Insurance Won't Pay NorCal Mom's Cancer Treatment

[FlamesAddiction]

Originally Posted by mykalberta

Is gamma knife considered experimental?

I can see why they would reject it based on costs because those things tend to be bloody he77 expensive. And while it may be the better procedure than full on brain radiation why does this one patient deserve this treatment and not others. And if they do would the costs for this procedure if it became more widely use bankrupt these companies.

Hopefully this doesnt turn into a Medicare vs US Medicine because I doubt the gamma knife is even available up here.

According to the insurance company, the gamma knife is acceptable, but they don't think it is the best treatment. Basically, they are disagreeing with the doctors who have been treating her and are most familiar with her particular situation..

So who do you trust...? Personally, I go with the doctor who has been treating her.

[Bagor]

So this is a case of an insurance company overriding an oncologist's prescribed treatment based on their own "medical experts"?

Gamma knife vs whole brain radiation. Wonder which is cheapest?

They should make a court case out of this and challenge the company to present their "best evidence-based medical research" to justify their three tumour rule.

[Phanuthier]

Originally Posted by FlamesAddiction

According to the insurance company, the gamma knife is acceptable, but they don't think it is the best treatment. Basically, they are disagreeing with the doctors who have been treating her and are most familiar with her particular situation..

So who do you trust...? Personally, I go with the doctor who has been treating her.

In capitalism, its the ones with the money that makes the rules, which is why I think the US health care system is garbage. Canada might not be great, but I'll take public health care over private health care.

[LChoy]

To plays devil's advocate, I doubt Canada even has a gamma knife to use unless it's still in experimental stage. However, Ontario government recently ruled that they would cover the cost of experiemental treatment if it's common place else where. IE, someone from Toronto gets the procedure, that isn't approved here, done in the States where it's common. All case by case though

[badnarik]

Originally Posted by mykalberta

Hopefully this doesnt turn into a Medicare vs US Medicine because I doubt the gamma knife is even available up here.

One way to ration things is to not have them.

[redforever]

Originally Posted by Lchoy

To plays devil's advocate, I doubt Canada even has a gamma knife to use unless it's still in experimental stage. However, Ontario government recently ruled that they would cover the cost of experiemental treatment if it's common place else where. IE, someone from Toronto gets the procedure, that isn't approved here, done in the States where it's common. All case by case though

http://www.elekta.com/healthcare_us_canadian_leksell_gamma_knife_centers _.php

[LChoy]

Originally Posted by redforever

http://www.elekta.com/healthcare_us_canadian_leksell_gamma_knife_centers _.php

I stand corrected

[Clever_Iggy]

Originally Posted by Bagor

They should make a court case out of this and challenge the company to present their "best evidence-based medical research" to justify their three tumour rule.

A woman who can't afford to pay her medical bills probably isn't in a position to bring a lawsuit against a medical insurer and I can't see any lawyer worth his salt taking this on contingency.

[Tower]

Originally Posted by Dion

I was being sarcastic. There's no way i'd give you his contact info.

Really? You were not posting genuinely? Hmmm... What happens to those people on this board.... Perhaps your sisters partner and I are already friends.

[Bagor]

Originally Posted by Clever_Iggy

A woman who can't afford to pay her medical bills probably isn't in a position to bring a lawsuit against a medical insurer and I can't see any lawyer worth his salt taking this on contingency.

Not to mention that she'd probably be dead before the whole thing concluded. I was thinking more along the lines of some sort of medical association. Surely there's an ethics issues here re quality of life where insurance companies are over-ruling and dictating treatment based on their sole "evidence based medical research" without considering the alternative argument.

Sneed is considered an expert on both procedures but said Blue Shield representatives didn't seem to want to listen to her opinion.

"There wasn't enough opportunity, I believe, to discuss it and talk about the pros and cons, and my rationale," she said.

If they don't want to discuss the issues fully but instead dictate the treatment then they need to be called to justify and defend their decisions and the reasoning behind what appears to be an arbitrary 3 tumour rule.

[Hack&Lube]

The thing is that capitalism works on the fundamental notion that competition drives prices to the market for goods and services that customers can choose between or go without.

The problem with healthcare is that is it not a good that can be foregone (or else you choose to suffer instead, perhaps die), the demand is always there and therefore the price can get jacked up through layers and layers of business and insurance and bureucracy and profit motivated medical companies and care providers.

[puckhog]

Let me first say that this is a terrible situation, and I very much disagree with this insurance company's decision. However, many people here seem to be using this an argument for public healthcare, when the same problem exists in our (Canadian) system. As another poster said earlier, it's simply a corporate bureaucrat vs. a government bureaucrat, either way they both have to justify the costs. I've got two stories to illustrate my point, both about family friends:

One of my parents friends was diagnosed with cancer. The doctors here in Canada told him that they would not offer him treatment (other than for pain), estimated that he had six months to live and told him to get his affairs in order. Not being content with this, and in the position to do so, he travelled to the Mayo clinic for a second opinion. The doctors there could not believe that our doctors would not offer treatment; they wrote up some paper work recommending immediate commencement of chemotherapy and sent him back. Our system refused to take this recommendation, told him what they had before and left it at that. He has since been travelling regularly to the States for his treatment, and instead of six months has lived for three years.

Another friend went to her doctor with symptoms that were potentially consistent with both uterine cancer and benign cists. The doctor examined her and concluded that it was more likely that she had benign cists, and sent her home with a treatment plan for that. There was a test he could have run to conclusively tell which condition she had, but refused to do so because of the cost. Five weeks later her condition had gotten worse, so the test was finally performed - oops, turns out it was cancer. Unfortunately she passed away several months later. I'm not going to argue that the earlier testing would have saved her life for sure, but it would have at least given her a better chance.

I'm not going to argue which system is better, I'm just pointing out that this same flaw is present in both systems.