• Does your insurance company want you to die? Tuesday, February 23, 2010

    “My best guess is that they want me dead as soon as possible….They know that the premiums I pay will never cover how much they’ll spend on me.”

    Those were the words of Bob Iritano in a conversation with Los Angeles Times business columnist David Lazarus.  Iritano has terminal cancer, and Lazarus went on to write about how Iritano’s health insurer, Health Net, decided not to cover the treatment that could extend his life.

    Iritano was diagnosed with Stage IV metastatic sarcoma in February 2007.  He underwent chemotherapy shortly afterward, but an allergic reaction almost killed him.  Iritano was hospitalized for two weeks.

    When tumors appeared on Iritano’s liver last August, his doctor tried a procedure called radio frequency ablation — tightly targeted microwaves that zap the lesions.

    Studies at the University of Texas and Royal Marsden Hospital in London have found this to be an effective treatment for such tumors.  Health Net covered the procedure without question in August, and Iritano’s tumors were eliminated.

    “This procedure is not experimental and it’s not investigational,” said Dr. Ilya Lekht, Iritano’s radiologist.  “It’s been clearly shown in literature to be effective.  We’ve been doing it since the 1990s.”

    Health Net’s denial letter this month said that “a better choice for additional therapy would be chemotherapy” — a treatment that Iritano’s medical history suggests would almost certainly be fatal.

    Iritano is now scheduled to receive radio frequency ablation–after Lazarus contacted Health Net and told the company he would be writing about the case.  But company officials told Lazarus it would be “an administrative exception,” with no guarantee Iritano could receive the treatment again if needed…and his radiologist thinks it will be in a few months.

    Lazarus has posted a portion of his interview with Iritano online:

    Another case involving denial of treatment is now in Los Angeles County Superior Court.  Los Angeles Times reporter Lisa Girion, covering the trial, tells the story of Ephram Nehme:

    Nehme’s liver began to fail in 2006, and his Blue Cross network physician at UCLA recommended a transplant.  Blue Cross readily approved the procedure at UCLA Medical Center.

    But as Nehme’s condition deteriorated, he says his UCLA physician urged him to go to the Clarian Transplant Center, which is affiliated with Indiana University in Indianapolis, because wait times were much shorter there than in California.

    Blue Cross refused to cover the procedure in Indiana, telling Nehme his policy required him to stay in-state and at a contracted hospital.

    Fearing he would die waiting for an organ in California, Nehme went to Indiana and paid $205,000 out of pocket for the January 2007 surgery that saved his life.

    Nehme explained his motivation for taking Anthem Blue Cross to court:  “I’m trying to save lives.  There are a lot of people who need liver transplants, and they should be able to get them wherever they need them.”

    Anthem officials say Nehme’s condition wasn’t bad enough to warrant an immediate transplant, thus it did not feel it needed to pay for a procedure done out-of-network.  The company claims it makes exceptions to its in-state requirement if its physicians believe there is good reason to, which in Nehme’s case they did not.

    If Nehme were one of the 130 million Americans who have health insurance through their employer, he would not be able to take the case to court.  Federal law prevents that.  But because he purchased his policy on his own, Nehme is free to file suit.

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