Welcome to the Death Panel.
20 09 2009[cross-posted at The Huffington Post]
I got a phone call from my oldest friend yesterday. We’ve been friends since nursery school, stayed best friends in grade school, high school, college and beyond. We were the kind of friends that had hundreds of “in jokes” and we passed notes, and talked on the phone more than we should have, and drove our parents crazy. We survived Mrs. Nemchek’s Geometry class together. We liked the same music. Neither of us were the “popular” girls, but we didn’t want to be. We marched to our own drummer. We had each other, and we made each other laugh and we were always there for each other without reservation. We got a kick out of the fact that people would routinely ask us if we were sisters, when we looked absolutely nothing alike. There isn’t anyone else in the world with whom I share such a close personal history.
So, it wasn’t unusual to get a call from her. There are times when we talk every other day. Sometimes we seem to go for weeks without a call, but we’re always there in spirit.
“I need to tell you something,” she said. I wasn’t sure whether this was going to be good or bad, but “I need to tell you something” is always important. “I went to the doctor, and there’s something wrong with my heart.”
I wasn’t expecting that one.
My friend has had a series of health problems – a bad car accident resulting in two painful spinal surgeries, asthma, a breast cancer scare, but this was different. Her matter-of-fact tone quickly dissolved into tears of fear and vulnerability. “I can’t believe this. I’m only 43!” This wasn’t supposed to happen.
After her breast cancer scare, the doctor recommended a preventative regimen of tamoxifen, a drug which would help ward off the risk of cancer that her condition indicated might be a problem. But before they started her on the potent drug, they wanted to make sure she had a good healthy heart. A family history of heart disease put her in a high risk group, so the cardiologist insisted on a stress test.
She’s been living through multiple problems with her insurance provider, so she wasn’t surprised when they refused to pay for the test. She was surprised when the doctor decided to call the insurance company himself. He explained why it was important, and that he felt very strongly and in no uncertain terms that it needed to be done. They still refused to pay for the test. And then the cardiologist did an amazing thing. Outraged at the insurance company, he said that he would pay for the test himself, out of his own pocket. It was important, too important to cow to the insurance company representative whose job it was to deny claims just to increase the profits for the company.
My friend wasn’t even able to complete the stress test. After a few minutes on the treadmill, they stopped it and wouldn’t allow her to continue. Shortness of breath. Chest pain. She’d been experiencing these symptoms lately. She was mowing the lawn this week, and had to stop half way through because she couldn’t catch her breath. She chalked it off to asthma. But it was, in fact, a coronary blockage that was keeping one of the chambers of her heart from getting enough oxygen.
So, instead of starting a regimen of tamoxifen next week, she will be getting a stent in her heart tomorrow. She’s home right now, trying to “do nothing”, and trying not to get too stressed out by the thought that she’ll be in surgery in just a few hours, and never even knew anything was wrong.
If her insurance company had gotten its way, she would never have had that test. The next time she was out mowing the lawn, it could have killed her. “He saved my life,” she said, just as I was thinking the same thing. Yes, doctors are in the business of saving lives from disease, and illness and injury, but they shouldn’t have to be in the business of saving lives from business. “He saved my life from the insurance company, she continued. ”The insurance company… there’s your Death Panel.”
I didn’t even ask her his name, but I’m grateful to that cardiologist in the kind of way it’s difficult to express in words. He saved a wonderful, beautiful life. But how many people are not so lucky? A recent study found out that 45,000 people every year die because they are uninsured. And each one of those 45,000 has a story too. They are someone’s husband, or wife, or parent, or best friend since nursery school.
But my friend has health insurance. She pays $600 every month for it, and yet her coverage denied a test that saved her life. How many fully-insured Americans die every year because we allow the insurance industry to be a for-profit enterprise, making money off of people’s lives? How many die because our current system says that the money made for salaries and bonuses for insurance company executives is more important than they are? More important than your mother. More important than your son. More important than my friend. How long will we accept the harsh reality that the insurance company looks at human beings and sees nothing but a spreadsheet?
“We need a revolution in the health care industry,” my friend agreed. “We should not allow them to profit from our own illness.”
Until then, if you have insurance, get in line. Because whatever you are paying them, it’s only a matter of time before your number is up, and it’s you or someone you love that gets to stand in front of the Death Panel and plead your case. And guess what? They’d much rather pay politicians than pay to save your life. It’s cheaper.
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Update: I’ve gotten several requests for an update about my friend. Her situation was slightly more complicated than they originally thought, so she will be getting 2 stents on Tuesday. She is still in the hospital, and wanted me to pass on that she is very deeply grateful to all of you for your kind words of support, and for sharing your own stories. It really has meant a lot to her. I’ll check back in on this thread when there’s something more to report. Thanks, everyone.
Update II: She’s out of surgery and doing well. Three stents in all… But she’ll be home tomorrow. Thanks again to all for your good thoughts. Looks like things will be OK, thanks to a pretty amazing cardiologist. :0)
September 21st, 2009 at 9:35 AM
Big Pharma is just as bad.
Consider this: Why does big pharma have commercials for prescription medications? You can’t shop for them. As a sales tool the commercials are horrendous, the side effects sound worse than the disease. So…why? Because when you buy air time you make the media outlet less likely to say something negative about your product. 100,000 people die a year from the misapplication of prescription medicines? That should be a big story, shouldn’t it? Anti-depression medication that actually induces suicidal behavior. Should be big? By placing commercials on TV they are (to use a medical term) inoculating themselves from media scrutiny.
September 21st, 2009 at 10:29 AM
OMG!!! They’ll raise our taxes, and ration care. You don’t want the “government between you and your doctor,” do you?
Yet this woman pays $600/month in premiums, the equivalent of a luxury car payment, only to have an insurance bean counter tell her they are rationing her health care. Higher taxes would probably be a wash.
Me, I’ll take the government bureaucrat every time. At least he is accountable to elected officials, who are accountable to citizens. The insurance bureaucrat is accountable only to the bottom line.
September 21st, 2009 at 11:13 AM
As was suggested over at HuffPo, I’ve just linked to this on my Face Book page. I’m thinking most of my friends will think I’ve gotten very political. Such is life, I can only do what I can do and hope for the best.
Thanks AKM
September 21st, 2009 at 11:18 AM
Sorry, AKM, you missed the boat on this one. Horizon BlueCross/BlueShield is not a for-profit insurance company. It is a not-for-profit. It also isn’t an insurance company. It is a healthcare services contractor. Horizon isn’t trying to make money by denying your friend this test. I recommend that she *read her contract* with Horizon to determine why this claim was denied.
I’ve been a Mudflatter for 18 months – I’m not a troll or or lurker. However, when misinformation pillories the Blues with the same brush as for-profit insurance companies, critical details – such as these I’ve pointed out – are lost.
September 21st, 2009 at 11:34 AM
Is this them?
N.J. hospitals see red with Horizon Blue
By Shankar P.
9/21/2009 Print this page | E-mail to a friend | Submit news tips | Send a letter to the editor |
Jury trials have begun at Bergen County Superior Court in a contest between Horizon Healthcare Services, of Newark, and a group of 15 hospitals in New Jersey over the latter’s claim over unpaid bills. The hospitals want $83 million in damages from Horizon Blue Cross Blue Shield of New Jersey, accusing the insurer of improperly selling discounted hospital rates to self-insured groups and failing to administer claims.
Jeffrey Brown, partner at the Hackensack law firm of Garfunkel, Wild & Travis, who is representing the hospitals, said his clients hired Horizon to market their services to the self-insured because those payments tended to be delayed and poorly coordinated. But Horizon failed them, he said, describing the current fight as one over a “breach of contract” and one that was “at a much higher level than clerical errors.”
Brown said total damages would exceed $100 million if interest charges were included; they have not sought any punitive damages.
A Horizon Blue spokesman maintained his company met its contractual obligations and does not owe the hospitals any money. The self-insured labor unions were entitled to the same discounted rates as Horizon Blue’s other customers, he said.
Horizon Blue also contested the $83 million sought in damages. That figure “represents the additional amount these hospitals would like to have charged the labor union funds for the services they provided,” its spokesman said.
September 21st, 2009 at 11:35 AM
Horizon Blue Cross and Blue Shield of New Jersey
From Wikipedia, the free encyclopedia
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Horizon Blue Cross Blue Shield of New Jersey, headquartered in Newark, New Jersey, is the only licensed Blue Cross and Blue Shield Association plan in New Jersey, providing health insurance coverage to over 3.2 million people throughout all of North, Central, and South Jersey.
[edit] History
It has been operating since 1932. The company offers managed care, Medicare, and traditional indemnity health plans for individuals, families, and groups.
The plan has also shown a commitment to helping improve healthcare administration on a national level, and has been an active player in CAQH since 2001.
[edit] External links
September 21st, 2009 at 11:54 AM
Unbelievable, AKM. Good luck to your friend next week. Please keep us updated!!
September 21st, 2009 at 11:58 AM
AKM prayers go out for you friend.Janet in Texas. something like that should never have happened.
My doctor had called to let me know he had samples for me for a condition he often gives me samples to try and see if they work before he gives me a prescription.Since I am no at the donut hole in my prescription plan I asked if he had any samples for my breathing problems and he did have one sample which will save me about 130.00 this month not counting the 75.00 dollars per pill for the other sample,at least I only take it once a month.So there are a lot of doctors out there who do listen and help when possible
September 21st, 2009 at 12:24 PM
AKM, How wonderful to have a special friendship going back to kindergarten! Your friend’s experience shows the disaster the private health insurance companies have created. My thoughts are with your friend for a full and speedy recovery.
Hugs to the mudpuppies who’ve shared their personal battles and magnified the need for a robust public option now. Tim Ellis writes at HuffPost that H.R.3200 has been amended to tie the PO premiums to average private insurance co’s…”gutting the public option.”
http://www.huffingtonpost.com/tim-ellis/subverting-the-public-opt_b_292720.
I’m paying almost $8000/yr for health insurance and I’m angry as he!! that a good chunk of my premium is going for high exec pay, bonuses to deny coverage, profit, directly to members of Congress and to lobbyists who are fighting health insurance reform.
September 21st, 2009 at 12:53 PM
Infuriating! I’m so sorry for your friend AKM but thanks for sharing with us. Perfect example of why health care under Obama must be passed with the public option.
AKM please tell your friend to also have her Dr. check for Factor V (5) Leiden. Genetic blood disorder discovered in 1994 by Sweedish docs. People with F5L tend to ‘over’ clot leading to miscarriages(clot blocks flow thru umbilical chord), heart attack, stroke, dvt(deep vein thrombosis,etc) Some people carry a gene from each parent, some from one. My doc tells me it is probably the ‘unknown’ culprit in a lot of cases. 1) b/c it’s still fairly news to docs, 2) b/c unless you know of another family member that has it you would never be tested. Some Docs to this day still don’t know what it is.
Most people never discover they carry this but could be the reason for heart attack, stroke, etc. People with F5L should NEVER receive clotting meds if they are in a situation w/heavy bleeding. Also should or can be taking aspirin a day or blood thinner (if necessary).
Women who have had seveal miscarriages should also be checked b/c it could be why. There is treatment for women so they don’t develop clots in chord if it turns out they carry gene.
Doc can find it with simple blood test. My doc also checked my C protein levels b/c levels because the levels C protein plays a part in this disorder. She said checking both assured her that a positive or negative result was more credible.
http://www.fvleiden.org/index.html
September 21st, 2009 at 1:13 PM
AKM, my thoughts and prayers are with your friend – and you. No one should be fighting for life through health “insurance” companies. Only qualified medical staff should be making health decisions along with the patient him/herself. Kudos to the doctor in this case.
Read and posted at HuffPo to “progress” the story – sorry, just never used a noun as a verb before and it fit
I am obviously having some serious mental issues today.
September 21st, 2009 at 1:36 PM
My thoughts are also with your friend. My current job involves getting authorizations from insurance companies for inpatient treatment. I’m impressed the cardiologist was willing to pay for testing instead of just giving up in the face of insurance company opposition. As I said on another blog, people who are afraid of government death panels have never spoken to insurance companies to precertify care.
September 21st, 2009 at 2:26 PM
Praise be to that cardiologist who paid for the test! I will post this article on my facebook page too.
September 21st, 2009 at 5:20 PM
Best of luck to your friend! She truly is very lucky.
Here’s a touching TRUE story for you, courtesy of my husband who is a physician:
Recently he saw a young man who had a pre-existing condition and had been denied health insurance. He is a shift-manager at a fast food establishment and a father of two young children.
My husband determined he needed medication or he would die. Period. He didn’t have enough money to buy the drug he needed, and wouldn’t have time to try to qualify for assistance. Seriously, he probably wouldn’t have survived another month.
My husband went downstairs to the ATM and came back and handed him $100 dollars so he could get the medication.
Please, for those of you who have had bad experiences with physicians, don’t lump them all together. There are lots and lots of good ones out there who share the same issues with health insurance companies. I personally have had nightmare experiences with health insurers. No special treatment here.
September 21st, 2009 at 7:56 PM
My sister a younger one lost her job when her plant shut down,She has a pension that she earned after 30 years of working there,but it does not have any insurance and is not enough to pay for her own insurance even if she could get it.She is diabetic.So far her Doctor has been giving her samples,she is on pills not shots.But her doctor knows her situation and helps as much as she can.I know my sister has cataracts on one eye but even before she lost her insurance the eye doctor wanted money for the procedure upfront in case insurance would not cover it and of course with knowing her plant was going to close she could not afford it.So she lives with it. There are many Doctors that are disgusted with insurance companies and that includes the Va and medicare because of having to have everything just so one number or letter different and you could be denied.Even when I had regular insurance instead of medicare I always told the receptionist what to code my appointment as so it would be paid for.
September 21st, 2009 at 10:23 PM
Thanks for the update on your friend, AKM. Thoughts continue and will check back tomorrow.
September 22nd, 2009 at 4:51 AM
There are, fortunately, many good people practicing medicine out there. In 1992 my husband was dying of kidney cancer which had spread to his bones. He had several lesions in his spine and was soon to be, not only bedfast, but paralyzed. A very caring surgeon performed 12 separate procedures on his spine,at a cost of $12,000 each,and our insurance company said they would not pay for “experimental treatment”. This surgeon ,personally, rewrote what he had written for the insurance company or maybe he just stated so the poor schmuck in claims could understand what had been done, and the claim was settled and paid for.
At the time, I had excellent insurance, and it covered hundreds of thousands of dollars worth of treatment in the nine short months he lived after diagnosis,but still, I paid 10s of thousands of dollars more out of pocket for prescriptions drugs, nursing care (I was teaching full time) and other expenses associated with a catastrophic illness. I was lucky, I was able to pay and not lose everything. Others are not so fortunate and illness such as my husband’s would put them into debt for the rest of their lives.
September 22nd, 2009 at 8:47 AM
[...] a nagging question that I’ve been mulling over, which came back to me after reading a post on the AK Muckraker today: in this whole argument of government vs. private health insurance, the Republicans keep [...]
September 22nd, 2009 at 7:34 PM
Great news! Wishes for her speedy return to strength and stamina…soon to finish mowing the rest of her lawn.