Insurance company denies treatment for a 5 year old

[Patranus]

...until they deny your cancer treatment on the day of your surgery.

You see, your beloved insurance company has a "Death Panel" and employees who receive commissions if they can find ways to rescind people's insurance coverage when they get sick. So if your insurer's death panel determines that you failed to report an ingrown toenail when you were age nine, they could claim that your insurance application was fraudulent and then deny you care for your completely unrelated cancer diagnosis.

You mean the same insurance company that doesn't cover treatments that are not approved by the FDA?

 

[StageLeft]

Insurance companies suck and so does UHC, just in different ways. Anybody can find endless examples proving how one sucks more than the other, not to say they both suck equally, but the point being a single case is damn near 100% meaningless.

 

[Lemon law]

Lets look at the parents options. Which is basically going to be suing the insurance company in a court of law. A court case that will not be resolved for years.

If the child dies meanwhile, the pot just gets sweetened with a wrongful death suit and probable punitive damages.

I doubt a jury in the world would find for the insurance company, so the insurance company is making an awful risky bet in denying coverage.

Don't like lawsuits of this nature? Realize the threat of a lawsuit is about the only thing that keeps the insurance company honest.

 

[WhipperSnapper]

Yeah, because a UHC system would never deny a patient treatment!

Oh wait.

So why aren't the British people marching in the streets and demanding an end to the NHS and the adoption of the American system? Oh, that's right, they think that our system is completely retarded, barbaric, and economically inefficient and far worse than their current system, whatever its flaws may be.

Perhaps real socialized medicine wouldn't be perfect. Few systems are, but it would be far, far superior to the Kafkaesque system that we have right now.

You don't need to be a rocket scientist to understand that when we're spending 17% of our GDP on health care while leaving tens of millions of Americans uninsured or under-insured with the rest of the populace living in sheer terror of losing their jobs and health insurance while also suffering hundreds of thousands of medical bankruptcies and having burdened businesses that we should adopt a better system but you do need to be a Town Hall Moron to support the current system.

 

[Patranus]

Lets look at the parents options. Which is basically going to be suing the insurance company in a court of law. A court case that will not be resolved for years.

If the child dies meanwhile, the pot just gets sweetened with a wrongful death suit and probable punitive damages.

I doubt a jury in the world would find for the insurance company, so the insurance company is making an awful risky bet in denying coverage.

Don't like lawsuits of this nature? Realize the threat of a lawsuit is about the only thing that keeps the insurance company honest.

Denying coverage for what? A treatment that isn't even approved by the FDA?

How is suing an insurance company for something that they clearly didn't cover and the end user now wants an attempt to keep them honest?

 

[WhipperSnapper]

You mean the same insurance company that doesn't cover treatments that are not approved by the FDA?

You keep repeating that as though it is a brilliant response that will confound the opposition and yet other people in this thread have reported that many accepted treatments including ones that medicare covers are not approved by the FDA.

Has the FDA affirmatively disapproved of this treatment?

I find this part of the article to be rather telling:

But that doesn't mean MIBG is ineffective.

"It's considered the standard of care in Europe and the United States for recurrent neuroblastoma," says Grupp. "It's not an unproven treatment with no basis in medical science. Actually, the results are often very good."
Paul VanNocker appealed HealthAmerica's decision, which once again denied MIBG.


"They have a plan for Kyler," says Paul angrily. "Their plan is for him to die."

Check this out! We have what appears to be a medical bankruptcy for someone who had insurance coverage!

If Medicaid doesn't come through, the VanNockers have no savings to pay for additional MIBG procedures that Kyler might need to stay alive, because the out-of-pocket costs associated with Kyler's illness have left them bankrupt. Paul estimates that he and Maria have spent "well over $60,000" of their own money - exhausting cash savings, IRAs and almost every asset but their home to pay expenses not covered by insurance.

 

[Patranus]

You keep repeating that as though it is a brilliant response that will confound the opposition and yet other people in this thread have reported that many accepted treatments including ones that medicare covers are not approved by the FDA.

Has the FDA affirmatively disapproved of this treatment?

If the company says it will not cover a treatment that is not approved by the FDA (and this treatment isn't covered by the FDA) than I am not sure what argument is here.

Maybe this family should have read their insurance contract before signing it to see what treatments their insurance did and didn't cover.

If anything this is a failure in government and its ability to regulate treatments.

 

[WhipperSnapper]

If the company says it will not cover a treatment that is not approved by the FDA (and this treatment isn't covered by the FDA) than I am not sure what argument is here.

Was that in large bold red print near the front of the insurance contract? Did the purchasers have to initial it? Were any other reasonable insurance choices available or did this company have a monopoly on health insurance coverage in the region? If not was it part of an oligopoly on insurance in the region? Are there other insurance plans in the region that don't carry that limitation?

Maybe this family should have read their insurance contract before signing it to see what treatments their insurance did and didn't cover.

All 300 pages of it, including the parts in fine print that use misleading language and terms of art that a layperson could not possibly be expected to understand?

 

[StageLeft]

So why aren't the British people marching in the streets and demanding an end to the NHS and the adoption of the American system? Oh, that's right, they think that our system is completely retarded, barbaric, and economically inefficient and far worse than their current system, whatever its flaws may be.

Perhaps real socialized medicine wouldn't be perfect. Few systems are, but it would be far, far superior to the Kafkaesque system that we have right now.

You don't need to be a rocket scientist to understand that when we're spending 17% of our GDP on health care while leaving tens of millions of Americans uninsured or under-insured with the rest of the populace living in sheer terror of losing their jobs and health insurance while also suffering hundreds of thousands of medical bankruptcies and having burdened businesses that we should adopt a better system but you do need to be a Town Hall Moron to support the current system.

Most in Britain are not equipped whatsoever to meaningfully compare their system to another, and the same goes for most in most countries. Canadians probably don't want Englands. Does that mean theirs is better than Englands? Brits don't want Canada's, does that mean theirs is impossibly better at the same time? People get jingoistic over their national healthcare and it pollutes a real comparison.

 

[Genx87]

Medicare is relevent since it's the model being used to predict what would have happened if we actually had UHC.

Ho hum, another day, another innocent child killed by our collective refusal to treat a curable disease. Seriously though, it's definitely his fault for not getting a high paying job at the age of five so he could cover his costs.

At what cost would you keep the child alive indefinately? This is the cold hard truth we as a nation have to look at when we socialize our healthcare system. Is it right and moral to plow 2 million into a child by the time they are 5 when it is obvious they will continue to cost the system so much? The system will have finite resources. That 2 million could be used to treat other people.

And I dont think this kids cancer is curable in the traditional sense. For 1.6 million all the current medical care in this world has done is provide him with bouts of remission for periods of time. But the cancer always comes back.

I know it is popular to rail on this kind of case due to the childs age. But he could be 25 and the overall idea behind rationing still exists. And we will have to decide as a nation whether these types of cases are what we want to use our limited resources on.

 

[Genx87]

Lets look at the parents options. Which is basically going to be suing the insurance company in a court of law. A court case that will not be resolved for years.

If the child dies meanwhile, the pot just gets sweetened with a wrongful death suit and probable punitive damages.

I doubt a jury in the world would find for the insurance company, so the insurance company is making an awful risky bet in denying coverage.

Don't like lawsuits of this nature? Realize the threat of a lawsuit is about the only thing that keeps the insurance company honest.

Read the article. The childrens parents already have 1.6-1.8 million dollars spent on their child and Hospital is going to use the experimental drug on the assumption Medicaid will foot the bill.

 

[WhipperSnapper]

Most in Britain are not equipped whatsoever to meaningfully compare their system to another, and the same goes for most in most countries. Canadians probably don't want Englands. Does that mean theirs is better than Englands? Brits don't want Canada's, does that mean theirs is impossibly better at the same time? People get jingoistic over their national healthcare and it pollutes a real comparison.

Are you trying to suggest that if they were more informed about the American system that they would demand the American system?

Obviously the Canadians and the British people aren't as familiar with the American health care system as Americans are, but do you think that they are completely ignorant of how it functions and of its merits?

I suspect that if they had to vote on it they would overwhelmingly reject the American system and that it wouldn't be a matter of national pride or complete ignorance. Surely they must have news reports and documentaries about the American system just as we have new reports and documentaries about their systems.

 

[Genx87]

Are you trying to suggest that if they were more informed about the American system that they would demand the American system?

Obviously the Canadians and the British people aren't as familiar with the American health care system as Americans are, but do you think that they are completely ignorant of how it functions and of its merits?

I suspect that if they had to vote on it they would overwhelmingly reject the American system and that it wouldn't be a matter of national pride or complete ignorance. Surely they must have news reports and documentaries about the American system just as we have new reports and documentaries about their systems.

So what is your point? People will want to keep what they have and resist change? Welcome to human nature.

 

[JEDIYoda]

I'll have to dig around to find a good link, but some of you people who think UHC wouldn't cover an experimental drug are wearing blinders.

NPR did a series on health care systems around the world and I don't know if you have to view the series to see the full info but here:

http://www.npr.org/templates/story/story.php?storyId=92136549

On the left in "Series At A glance" they talk about French health care being some of the best in the world and how they pay for experimental drugs.

aren`t the french known for having tanks that have one forward gear and 3 reverse gears......

 

[WhipperSnapper]

At what cost would you keep the child alive indefinately? This is the cold hard truth we as a nation have to look at when we socialize our healthcare system. Is it right and moral to plow 2 million into a child by the time they are 5 when it is obvious they will continue to cost the system so much? The system will have finite resources. That 2 million could be used to treat other people.

And I dont think this kids cancer is curable in the traditional sense. For 1.6 million all the current medical care in this world has done is provide him with bouts of remission for periods of time. But the cancer always comes back.

I know it is popular to rail on this kind of case due to the childs age. But he could be 25 and the overall idea behind rationing still exists. And we will have to decide as a nation whether these types of cases are what we want to use our limited resources on.

You raise a good point--we do need to publicly debate the value of a person's life and how much should be expended in trying to save someone. Regarding the costs, though, couldn't you say the same thing for many people who have cancer and who have received cancer treatment?

Some of the issues are how often people need this kind of expensive treatment and how effective it is. Ultimately you have to ask yourself if it makes sense to spend $X more per year to cover yourself for this kind of treatment in case you need it.

In this case we're dealing with a 5 year old (potentially lots of life left), and there is a good chance that he could be saved:

"It's considered the standard of care in Europe and the United States for recurrent neuroblastoma," says Grupp. "It's not an unproven treatment with no basis in medical science. Actually, the results are often very good."

Paul VanNocker appealed HealthAmerica's decision, which once again denied MIBG.

Do we want our medical system to treat people for cancer and other serious diseases or should it merely cover broken bones and other easy-to-cure ailments? Are we willing to pay money for the treatment of serious ailments in case we ourselves need that kind of treatment some day?

 

[WhipperSnapper]

So what is your point? People will want to keep what they have and resist change? Welcome to human nature.

You missed my point. My point was not that they would reject the American system because it is not the system they currently have and they are ignorant and filled with nationalist price, but rather that they would vote to reject the American system because they think it is a huge failure on the merits.

 

[darom]

<quote>At what cost would you keep the child alive indefinately? This is the cold hard truth we as a nation have to look at when we socialize our healthcare system. Is it right and moral to plow 2 million into a child by the time they are 5 when it is obvious they will continue to cost the system so much? The system will have finite resources. That 2 million could be used to treat other people."</quote>

We will keep fighting for the life of any person in this country as long and as expensive as it gets. We don't live in Sparta where the weakest were thrown off the cliff. We will do it because we live in a humane society and we take care of our elderly and sick.

A human life doesn't have a cost, that's why I deeply despise the insurance companies and the capitalism at its best in this regard. A life, all of a sudden, has a value and this is wrong.

How many of you on this board have kids and care about their well being? As a parent, can you stick a $1.5-2M price tag on your child's head?

If all possible means of treating a disease are exhausted, I would venture and try any other experimental treatments to save my child's life and the insurance company should not be the God telling me to give up.

<quote>I know it is popular to rail on this kind of case due to the child's age. But he could be 25 and the overall idea behind rationing still exists. And we will have to decide as a nation whether these types of cases are what we want to use our limited resources on.</quote>

You and your finite resources. If you are so concerned about them, how about reducing the military budget, cutting NASA programs etc.? I believe, a human life is more important than water on the Moon.

 

[darom]

Sorry, no idea how to use quotes on this new board.

 

[ohnoes]

You and your finite resources. If you are so concerned about them, how about reducing the military budget, cutting NASA programs etc.? I believe, a human life is more important than water on the Moon.

That's the most retarded argument I've ever heard.

 

[Genx87]

You missed my point. My point was not that they would reject the American system because it is not the system they currently have and they are ignorant and filled with nationalist price, but rather that they would vote to reject the American system because they think it is a huge failure on the merits.

I dont really see your point. If given to a vote people would reject Britains system in the United States as well based on the same reasoning.

 

[Genx87]

We will keep fighting for the life of any person in this country as long and as expensive as it gets. We don't live in Sparta where the weakest were thrown off the cliff. We will do it because we live in a humane society and we take care of our elderly and sick.

A human life doesn't have a cost, that's why I deeply despise the insurance companies and the capitalism at its best in this regard. A life, all of a sudden, has a value and this is wrong.

How many of you on this board have kids and care about their well being? As a parent, can you stick a $1.5-2M price tag on your child's head?

If all possible means of treating a disease are exhausted, I would venture and try any other experimental treatments to save my child's life and the insurance company should not be the God telling me to give up.

Your ideals dont match reality nor practicality. We simply will be unable to afford paying for everything. I know you dont want to hear that but once socialized these same situations will arise and have to be dealt with by politicians. Often much more brutally than they are no within the public\private system we currently have.

You and your finite resources. If you are so concerned about them, how about reducing the military budget, cutting NASA programs etc.? I believe, a human life is more important than water on the Moon.

You do realize even in a public system resources will not be infinite right? Within 20 years we could cut all of those programs to zero budget and still fall short. My finite resources are dose of reality for some of you.

 

[Pens1566]

As sad as this situation is, a kid with neuroblastoma has zero chance of any meaningful survival. I understand the parents holding out hope, but to me its just unreasonable.

If you're in the "unlimited spending" crowd, use the $$$ on research for better treatments.

 

[Pens1566]

Stupid forum double posts ....

 

[Genx87]

Do we want our medical system to treat people for cancer and other serious diseases or should it merely cover broken bones and other easy-to-cure ailments? Are we willing to pay money for the treatment of serious ailments in case we ourselves need that kind of treatment some day?

I say yes but in certain situations there will have to be a cost\benefit analysis. For instance should an 80 year old person who developes cancer have the same resources spent on them as the 20 year old if both are curable?

 

[Codewiz]

How about this.....Get rid of the damn FDA. Do you actually think it protects us? We still have tainted meat. We still have drugs that kill us.

Strengthen the laws to go after companies that act reckless and get rid of the FDA.

Then every doctor can prescribe whatever treatment they want and the insurance companies can't hide behind the FDA.