigent so don’t qualify for Medicaid, but don’t have a choice for insurance coverage through an employer might be offered the dignity of providing coverage for their family through a public option — and somehow they are not worthy? Human beings who decide other human beings aren’t worthy of affordable health care?

    • That’s the thing…no one knows, no one will ever know until the need comes, and then its too late.

      If you do know, under the current circumstances, could you ever afford to upgrade?

      So we’re all potentially grist for the profit mill of the insurers.

      Why can’t they see Sarah’s wonderful gift, not to see the future, but to predict the current? We’ve already got what shes afraid of.

  3. jammer5

    When a business exists with the sole purpose of making money off the sick and dying, then it really doesn’t matter what they do, because they will make the rules, regardless of the consequences to the people they insure.

  4. A snip of President Obama’s radio address:

    “This is an issue of vital concern to every American, and I’m glad that so many are engaged,” Obama said in his weekly radio and Internet address Saturday. “But it also should be an honest debate, not one dominated by willful misrepresentations and outright distortions, spread by the very folks who would benefit the most by keeping things exactly as they are.”

    “So today, I want to spend a few minutes debunking some of the more outrageous myths circulating on the Internet, on cable TV and repeated at some town halls across this country,” the president said.

    I will not be dragged down in disappointment yet! I still think it’s good that more Americans are thinking about and aware of the health-care debate and that we’ve had the opportunity to see the naysayers for exactly what they are. They’ve lied, they’ve exaggerated, they’ve shown their butts and because more Americans are paying attention more have seen this shameless display!

    • I do notice that there seems to be more of an effort in the media to fact check the bizarre claims that are being made. Perhaps the fascination with the “phenomenon” is giving way to looking into the facts.

  5. Dave, Mary’s hubby, came home today from having the pacemaker installed. He is doing great! Mary said before this surgery the costs of Dave’s heart attack were over $700,000 and they are close to maxing out the insurance benefits.

    6176 is doing pretty good, but there is therapy and work ahead. His out of pocket expenses to date would scare the bejeejus out of all of us (it did me when he quoted it)!

    These are two people I know and love. They are professional people who worked hard and did all the responsible things — saved, paid for insurance… So 6176 who is in private practice and doesn’t get paid when he doesn’t work will use his savings to pay medical expenses instead of being able to retire. Mary will continue working until age 65 unless there is a public option for health-care insurance. She MUST to ensure they have coverage — she is a cancer survivor, Dave now a heart disease patient — pre-existing conditions.

    And, IF ‘things’ go well they won’t max out their lifetime benefit on their insurance.

    Now isn’t that the pits!? Yes, it is!

  6. Mary, Dave and 6176 are all in their late 50s. They all thought their best years were ahead because they worked hard, they prepared, they planned.

    I’m sure you all remember that 6176 was widowed recently. So he has to do it all!

    What we all must be aware of is that every single one of us is one serious illness away from financial ruin! One serious illness away from our whole world changing, no matter how hard we worked, how responsible we are, how well we planned and prepared!

  7. lilacluvr

    I know first-hand how the cancer journey works in our current health care system. My insurance was very good – but even with tht said – I still had to fight like the devil to get them to pay certain things.

    I remember two bills in particular – one bill wa

    • lilacluvr

      sorry for delay – somehow I hit the send button by mistake… now to pick up where I left off…

      One bill was for pre-op lab that the insurance company told me I was going to have to pay for out of pocket and they would reimburse me later. They kept telling me they would not pay it because the hospital was not in their network – but the kicker is – they paid the same hospital for the entire surgery bill…. WTH??

      The second bill was for the anesthesia for the same surgery – again the same reason was given – this hospital was not in network and I would have to pay the bill first and then they would reimburse me.. Yeah, right.

      So, let’s get this straight…..the pre-op lab and anesthesia by the same hospital is OUT of network but the surgery at the same hospital was IN network???

      I called several times and one time I was told ‘why can’t you just put it on your credit card?’. I asked the woman where this magic credit card was she kept bringing up in our conversation. I reminded her that I just about died from cancer and was not back at work yet – so how was I going to get that magic credit card???

      After 4 months of fighting with these jerks – I turned them into the Kansas Insurance Commissioner and within 2 weeks – both bills were paid!

      Imagine that – only when they get threatened with their license to do business in Kansas is when they get serious about upholding their end of the insurance contract.

      But, I want to relay something that I saw and my brother, who died of liver cancer 2 years ago this week, also witnessed – it is heartbreaking to hear a doctor or nurse tell the patient sitting in the next chair in the chemotherapy room that their insurance refused to pay for their treatment that day or that their insurance has maxed out.

      The desperation and frustration in the patients’ eyes was almost too much to bear. And when that happened, the rest of us were thinking – is our turn next time – is our insurance company going to pull that trick on us the next time?

      We, as a country, should be doing better by our fellow Americans. If Bush and fellow Republicans can spend $600 billion on the Iraq War – then we should be able to take care of all Americans.

      May God have mercy on our souls if we continue to treat our citizens like this any longer.

  8. lilacluvr

    BTW – my insurance company changed their lifetime maximum benefit from $2 million to $500,000. Don’t these so-called professionals realize that $500,000 to a cancer patient is like a drop in the bucket?

    But they had no problem raising their premiums.

    The US has the most expensive health care in the world and our outcomes are not always the best. But try to tell the Republicans these facts and you’ll get called everything from a Nazi to a Socialist and everything in between.

  9. wicked

    lilac, thanks for the tip on the Kansas Insurance Commissioner. I’m going to pass it on to my daughter and her hubby who have had endless battles where insurance is concerned. COBRA canceled them just days before baby Payton was born. Payton is covered by Healthwave, but the delivery apparently isn’t…now.

    They’ve been told to do whatever necessary to get Payton declared as disabled…at not quite two weeks old. Why? Her heart defect will be considered as a pre-existing condition. If legally declared disabled, insurance companies cannot refuse to cover her.

    When people have to jump through hoops to get insurance, Houston (& Congress), we have a problem.

    • lilacluvr

      wicked – the Kansas Insurance Commissioner has a website that you can even report your complaints – there is not even a postage stamp required!

      When I dealt with them, they were very fast and very thorough. They even emailed me after the fact and asked if the insurance company had followed through on their promise to pay.

      So, see, government programs CAN and DO work!

  10. tosmarttobegop

    My wife and I kind of lucked out, her open heart surgery was done at a Hospital that was not in the network too. But even though, her insurance covered most of all of it. I would have had to be treated for heart problem if we had to cover 100 %. The other side of the coin is the insurance I had through Wal-Mart.
    Blue Cross & Blue shield of Arkansas. Refused every claim the Doctor sent in for me. Dismissed them all as preexisting condition even though I had not been diagnose till after I had their policy.

    I gets me too, I would think it is not brain surgery when it came to getting support for health care reform.
    Kind of like yelling fire in a house on fire, so plain and obvious to everyone inside the house. And we are all in that house.

  11. tosmarttobegop

    Plus most of all those objecting are of the age you would think they would want the best coverage they could have!