An Insurance Company Denied a Life-Saving Treatment. A Judge Just Called It An "Immoral" Decision.

[babylonsister]

An Insurance Company Denied a Life-Saving Treatment. A Judge Just Called It An “Immoral” Decision.
In a stunning court filing, U.S. District Judge Robert N. Scola Jr. made it very clear how he felt about United Healthcare.

Abigail Weinberg


When a personal injury attorney had to pay $85,000 out of pocket for a life-saving prostate cancer treatment, he filed a class-action lawsuit against his insurer, United Healthcare. On Monday, the judge assigned to hear the case recused himself: not only had he been recommended the same treatment for his own prostate cancer, but a friend of his had paid $150,000 for the treatment when United Healthcare denied him coverage.

Proton beam radiation therapy has been an accepted cancer treatment method since the 1980s, according to the Washington Post, but United Healthcare denied the treatment to Miami-based attorney Richard Cole on the grounds that it was “experimental,” Cole said. Although Cole was able to afford his medical care, he filed the lawsuit on behalf of the potentially thousands of others who had been denied treatment as well.

On Monday, U.S. District Judge Robert N. Scola Jr. recused himself from the case because he felt that his personal experiences with prostate cancer prevented him from viewing the situation impartially. He wrote in his order of recusal that although he opted for surgery rather than radiation therapy, medical experts’ positive opinions toward radiation still resonated with him. (Cole’s case has been reassigned to another judge.)

Two other judges had previously recused themselves, saying they knew Cole too well to judge his case fairly.

Scola wrote in his recusal letter that a “very close friend” of his was diagnosed with cancer in 2015 and that United Healthcare had refused to pay for his proton radiation treatment. “Fortunately, he had the resources to pay $150,000 for the treatment, and only upon threat of litigation did United Healthcare agree to reimburse him,” he wrote.

The judge went on to rebuke the insurance company for denying patients care.

“It is undisputed among legitimate medical experts that proton radiation therapy is not experimental and causes much less collateral damage than traditional radiation,” Scola wrote. “To deny a patient this treatment, if it is available, is immoral and barbaric.”

more...

https://www.motherjones.com/politics/2019/05/united-healthcare-immoral-barbaric/

[marble falls]

1. Thank G*d for my socialist, single payer system: the VA. Everyone should have the same quality ...

of health care I get.

[IronLionZion]

12. Glad the VA is working for you

I've heard the same from most veterans I know. They mostly like it.

Republicans keep on spewing complaints about the VA's problems as why we shouldn't have single payer.

[marble falls]

21. Because there'd be too much oversight in over watching a single payer system. They want ...

to privatize the VA not because of any altruistic desire improve the lot of Vets. Their interest really isn't about the level of care for vets. Their interest is skimming the top of the billions well spent on vets.

[pazzyanne]

2. What can you expect from insurance companies

when the people in charge of approving changes to drug formularies do not know that albuterol (not covered by their formulary) is the same as albuterol sulfate. which is covered by their formulary. I spent almost an hour on the phone with my insurance company representative and the result was that I had to file formulary exception paperwork to get my asthma medication covered. The people they hire apparently have little to no education/ experience in working with the departments they are hired to oversee. In this case, they apparently did not have a Physician's Desk Reference available to their employees either.

[stevesinpa]

5. that's because

the insurance plan is to provide as little help as possible. they want their customers to get frustrated and give up.

[unblock]

11. medically, there may not be much meaningful difference, but

from an insurance perspective, it's all about which drug companies they have better pricing contracts with.

i've had insurance companies tell me my preferred med was non-fomulary, so i had to switch to a competitor's similar medication.
the next year, they told me the exact opposite, and i had to switch back.

such things are clearly not medical decisions, though obviously the have a medical impact on patients.


chemically, albuterol and albuterol sulfate are not the same thing.
albuterol is c13h21no3
albuterol sulfate is (c13h21no3)2so4

but insurance companies don't care about that, or any medical difference, they just want to steer you to the whatever is cheaper for them.

[hunter]

14. I suspect it's not about "cheaper for them..."

... and thus presumably cheaper for the customer.

Instead health insurance companies seem to be maximizing the flow of money they control.

The more money they control, the more they can siphon off for things like outrageous CEO incomes and private jets.

It's not exactly bribes and kickbacks within the system (although some of that probably exists) it's not exactly collusion with other health insurance companies or the pharmaceutical industry (although some of that probably exists) it's mostly that the business isn't transparent, and the various insurance companies are semi-monopolistic in their structure.

Our insurance company doesn't seem to be using the least expensive drugs from what I see of prices in Canada, Mexico, or other nations, or even based on the prices drug companies charge the VA. Our "copays" often seem to be similar to the true market price of the drug.

[unblock]

16. yes, it's all about their profit

correct, a lower-cost deal for them is not the only way to make more profit.

and yeah, you're right about copays. i have a migraine medication that insurance covers at 50% after i've hit my insanely high deductible. but the "retail" price is now double what it was a few years ago (it doubled after a generic became available -- ) so now i pay, *after* i hit my deductible, about 100% of the price i would have paid a few years ago without any insurance at all....

[pazzyanne]

18. Actually my asthma inhaler is Ventolin.

The generic is listed as albuterol (albuterol sulfate) on the inhaler pharmacy label. The pharmacy billed the inhaler as albuterol which the insurance would not cover. However, if they had billed it as Ventolin, it would have been covered. I had my pharmacy place a note for their billing department that from now on they needed to bill it as Ventolin.

[unblock]

19. Yeah, you know something fishy is going on

when they'll cover the brand name but not the generic....

[pazzyanne]

20. My thoughts also.

[ck4829]

23. Feature, not a bug. This is how they make money, and that's what it's all about.

[appalachiablue]

3. The US private, for profit healthcare system must be replaced

with Medicare4All. Canada's universal Medicare began in the 1960s, and the opposition then by insurance cos. and pharma was the same.

[genxlib]

4. To all such stories I say

"Thank God he doesn't have the Government between him and his Doctor"



Everyone arguing against Government involvement in health care must have much better luck with their insurance than I do. We have some of the best coverage money can buy and I still end up yelling into the phone several times a year.

[luvtheGWN]

15. Here's the thing about "government-run healthcare".

In Canada, the federal government makes payments to the individual provinces and territories. The provinces' health ministries manage those monies. Your doctor and you make the decision about treatment. Your doctor bills the health ministry. You never see the bill.

Now, not everything is covered. Drugs for those under 65, dentistry, physiotherapy, eye care, in fact pretty much everything that doesn't take place in hospital. But supplemental insurance which does cover those things is a benefit for full-time employees (and some part-time ones too), and if you are unemployed or have taken early retirement, you can generally afford supplemental insurance (usually around $200-$225/per month). Disabled folks receive a monthly income. Children who must spend their lives in institutional care are covered. I know several retirees who do not bother with supplemental insurance. because they know that if they get cancer, or suffer heart attack or stroke, or require joint replacement surgery, or simply have a health checkup yearly (or more often if necessary), or land in hospital for any length of time, THEY ARE COVERED.

Companies which provide supplemental insurance are thriving!

And yes, when Premier Tommy Douglas (Kiefer Sutherland's grandfather) brought in medicare in Saskatchewan in 1963, the docs went on strike for a month or so, and there was the expected protest from insurance companies. But the vast majority in the province thought it was a GREAT idea. The docs went back to work, and the insurance companies adapted. And medicare for all soon expanded to include the entire country.

[Hortensis]

6. Irresponsible title and article as stated.

Sounds like this man was rejected to die without this treatment, instead of having a comparable treatment available for which both the benefits and risks are much better understood, not just in themselves generally but in very great detail that is applied to individual cases.

PBT is an accepted treatment but not necessarily one most urologists feel comfortable recommending at this point. Remember, following one treatment course means not benefiting from another. Most feel the treatment with the best proven efficacy for the individual case is the one that should be used.

Last I heard, which admittedly was not recently, the very small percentage of patients who have gotten PBT therapy instead of almost all with IMRT have shown some indications of additional benefit, but not necessarily sustained, longer term effects of using protons are still to be determined, and patients have tended to be younger and more affluent, factors in results not adequately adjusted for. Yet.

More study and probably technical development needed.

[neeksgeek]

7. It's not just the costly procedures, either

The goal of the health insurance plans is to pay as little as possible. A personal anecdote to illustrate the point.

I’ve got a whole host of medical eye problems, I’ve had a few eye surgeries, and see an ophthalmologist (MD) several times a decade. I generally don’t bother with optometrists (OD), because a lot of them don’t really know what to do for my visual peculiarities. Anyway, the full medical eye exam includes refraction (getting an eyeglasses prescription), and even though it’s coded as a medical exam and not optometry, I always have to fight to get the medical insurance to cover that part.

[yaesu]

8. Its a criminal decision, attempted murder, & we have capitalism to thank for it. nt

[ck4829]

24. Indeed

[dlk]

9. The Judge's Ruling was Correct - And By the Way, Speaking of Death Panels...

Profit-based insurance companies, with their daily decisions that literally mean life and death for their customers, are the true death panels.

[pandr32]

13. Absolutely

[ck4829]

25. How true

[superpatriotman]

10. But NOT Illegal

Shouldn’t it be?

[area51]

17. Please support

comprehensive Medicare For All, and ask Speaker Pelosi to support it.

[ck4829]

22. K&R

[redstatebluegirl]

26. I remember when I needed back surgery my Primary Care Physician

referred me to another doctor to see if the pain could be managed. She did for about 2 years, after than nothing worked, I was using 2 canes and could barely walk. My insurance company at the time refused to allow a back fusion surgery she said I needed ASAP. She had me call them and then she took the phone, she told them she was a Harvard educated physician and asked the person from the insurance company what type of medical qualifications they had, when they said none, she said fine, you are practicing medicine without a license. The following day I was approved and in the hospital awaiting a fusion that changed my life. I have had 12 years of a decent quality of life.

Insurance companies are a plague on society.

[babylonsister]

28. WOW! Props to your doctor for

going to bat for you! And I'm glad the surgery was approved and helped you so much.

[redstatebluegirl]

30. Yea I love her and still see her to this day!

[Kurt V.]

27. That's my health health insurer. i had an opposite experience. they ok'd a new machine that would

assist the surgeon putting a stent in my leg. the stent failed in 6 months.

[Hoyt]

29. It appears proton beam therapy has very limited coverage in Britain and Canada. They more or less

have determined other radiation treatment is just as good for prostate cancer.

They do seem to cover it most often for cancer in children to avoid harming other tissue and minimize long term side effects.

Literature does show increasing coverage in these countries. But, the truth is, these countries do limit care to make universal coverage affordable. Don’t see that working here because people don’t like to be told “No,” even when it’s for good of society.

Here’s one link. Sorry, I’m on phone and it’s tough to link to everything out there.

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/07/16020_FINAL.pdf