Single Payer Health Systems

ck4829

(36,462 posts) Mon Dec 30, 2024, 12:49 PM Dec 30

'Would he have lived?' When insurance companies deny cancer care to patients

Angela Pike’s husband, Tracy, had just celebrated his 45th birthday when he was diagnosed with Stage 4 stomach cancer. A father of three and the maintenance chief of a Louisville, Kentucky, skyscraper, Pike immediately started chemotherapy, which reduced the size of the tumor his doctor had discovered.

After MD Anderson agreed to provide Pike with the treatment, he and his family traveled to Texas in 2023. The night before the first procedure, Pike’s surgeon called to let the family know Blue Cross and Blue Shield of Illinois, Pike’s health insurer through his employer, had declined to cover the roughly $40,000 treatment.

The insurer ruled Pike’s treatment was “not medically necessary” because it was “experimental, investigational and unproven,” documents show.

Angela said the last straw came when she learned that one of the insurer’s physicians who had rejected the treatment was not a cancer doctor at all. He was an obstetrician-gynecologist. In January 2024, Tracy Pike died, leaving behind his wife of 22 years and their three children.

https://www.nbcnews.com/news/investigations/-lived-health-insurance-companies-deny-cancer-care-patients-rcna182611

2 replies

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Highlight:

'Would he have lived?' When insurance companies deny cancer care to patients (Original Post) ck4829 Dec 30 OP

Even traditional Medicare will disallow "experimental, investigational and unproven" treatments. Silent Type Dec 30 #1

"we are stuck with this mess" - How did we become so weak and helpless? ck4829 Jan 20 #2

Silent Type

(7,880 posts)

1. Even traditional Medicare will disallow "experimental, investigational and unproven" treatments.

Reply to ck4829 (Original post)

Mon Dec 30, 2024, 01:14 PM

Dec 30

As the linked article points out-- "And this year, Medicare began denying claims for breast cancer imaging needed to identify cancers among many women."
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I believe one reason Congress doesn't approve Medicare-for-All is that they'd rather people who are unfortunately likely to die/suffer anyway (ie, Stage 4 cancer) blaming them, rather than insurance companies for not wanting to spend every possible dollar on treatment that has little chance of success.

Of course, the example in the OP is an employer based insurance plan, not Medicare or Medicaid.

And, MD Anderson could have continued the treatment. They make good money, have big cash reserves, have a well funded foundation, sponsor research, etc.

So, until Congress decides to do something (even if not perfect), we are stuck with this mess.

ck4829

(36,462 posts)

2. "we are stuck with this mess" - How did we become so weak and helpless?

Reply to Silent Type (Reply #1)

Mon Jan 20, 2025, 08:14 AM

Jan 20

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