Tuesday, December 1, 2009

Man with cancer says Blue Cross rations care

Posted by on Tue, Dec 1, 2009 at 2:19 PM

A couple of people were hanging out with signs in front of the Blue Cross Blue Shield building near Main and Pershing Road this morning. It was a pretty unusual sight.

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And up close, the signs turned out to be incredibly sad.

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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.

His wife, Linda, was there holding a sign with him. He says he

had his own business selling "aftermarket automotive supplies," but now

they've been through all of their savings. Linda says she got a

part-time job at the YMCA for $8.50 an hour, but it doesn't pay the

bills.

"You get sick and you lose everything you have in this

country," Wolf says. "They they send you a letter saying 'Due to rising

costs, we have to raise your rates.' To be on Medicaid, I'd have to

have nothing -- lose my house and everything I've worked for."

Which is just another argument for a single-payer national health plan. If only Americans were brave enough to demand real health-care reform.

I put in a call Blue Cross for a statement, but haven't heard anything back.

They'd probably just point me to all of those big new Blue Cross "bigger and better" billboards around town.

Update: Blue Cross and Blue Shield of Kansas City's Director of Corporate Communications, Sue Johnson, later issued this statement: 

Federal HIPAA regulations don't allow me to speak to any case specifically, and I can tell you that we were not contacted directly by the people outside our offices this morning. Our members have the right to appeal any decision they don't agree with, and we advise them of that right. There are three levels of appeal available, with third-party expert physicians reviewing the cases at each level. We welcome our members to contact us for more information or to talk further about their issue. Our medical policies are consistent with the Blue Cross and Blue Shield Association medical policies and we evaluate all policies on an annual basis, updating them as technology changes and evolves.


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