Man with cancer says Blue Cross rations care

[proud2BlibKansan]

Vic Wolf, of Mission, says he's had eight surgeries in 12 months to treat his colon cancer. He also has four tumors in the left lobe of his liver. In July, he says, his radiologists and oncologists recommended treating the liver tumors with TheraSphere, radiolabeled glass beads that, as Wolf puts it, "explode the tumor from within." (The National Institutes of Health says this "may be an effective treatment for liver cancer that cannot be removed by surgery.")

And, yep, Blue Cross won't pay for the treatment, he says.

"They say it's an experimental procedure, but they've done it in other states. They also approved it for another patient in Kansas this year -- but they had to get the Kansas Insurance Department involved." (That patient blogged about her experiences here.)

"I pay Blue Cross $1,200 a month for my wife and myself, and then they deny us benefits," Wolf says.

more . . . http://blogs.pitch.com/plog/2009/12/man_with_cancer_says_blue_cross_rations_care.php

[Cleita]

1. Yes, but they don't mind taking the money as long as they don't have

to honor their side of the bargain.

[applegrove]

2. That is so sad.

[glinda]

3. That is what we were paying for two of us until husband went on Medicare. BCBS

will deny just about anything. Do our Representatives really think we have this kind of money? F them.

[proud2BlibKansan]

5. I hate Blue Cross

[laughingliberal]

9. Yes, that was the premium my husband and I paid to COBRA our coverage

until we couldn't afford that. Now, we join 46,000,000 other Americans in hoping we don't get sick.

[glinda]

22. Yup. That was the deal with us also. Sorry about your situation. I may be there soon.

[BrklynLiberal]

4. horriific. THIS is the face of American Health care today!!!!

:mad: :mad:

[Lint Head]

6. Universal Healthcare! Universal Healthcare! Universal Healthcare!

Universal Healthcare! Universal Healthcare!Universal Healthcare! Universal Healthcare!
Universal Healthcare! Universal Healthcare!Universal Healthcare! Universal Healthcare!
Universal Healthcare! Universal Healthcare!Universal Healthcare! Universal Healthcare!
Universal Healthcare! Universal Healthcare!Universal Healthcare! Universal Healthcare!
Universal Healthcare! Universal Healthcare!Universal Healthcare! Universal Healthcare!

[TreasonousBastard]

7. This is not a story-- TheraSphere hasn't even started...

phase two clinical trials and any effect it may have is speculative. It IS experimental.

Do you really belive that any and every new drug, procedure, or treatment should be paid for, no matter how little it may help?

[WillowTree]

8. Exactly.

And many here seem to think that a government-run plan would necessarily pay for treatments which are clearly investigational, as indicated by the study information linked to in the full article.

[laughingliberal]

12. Pays to navigate a little further into the links

That one was to this:

http://clinicaltrials.gov/ct2/show/NCT00039078

Radiolabeled Glass Beads (TheraSphere®) in Treating Patients With Primary Liver Cancer That Cannot Be Removed by Surgery
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), December 2008
First Received: June 6, 2002 Last Updated: February 6, 2009 History of Changes
Sponsor: UPMC Cancer Centers
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00039078
Purpose
RATIONALE: Internal radiation therapy uses radioactive material placed directly into or near a tumor to kill tumor cells. Using radiolabeled glass beads to kill tumor cells may be effective treatment for liver cancer that cannot be removed by surgery.

PURPOSE: This phase II trial is studying the side effects of hepatic arterial infusion using yttrium-90 microspheres (TheraSphere®) to see how well it works in treating patients with liver cancer that cannot be removed by surgery.



Condition Intervention Phase
Liver Cancer
Radiation: yttrium Y 90 glass microspheres
Phase II <snip>

Note the bolded area above

[laughingliberal]

10. Really? Cause Medicare has approved it for reimbursement

2. Will insurers pay for TheraSphere treatment?
TheraSphere is approved for Medicare reimbursement. It is assigned
to Ambulatory Payment Classification (APC 2616) and is billed
to Medicare under HCPCS code C2616. To date, all Medicare cases
have been reimbursed.
In addition to Medicare coverage, TheraSphere has been reimbursed
by a variety of commercial insurance plans. These plans include HMO,
PPO, indemnity, and self-insured employers. Government sponsored
programs such as state Medicaid programs, Veterans Administration and
Tri-Care for military personnel have also provided coverage. For those
insurance plans that require it, your health care provider will work with
you to achieve pre-certification for TheraSphere treatment

http://www.nordion.com/therasphere/patients-info-guide/Patient_Information_Booklet_v2.pdf

[TreasonousBastard]

17. I suppose I should pay more attention to dates, but...

the question now is just what reasons Blue Cross gave for denying it.

[laughingliberal]

20. The reason Blue Cross stated was that it is experimental but I've not seen Medicare reimburse for

experimental procedures unless they are conducting a study. I'm sure the real reason is the same as it usually is: more for us if we deny this patient this procedure. My experience with private insurance companies is they pay just enough claims to avoid the appearance of blatant theft.

I once had an insurance company try to deny a prescription my doctor ordered. When I asked why they told me it was not the preferred drug. The fact was it was the only drug with FDA approval for the diagnosis I had. I asked what the preferred drug might be and the "customer service" rep started spelling the name of the drug on her list. I informed her that drug was most definitely not approved for use in my diagnosis and, not only that, but it would be contraindicated and any doctor who ordered it for this condition would probably face some legal problems. I got my approval.

[laughingliberal]

11. Link to Phase II clinical trials with a start date in 2000

Oh, and look, published results at the bottom of the page. Hmmmm.

http://www.cancer.gov/clinicaltrials/PCI-IRB-0611014#PublishedResults_CDR0000069336

[proud2BlibKansan]

18. Yes I do

:)

[TreasonousBastard]

23. But who's gonna pay for all this care?

[proud2BlibKansan]

24. The insurance company

http://www.aflcio.org/issues/healthcare/facts_insurancecompanyprofits.cfm

[laughingliberal]

13. K & R for exposing rationing for profit in America nt

[HughMoran]

14. Yes, Blue Cross rations care

They do it in less obvious ways too through deliberate inefficiencies. We should take over their buildings - that's what I call a public option :)

[laughingliberal]

15. I like that idea for a public option a lot!

With apologies to Bartcop: When someone makes a mistake which results in benefit to them, look for them to make that mistake over and over and over, again.

[HughMoran]

16. Don't get me started about how many claims were "lost"

We really should occupy their buildings. We are the government - fuck having our healthcare be determined by the 4 horsemen of the apocalypse (Traitor, Nelson, Landrieu & Lincoln).

[laughingliberal]

19. Oh, I once faxed a certificate of credible coverage to my insurance agency 14 times

and each time they claimed they didn't get it. I finally informed them that my husband would be in the insurance commissioner's office with all my transmittal confirmations if I did not hear from them before then. I got a call the next morning at 9:00 that they had received the certificate and were processing his claim. Amazing!

[HughMoran]

21. They are lucky they havn't been hurt yet

It's not like we don't know where they live.