At issue is a procedure known as "cyberknife." I'm not a doctor, so I won't pretend to know what exactly this involves. But the treatment is not considered surefire, although it is believed that it's Nick's best hope for survival. There is some dispute about whether or not the treatment is "experimental" and one Kossack who called PacifiCare was told this:
Just called and talked to Tyler Mason, the spokesguy...
He said that Nick Colombo's claims were reviewed by USC and Stanford (which developed cyberknife). Both hospitals said that Nick was not a good candidate for the procedure. He also said that California regulators reviewed the request. He said that the family found a doctor in Oklahoma who holds out some hope for cyberknife and they are pinning their hopes on this.
Poor Msson was upset at the 100s of calls he was getting and didn't know where they were coming from or why. :)
I don't doubt that Mason is spinning the facts and that there is more to the story. I also think that Pacifica should pay for the procedure even if only one doctor says that it could help. But I thought I should post Mason's response.
And California Nurses Shum had this to say about the dispute between Nick's doctors and PacifiCare:
For now, we have a compelling case with an important point: the medical decisions of this youth have been compromised by the system we have let him fall into. For now, we can save one person shortchanged by the industry--and hope that his story will inspire the changes that all of us need.
At the end of the day, none of us can truly unwind the medical disagreement here: Nick's doctors vs. PacifiCare's. But we can all see that Nick's care decisions are taking place in an environment where PacifiCare's profits are valued as much as his life, and we can never trust the results.
I think that's an excellent response to PacifiCare's attempt to muddy the waters. Many doctors dislike the insurance system partly because it limits their ability to provide care to their patients in this way (and it doesn't help that insurers routinely stiff doctors on reimbursements).
Ultimately this is another example of why it is such a bad idea to have insurance involved in the delivery of basic health care at all. That's not to say that government-run single-payer care would not have limits on what it could provide. But it would also not have the profit motive that leads insurers like Cigna and PacifiCare to coldly allow a young patient, who is insured, to die.
In Canada, for example, when there aren't enough beds in town for a patient, the provincial health care authority will fly a patient to a place where there ARE enough beds, at no cost to that patient. In France the government health provider ensures that a sick child gets the full range of treatment he needs to live.
In America, however, we have this:
Hospitals Rank UnitedHealth/PacifiCare "Worst" Insurance Company in Nation
The Minnetonka, Minn.-based insurer received an "unfavorable" opinion from 91% of the hospital executives who responded, while 8% gave it a "favorable" rating. United owns PacifiCare of California.
California investigates 100,000 claims processing problems by Pacificare
UnitedHealth/Pacificare Looking at 13% Growth
UnitedHealth Group Inc., the largest U.S. health insurer, is poised to reach its forecasts of 13 percent profit growth this year and next, even after being accused of cheating customers by New York's attorney general.
Former CEO of UnitedHealth had to surrender ***$620***million in pay for options backdating scandal
And PacifiCare was fined for its claims denial problems...a paltry $3.5 million:
Pacificare fined $3.5 million
"This is off the scales in terms of severity. We rarely see so many complaints," said state Insurance Commissioner Steve Poizner. "I simply will not tolerate shoddy claims practices."
Stories like Nick Colombo's and Nataline Sarkisyan's show us just how dire the state of health care in America has become, just how much we need root and branch reform - single-payer reform. With the failure of the pro-insurance industry mandate plan back in January, the initiative now seems to be with the advocates of single-payer care. Protest actions such as this will not only help save the life of a SoCal teen, but will help save many more lives as they hopefully become the basis of a broader single-payer movement.
It's horrific that it takes a teenager facing death for us to see just how deeply flawed the health insurance concept has become in America. But, here we are. Let's hope that PacifiCare does the right thing for Nick Colombo, and that WE can do the right thing and start working to ensure that all Americans have guaranteed access to affordable health care whenever and wherever they need it.
A full list of contact info, from nyceve:
You can also call this guy:
UnitedHealthcare
Tyler Mason, 714-226-3530--spokesperson
tyler.mason@phs.com
Main #: 714-952-1121
Then, you can move on to investor relations:
UnitedHealth Group
P.O. Box 1459
Minneapolis, MN 55440-1459
Ph. (800) 328-5979
Investor Relations Contact:
Cheryl Mamer
UnitedHealth Group
MN008-T930
9900 Bren Road East
Minnetonka, MN 55343
Ph. (800) 328-5979
Fax (952) 936-1819
Investor_Relations@uhc.com
Here's contact information for Pacificare:
Contact Information
Telephone Numbers
Main Telephone Number: 1-800-624-8822
Hearing Impaired (TTY): 1-800-442-8833 |
