Sunday, July 12, 2009

What does This tell you about health care in America?

Everyone that I know, is going through this insurance Nightmare.
I wonder if anyone suggested, that He try Colloidal Silver? Corporate interest care Nothing about "We the People", showing us that Money is their bottom line. ~LisaMarie~

This story will make you hope and pray you don't get sick
By Mike Thomas

Dick Turrill was too young to die and too old to save.

He was in desperate need of fast medical care but had an insurance company that balked at providing it.

His battle for life gives disturbing insight into the bureaucratic maze of an industry that holds our lives in its hands.

I met Dick, 64, right before he was about to give up the fight.

He lives in Ormond Beach, where he retired as postmaster in 2006, with his wife, Pam.

They are an old-school couple. Together 38 years, they take pride in having always played by the rules, working hard, paying their bills, planning for retirement, buying the best health-insurance policy available.

Last June, Dick found himself getting easily winded, having to take three and four breaks just to cut the grass.

Doctors at the University of Florida Shands hospital eventually diagnosed him with myelodysplastic syndromes (MDS). It is a disorder in which bone marrow produces misshapen blood cells. It often is a precursor to leukemia.

Dick was treated with chemotherapy to clear out the bad cells, and then infused with donated blood to replace them.

This only was a stopgap.

The doctors gave him a year to live if he did not have a bone-marrow transplant. It is an elaborate procedure, requiring weeks of hospitalization and months of out-patient care. The cost is about $500,000, according to the National Foundation for Transplants.

Shands could do the transplant but was not on the list of facilities under contract to Dick's insurance carrier, the Mail Handlers Benefit Plan.

So Dick went to the Moffitt Cancer Center in Tampa. He was scheduled to have a port inserted in his chest for chemotherapy infusions, which precede the transplant. But then the insurance company did not renew its contract with Moffitt and Dick had to find another hospital.

That led him to the University of North Carolina Lineberger Comprehensive Cancer Center. Dick says the delay cost him two months.

"Any delays increase the risk of mortality and morbidity," wrote Dr. Teresa Field, a specialist from Moffitt, about his need for quick treatment.

And then came more delays.

Bone-marrow transplants usually entail a heavy dose of chemotherapy to kill off the old bone marrow.

Such a dose can be fatal for someone Dick's age.

Specialists have modified the treatment, using lower doses of chemo, not quite killing off all the bone marrow but enough to do the transplant.

Dick and his doctors prepared for the procedure. But then the insurance company balked at paying for it, saying the University of North Carolina protocol only would be covered if part of a clinical trial.

"We hope this information is helpful and thank you for this opportunity to assist you in this manner," a letter from the insurer concluded.

The Catch-22 was there are no such trials going on anywhere in the country.

The clock ticked while Dick appealed to the U.S. Office of Personnel Management — the human-resources arm of the federal government.

This is when Dick called me. I sat in his living room, listening to him and Pam voice their fears and frustration, the piles of paperwork spread out on the coffee table. I couldn't help think how we once battled for our lives using clubs, then swords, then guns. Now we use pens and bureaucratic appeals.

On June 10, the Office of Personnel Management sided with Dick and ordered his insurer to cover the treatment.

But that was not the end of the story.

Dick turns 65 in October. At that point, Medicare becomes his primary health-care provider.

Dick said representatives from his insurance company told him it would not cover the cost of a transplant after that date. And Medicare did not cover the procedure.

This meant that if the procedure was delayed past September in the search for a suitable donor, Dick would be without coverage. He asked the Office of Personnel Management for clarification.

His response came in a letter dated July 1.

It said he would be covered under his insurer's "transplant network" until Sept. 30. After that date, his insurer would pay for any follow-up care up to a maximum of $200,000.

Dick was devastated. Even if he could get the transplant before October, he feared the resulting follow-up care would wipe out his and Pam's savings, forcing them both to live in debt the rest of their lives. And if he didn't survive the procedure, and it is a very risky one, she would be on her own.

"I don't know if I can commit to this," he said.

For the first time, I heard surrender in his voice.

After numerous calls to the insurance company, I finally got a call Friday afternoon from Jim Barnett. He is vice president of federal programs for Coventry Health, which administers the transplant program for the Mail Handlers Benefit Plan.

Barnett could not talk about Dick's case specifically without a signed release from him. So we muddled through this using a hypothetical patient.

Basically, the letter from the Office of Personnel Management was misleading.

A patient in Dick's position would be covered for a transplant after Sept. 30. He would be covered for the full million dollars, not $200,000.

Barnett said the letter from Personnel Management was referring to a scenario in which both Medicare and the insurance company covered the cost of a procedure.

In that case, Medicare would be the primary provider. The insurance company would be the secondary provider, covering any costs not picked up by Medicare up to the $200,000 maximum.

But since Medicare doesn't cover the transplant, this scenario does not apply. The insurance company becomes the primary provider and covers costs up to $1 million.

Ten minutes on the phone cleared up weeks of misinformation and confusion that had left Dick and Pam in turmoil, and the transplant staff at the University of North Carolina scrambling to find a donor to get Dick in before October.

What does that tell you about health care in America?

I called Dick to tell him. He couldn't believe it. His voice cracked, and he started crying.

I gave him contact names and he verified the information. He has heard from the hospital, which has begun testing blood samples to find a match.

For the first time in months, Dick can envision the life he had planned to live with Pam.,0,516363.column