When it rains, it pours
When it rains it pours.
As we continue to manage one family member's 8-1/2 year battle with ovarian cancer, another family member was just diagnosed with a fairly aggressive and somewhat advanced melanoma. After extensive research and discussions with a number of experts, we arranged for him to enroll in a promising vaccine protocol. It is overwhelming to simply be diagnosed with an advanced version of a bad cancer. Then, to top it off, to be told that most of the standard therapies have not been shown to prolong life span. Tough news to absorb when you are feeling great. So he has opted for a combination of a new chemotherapy agent, Abraxane, with a protocol using his own melanoma cells to create a vaccine.
After many visits and quite a few blood tests and x-rays, the moment has finally come to get his first dose of chemotherapy. As he sits, waiting for an unknown but potentially unpleasant experience, the nurse comes out and announces, "everything looks good but there is a slight glitch" that must be taken care of. Even though the world's experts in melanoma have recommended this new and exciting chemotherapy agent, apparently Medicare and the FDA have not approved this drug specifically for melanoma. This means he is now responsible for almost $5,000 dose of medication, or he can come back in a few weeks for another treatment to be decided at a later time.
What a decision to have to make under such pressure! How do most people deal with this unexpected problem? What if there are no other options and you cannot afford the high price of a new chemotherapy agent? But how can you not proceed, knowing that all the other treatments are relatively ineffective? And why, if the world's specialists in melanoma feel that this drug is the best thing to do to save his life, do the bureaucrats and pencil pushers at Medicare and the FDA have the power to override these doctors' recommendations? At what point is this interfering with the doctor-patient relationship?
This is not the first time we have encountered stupid, blanket decisions from non-medical decision-makers that can and do hurt patients. Going back to my other family member with ovarian cancer, year after year we have found that having a PET scan has been the most reliable way to diagnose her recurrent cancers. Even though the medical literature is filled with dozens of articles supporting the use of the PET scan for a evaluating recurrent ovarian cancer, our federal government is still many years behind the experts so each $1200 scan is still not covered by Medicare. "But what about private insurance companies," you ask? I'm sure you won't be surprised to learn that they, for the most part, follow the Medicare guidelines. These companies that claim to care about you have chosen not to follow the recommendations of the very experts and specialists that they employ. Sadly, I think it is not about doing what is best for the individual. It seems to be about the money.
What is the solution? It is relatively simple. Allow the doctors to be doctors. It is quite clear that the CEOs and accountants at the helm of our medical insurance companies (including Medicare) feel that cost control and bureaucracy are more important than caring for patients and saving lives. Why do non-medical business people feel qualified to interfere with and override your doctor-patient relationship? If you find yourself in one of these situations, become vocal. Call and write to the medical directors of your health plan. Call and write to your congressmen and senators. Tell them that unless they have gone through decades of training and practice, to get out of your doctor-patient relationship. It's just not right. Ask them if they are willing to assume personal liability for a negative medical outcome as a result of their decisions. It's about time we all say enough is enough.
Related Topics: Is Workplace Health Coverage Dying?, Milestone Medical Tests
Technorati Tags: ovarian cancer, melanoma, Medicare, cost of healthcare
As we continue to manage one family member's 8-1/2 year battle with ovarian cancer, another family member was just diagnosed with a fairly aggressive and somewhat advanced melanoma. After extensive research and discussions with a number of experts, we arranged for him to enroll in a promising vaccine protocol. It is overwhelming to simply be diagnosed with an advanced version of a bad cancer. Then, to top it off, to be told that most of the standard therapies have not been shown to prolong life span. Tough news to absorb when you are feeling great. So he has opted for a combination of a new chemotherapy agent, Abraxane, with a protocol using his own melanoma cells to create a vaccine.
After many visits and quite a few blood tests and x-rays, the moment has finally come to get his first dose of chemotherapy. As he sits, waiting for an unknown but potentially unpleasant experience, the nurse comes out and announces, "everything looks good but there is a slight glitch" that must be taken care of. Even though the world's experts in melanoma have recommended this new and exciting chemotherapy agent, apparently Medicare and the FDA have not approved this drug specifically for melanoma. This means he is now responsible for almost $5,000 dose of medication, or he can come back in a few weeks for another treatment to be decided at a later time.
What a decision to have to make under such pressure! How do most people deal with this unexpected problem? What if there are no other options and you cannot afford the high price of a new chemotherapy agent? But how can you not proceed, knowing that all the other treatments are relatively ineffective? And why, if the world's specialists in melanoma feel that this drug is the best thing to do to save his life, do the bureaucrats and pencil pushers at Medicare and the FDA have the power to override these doctors' recommendations? At what point is this interfering with the doctor-patient relationship?
This is not the first time we have encountered stupid, blanket decisions from non-medical decision-makers that can and do hurt patients. Going back to my other family member with ovarian cancer, year after year we have found that having a PET scan has been the most reliable way to diagnose her recurrent cancers. Even though the medical literature is filled with dozens of articles supporting the use of the PET scan for a evaluating recurrent ovarian cancer, our federal government is still many years behind the experts so each $1200 scan is still not covered by Medicare. "But what about private insurance companies," you ask? I'm sure you won't be surprised to learn that they, for the most part, follow the Medicare guidelines. These companies that claim to care about you have chosen not to follow the recommendations of the very experts and specialists that they employ. Sadly, I think it is not about doing what is best for the individual. It seems to be about the money.
What is the solution? It is relatively simple. Allow the doctors to be doctors. It is quite clear that the CEOs and accountants at the helm of our medical insurance companies (including Medicare) feel that cost control and bureaucracy are more important than caring for patients and saving lives. Why do non-medical business people feel qualified to interfere with and override your doctor-patient relationship? If you find yourself in one of these situations, become vocal. Call and write to the medical directors of your health plan. Call and write to your congressmen and senators. Tell them that unless they have gone through decades of training and practice, to get out of your doctor-patient relationship. It's just not right. Ask them if they are willing to assume personal liability for a negative medical outcome as a result of their decisions. It's about time we all say enough is enough.
Related Topics: Is Workplace Health Coverage Dying?, Milestone Medical Tests
Technorati Tags: ovarian cancer, melanoma, Medicare, cost of healthcare
2 Comments:
My mother is now an end-stage ovarian cancer patient and also, unfortunately for her, a senior citizen on Medicare. While she worked long hours for many, many years to provide her, my father and the rest of her family health benefits while earning a meager wage, now it is hour of need. She was so concerned in 2005 about getting my father enrolled in Medicare D that she did not stop to enroll herself, only to have the 'enrollment window' close on her. None of us were aware of this deadline. Now we are clinging to the hope that we can get her signed up for next year's enrollment. But her oncologist has been making foreboding comments about how certain plans do not have 'gap coverage' which she will surely need (this wretched 'donut hole' in coverage reached after likely just one chemo treatment was another big unknown to us all until this point). And the good doctor tells us that still other plans, which currently may cover her present littany of drugs on top of the chemo, may elect NOT to cover those same drugs next year. Who can advise us on these things? How does one cram this in in between the business of fighting cancer? This is tantamount to our government turning its back on the people. We have so few resources, it is appalling. And as you say, it's disheartening enough to get the doomsday diagnosis, but to be told you must pay out of pocket or 'walk'...? I never thought I would see the day when I heard myself say this, but it makes me wish we lived in...Canada.
Unlike lynn I am so glad we do not live in Canada. The waiting for surgery and treatments can be months even with catostrophic illness such as cancer. People can die before the appointment date rolls around or come to The U.S.A. to get treatment. There one can not even pay for ones treatment as it is against the law to do so.
My problem is Blue choice Insurance denying a PET scan for a closer look at my husband. He has been treated sucessfully in the last 10 years for prostate cancer. But now there is a few things that the Doctor is concerned about a tumor was removed in the bladder and a rectul mass was also observed. Due to his past history and family history of cancer,both parents died of cancer.The Father of prostate and mother of colon cancer. The Doctor thinks it is most necessary for my husband to have a PET scan. He spoke to the Doctor who works for the insurance co. Blue Cross. The one who is getting paid for saying no to these ill people, who would have hope with the medical treatments available to us these days. I just wonder how quickely this Doctor would say yes to the same and any other treatments if it was to save her or loved one of hers. I would like to know this. We need to write to our Senators and congressmen to get out of the Doctor patient relationship unless they are willing to take personal liability for the negative outcome due to the results of their decisions. Jn.
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