Insurance company deny treatment to 5 year old with Cancer

[rdean]

Before you decide to blast me, see my post above this.

Children's Hospital, where Kyler receives much of his care, proceeded with two rounds of MIBG therapy for Kyler - at a cost of $110,000 - despite the VanNockers' inability to pay for it. (CHOP hopes that HealthAmerica will reconsider or that Medicaid will cover the MIBG cost; the VanNockers are Medicaid-eligible because they are bankrupt by medical costs).

$55,000 per round of experimental therapy? Conventional chemotherapy treatments cost roughly $2000 per round. For the price of these two MIBG treatments, over 50 people could receive traditional chemotherapy treatment.


And people wonder why healthcare is so expensive in this country? Nobody wants to draw a line...

$73 million for CIGNA’s retiring CEO

Denial of Care Profits: $73 million for CIGNA?s retiring CEO | Physicians for a National Health Program

Hey, while you are doing the math, can you tell us how many insurance policies it takes to pay one 73 MILLION DOLLAR bonus?

 

[FireGod]

Before you decide to blast me, see my post above this.

Children's Hospital, where Kyler receives much of his care, proceeded with two rounds of MIBG therapy for Kyler - at a cost of $110,000 - despite the VanNockers' inability to pay for it. (CHOP hopes that HealthAmerica will reconsider or that Medicaid will cover the MIBG cost; the VanNockers are Medicaid-eligible because they are bankrupt by medical costs).

$55,000 per round of experimental therapy? Conventional chemotherapy treatments cost roughly $2000 per round. For the price of these two MIBG treatments, over 50 people could receive traditional chemotherapy treatment.


And people wonder why healthcare is so expensive in this country? Nobody wants to draw a line...

$73 million for CIGNA’s retiring CEO

Denial of Care Profits: $73 million for CIGNA?s retiring CEO | Physicians for a National Health Program

Hey, while you are doing the math, can you tell us how many insurance policies it takes to pay one 73 MILLION DOLLAR bonus?

That CEO earned every penny, just ask those who were covered oh and those who were dropped too. I am sure that he has a better job satisfaction rating than Obama.

 

[thomascaelyn]

I don't really understand what going on here to be honest...Because I am newbie here..Any help and advice much appreciated....

 

[Annie]

Assuming all the 'facts' are here, what leads anyone to think this boy would have received the treatment under the Obamacare bills?

 

[Christopher]

Ronnie Polaneczky: Parents suing to force insurance firm to cover their ailing son's therapy needs | Philadelphia Daily News | 02/09/2010

PAUL AND MARIA VanNocker are filing a federal lawsuit today on behalf of their 5-year-old son, Kyler, whose insurance company, HealthAmerica, refuses to pay for the latest treatment needed to prolong his life.

The complaint raises lots of questions that I assume will be answered at trial, should it come to that. The question it won't answer is one that's been gnawing at me since I first wrote of Kyler's plight in December:

How do HealthAmerica's overlords sleep at night?

I know my own dreams would be haunted if I acted as arbitrarily, capriciously and abusively - to borrow some pointed adjectives from the complaint - as the VanNockers allege HealthAmerica has regarding their little boy.

The Harrisburg-based company's denial of benefits to Kyler, the lawsuit claims, is the result of "a biased, self-serving misreading and misinterpretation" of everything from Kyler's medical records to the company's own internal documents.

The Harrisburg-based company's denial of benefits to Kyler, the lawsuit claims, is the result of "a biased, self-serving misreading and misinterpretation" of everything from Kyler's medical records to the company's own internal documents.

HealthAmerica's Kendall Marcocci told me yesterday that the company won't comment on pending litigation. Center City attorney David Senoff, though, was happy to explain why he is representing the Van Nockers for free in the lawsuit.

"These companies have to be brought to the courthouse to get them to do the right thing," said Senoff, a specialist in insurance disputes. "This child needs this treatment, or else."

He didn't need to explain what "or else" meant.

Readers may recall that Kyler has neuroblastoma, a rare, deadly childhood cancer that attacks the nervous system, creating tumors throughout his body.

He was diagnosed in 2007 and endured a year of medical treatment, with complications he barely survived. Thankfully, it knocked his cancer into remission for 12 lovely months, and he got to revel once again in the glories of childhood.

Last September, the disease came roaring back. This time, only one form of treatment, something called MIBG therapy, could help save his life.

But HealthAmerica refused to pay for the MIBG, which it considers "investigational/experimental" because there is "inadequate evidence in the peer-reviewed published clinical literature regarding its effectiveness." Nor is MIBG approved by the Food and Drug Administration, another criterion that HealthAmerica requires.

How come, then, asks the lawsuit, HealthAmerica covered not one but two prior therapies for Kyler that did not possess these supposed requirements?

What the Hell.

What's your opinion USMB?

Well, we could react to this in three main ways that I can see:

1. The community could come together and raise the money to pay for the treatment. This would require zero government involvement.
2. We could blame the FDA for not approving the treatment fast enough. This would require changes within the FDA. If it really is considered the standard of care in the US and Europe, why is it not approved by the FDA?
3. We could demonize the insurance company for not paying and argue that a government health insurance system is needed. This would require much more government involvement, that would most likely lead to similar issues that just about every government program has (see item 2 above).

I would prefer to see a combination of 1 and 2. Obviously, if you want to argue for a single payer system or a public option, you would choose 3.

 

[rdean]

The sad fact is, no matter how much money you spend on treatment, you can't cure everybody.

Very good point.

We could spend unlimited amounts of money on each individual, even if the treatment has a near zero percent chance of working...but this would raise the cost of healthcare even higher.

Yet the right wingnuts went ballistic about taking a brain dead woman off of life support, yet support not giving a five year old boy a chance to take an experimental regime that might extend his life until a cure could be found.

Good point. The problem is the right is not consistent. Right wing leaders will not support this little boy because it costs lots of money. Money better spent giving an insurance company CEO a 70 million dollar bonus package.

Of course, the 17 year old girl who was denied health care and died and whose mother was given the bird by health care employees were made out to be the bad ones.

I just don't know what has gotten into Republicans? Health care companies have no doctors, no nurses, no hospitals. They stand between patients and care and skim money off policies. In a way, they are supposed to be like Unions, getting the best care for the smallest amount of money.

Instead, it's all about how much they can scam the American People and Republicans applaud that. Go figure.

 

[boedicca]

This is just a cynical sob story, for which the germane point is:

But HealthAmerica refused to pay for the MIBG, which it considers "investigational/experimental" because there is "inadequate evidence in the peer-reviewed published clinical literature regarding its effectiveness." Nor is MIBG approved by the Food and Drug Administration, another criterion that HealthAmerica requires.


Does anybody think that ObamaCare will pay for treatments not approved by the FDA?

Health care is a consumable, not an inalienable God given right. There has to be some limit to the extent of coverage, and the amount to be spent on treatment. Demonizing insurers for being subject to economic reality while ignoring the far worse outcome of politicized rationing is rather foolish.

 

[rdean]

This is just a cynical sob story, for which the germane point is:

But HealthAmerica refused to pay for the MIBG, which it considers "investigational/experimental" because there is "inadequate evidence in the peer-reviewed published clinical literature regarding its effectiveness." Nor is MIBG approved by the Food and Drug Administration, another criterion that HealthAmerica requires.


Does anybody think that ObamaCare will pay for treatments not approved by the FDA?

Health care is a consumable, not an inalienable God given right. There has to be some limit to the extent of coverage, and the amount to be spent on treatment. Demonizing insurers for being subject to economic reality while ignoring the far worse outcome of politicized rationing is rather foolish.

Doesn't make any sense. FedEx and UPS are doing quite well and the US Mail, the "public option" never drove them out of business. Because one is available doesn't mean the other isn't.

Besides, I didn't know health care companies did "research". Think of that 73 million dollar CEOs salary going to research. What we couldn't have learned. Instead, he has a couple more mansions he will never use.

 

[American Horse]

When there is a diagnosis of a terminal cancer with no chance of recovery, treatments that are experimental, by real medical organizations, should be used, whether paid for by insurance companies, drug companies, or the government. How else do we find the efficy of the treatment, particularly for rare cancers?

This would seem to be a reasonable approach, and a proper role of government, particularly Federal Govt. Is anyone proposing it now or have they in the recent past?

 

[Christopher]

Very good point.

We could spend unlimited amounts of money on each individual, even if the treatment has a near zero percent chance of working...but this would raise the cost of healthcare even higher.

Yet the right wingnuts went ballistic about taking a brain dead woman off of life support, yet support not giving a five year old boy a chance to take an experimental regime that might extend his life until a cure could be found.

Good point. The problem is the right is not consistent. Right wing leaders will not support this little boy because it costs lots of money. Money better spent giving an insurance company CEO a 70 million dollar bonus package.

Of course, the 17 year old girl who was denied health care and died and whose mother was given the bird by health care employees were made out to be the bad ones.

I just don't know what has gotten into Republicans? Health care companies have no doctors, no nurses, no hospitals. They stand between patients and care and skim money off policies. In a way, they are supposed to be like Unions, getting the best care for the smallest amount of money.

Instead, it's all about how much they can scam the American People and Republicans applaud that. Go figure.

Wow, you just added to my list. Item 4: demonize the Republicans.

 

[American Horse]

Yet the right wingnuts went ballistic about taking a brain dead woman off of life support, yet support not giving a five year old boy a chance to take an experimental regime that might extend his life until a cure could be found.

With all due respect OR, you are comparing apples to oranges, the dilemma is not the same at all.

 

[American Horse]

$55,000 per round of experimental therapy? Conventional chemotherapy treatments cost roughly $2000 per round. For the price of these two MIBG treatments, over 50 people could receive traditional chemotherapy treatment.


And people wonder why healthcare is so expensive in this country? Nobody wants to draw a line...

I see now that you see that it does work and is recommended, you've moved off that argument and gone on to the $$$ issue.

If you want to draw a line, then admit there is Health Care Rationing, simple as that. You seem to miss the fact that this is not some regular sort of cancer as well.

I think you need to read the article in full, then come back to debate.

At least it is rationing as a result of a decision that for their part can be made by the purchaser of the insurance, not a decision made by a bureaucrat on a federal level, leaving no choice in the open market. Furthermore there would never be an opportunity to question in court a decision made by a bureaucrat; it would be just one of many many thousands if not one of millions.

 

[boedicca]

Doesn't make any sense. FedEx and UPS are doing quite well and the US Mail, the "public option" never drove them out of business. Because one is available doesn't mean the other isn't.

Besides, I didn't know health care companies did "research". Think of that 73 million dollar CEOs salary going to research. What we couldn't have learned. Instead, he has a couple more mansions he will never use.

FedEx and UPS are not required to provide the same services as the US Mail - they are in very different businesses. The US mail provides 6 day a week residential and commerical delivery (largely of junk mail) - FedEx and UPS provide much higher fee based per item delivery.

Demonizing the incomes of people who are paid in private arrangements, which is what the incomes of corporate employees are, is just class warfare nonsense. The CEO's pay is the business of the company's shareholders. Period. They are the ones paying for it.

If you are going to go down that trail of "think of the better us of $XXX", then how about attacking how much a baseball player or actor makes? Or how much money could be spent on research if the government paid us all $20,000 per year of government living expense allowance and decided how every other dollar was spent?

 

[Christopher]

This is just a cynical sob story, for which the germane point is:

But HealthAmerica refused to pay for the MIBG, which it considers "investigational/experimental" because there is "inadequate evidence in the peer-reviewed published clinical literature regarding its effectiveness." Nor is MIBG approved by the Food and Drug Administration, another criterion that HealthAmerica requires.


Does anybody think that ObamaCare will pay for treatments not approved by the FDA?

Health care is a consumable, not an inalienable God given right. There has to be some limit to the extent of coverage, and the amount to be spent on treatment. Demonizing insurers for being subject to economic reality while ignoring the far worse outcome of politicized rationing is rather foolish.

Doesn't make any sense. FedEx and UPS are doing quite well and the US Mail, the "public option" never drove them out of business. Because one is available doesn't mean the other isn't.

Besides, I didn't know health care companies did "research". Think of that 73 million dollar CEOs salary going to research. What we couldn't have learned. Instead, he has a couple more mansions he will never use.

The USPS has a Congressional monopoly on non-urgent mail. How is that competing?
United States Postal Service - Wikipedia, the free encyclopedia