Legislative Report: Two (personal) reasons for health reform
Health reform continues to be debated on national and state political stages. Sometimes the power of personal stories is lost in these debates. As we head toward another winter of debating health care in Montpelier I wanted to share a couple of my own experiences and ask you to share yours with me. The names in the stories below are not fictional because they all helped save my life. In an effort to be polite I have refrained from naming those who have not assisted in this effort.
Many readers will know that I am a cancer survivor. When I was diagnosed with non-Hodgkin’s lymphoma four-and-a-half years ago my doctor said that this was the best bad news he could give me because non-Hodgkin’s is one of only a couple cancers that can be cured.
The treatment for this cancer is pretty straightforward. The standard chemotherapy is a cocktail of five drugs administered four to six times, once every 3 weeks or so. I don’t recall all the drug names but I will never forget “Rituxin.” Rituxin is, by all accounts, a miracle cancer fighting tool. It shrinks tumors and it costs something like $5,000 per dose.
Mid-way through my course of chemotherapy I got a notice from my insurance company indicating that they had denied Dr. Nunnink’s request to administer Rituxin the following week. I made a couple of calls but figured this would work itself out as they had already approved a couple prior treatments.
Sitting in the drip room with an IV in my arm I started to get a bit worked up when the nurse told me that Dr. Nunnink was still arguing with my insurance carrier.
What followed was a bit surreal. Feeling some pressure to get the chemotherapy started I made some phone calls. I called my friend Steve Maier, then chair of the House Health Care Committee. Steve called the lobbyist for the insurance carrier who called me back. Miraculously, the bag of Rituxin appeared within minutes. Later, I learned from Dr. Nunnink that the insurance carrier’s pharmacist was questioning how often he was giving me the Rituxin.
A few questions linger from this experience. Is it fair that I was able to use my contacts in order to cut through the insurance approval haze? What about all the other patients in the drip room who didn’t have access to the folks I called? Lastly, what is an insurance company pharmacist doing questioning my oncologist’s chemotherapy protocol?
Fast forward to last week. I stopped in at Porter Hospital for what I hope is my last post-treatment CT scan. Chelsea at Dr. Nunnink’s office mentioned that the insurance carrier (a different one this time) had denied the chest CT.
Enter Roberta, the CT tech. She also mentions that the chest CT isn’t ordered even though we’ve done several previously. When she tells me that Dr. Nunnink won’t get a CT image of the area just above my heart (where the largest of my five tumors was) I get a little upset.
In my johnnie, I stroll out to the curb of the hospital (no cell service inside) to call my insurance carrier. The call taker was smart enough to put me on with a supervisor who insisted that they had not denied anything. Cell phones being what they are these days, I conference Chelsea who confirms both that the chest CT was denied and that Dr. Nunnink had argued (perhaps loudly) with the carrier to no avail. When the supervisor digs into the “correspondence” she finds a subsequent approval that was never sent to Dr. Nunnink. An hour or so later Roberta does the chest CT.
By now everyone knows that Americans pay more than anyone else on the planet for health care. And we know that Americans are no healthier for all that spending. These stories may help to explain this contradiction. It turns out that your health insurance carrier may not be working to promote your health. As we build a new system this must change.
Please share your health care stories (good and bad) with me at [email protected].
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