patrick.net

Nobody says

When my son was delivered through C-section. The total bill came out to more than $100K.

The better question is, did you really need a C-section, or was it done mainly so they could bill $100k? No other country has nearly as high a % of C-sections as the United States, but plenty of other countries have lower rates of infant mortality. C-sections have been done for thousands of years, but weren't nearly so common before they became so lucrative, and still aren't nearly so common in places where they aren't so lucrative.

Regarding the OP, it is wildly optimistic and unfounded to call the realtor's surgery "life-saving." We don't know yet what the result will be. According to the article, the 45-year-old realtor has endured a series of surgeries, the cancer has spread, and the insurer calls the procedure experimental or exploratory. For all we know, it might turn out to be life-ending surgery. BTW, the realtor has insurance, which is going to be mandatory for almost everyone starting next year. Speaker Pelosi said, "Never trust the insurance companies." Then she voted to make most people do exactly that, which is why she is no longer Speaker.

At least this guy got his surgery (the man in the story).

Weird. Why would they consider removing tumors as "experimental surgery"?

Homeboy says

Weird. Why would they consider removing tumors as "experimental surgery"?

They don't. They consider the procedures/surgeries as "experimental" and "exploratory" in nature. Insurance companies often require that a medical procedure be thoroughly tested and proven effective before they decide to cover it. Unfortunately, it's a lengthy process and people with life-threatening illnesses don't always have time to wait.

Homeboy says

Weird. Why would they consider removing tumors as "experimental surgery"?

Because they didn't want to pay.

Suburban Gal says

Homeboy says

Weird. Why would they consider removing tumors as "experimental surgery"?

They don't. They consider the procedures/surgeries as "experimental" and "exploratory" in nature. Insurance companies often require that a medical procedure be thoroughly tested and proven effective before they decide to cover it. Unfortunately, it's a lengthy process and people with life-threatening illnesses don't always have time to wait.

Sorry, I don't follow. I asked why they consider the surgery experimental, then you wrote "they don't", and wrote that they consider the surgery experimental. Did you mean to write "they DO"?

Maybe I should be more plain in my meaning. Haven't doctors been removing tumors for hundreds if not thousands of years? Would not the testing phase of tumor removal surgery have been completed by now?

When someone like me advocates universal healthcare, maybe it is really something the market has trouble with.

epitaph says

Homeboy says

Weird. Why would they consider removing tumors as "experimental surgery"?

Because they didn't want to pay.

Gee, ya think?

Homeboy says

Sorry, I don't follow. I asked why they consider the surgery experimental, then you wrote "they don't", and wrote that they consider the surgery experimental. Did you mean to write "they DO"?

You initially asked why would they consider removing tumors as "experimental surgery." I said they don't because people have had tumors removed for a long time and it's generally covered by insurance. However, the particular procedures/surgeries this man is having are different from the norm. Because they're different from the norm, the insurance company refuses to pay.

Homeboy says

Would not the testing phase of tumor removal surgery have been completed by now?

It depends on how new these procedures/surgeries are.

Suburban Gal says

However, the particular procedures/surgeries this man is having are different from the norm.

Really? Is it the "norm" just to leave all the tumors in and not do anything about it?

Homeboy says

Is it the "norm" just to leave all the tumors in and not do anything about it?

No. However, his doctor determined that these new procedures/surgeries would be more beneficial to him as the patient. The doctor also most likely saw him as a good candidate to try the new procedures/surgeries on. The downside to that is that his insurance company decided they weren't going to pay and that the standard procedures/surgeries in place were good enough.

Paying for someone's care is costly. Insurance companies want to make sure that they're paying out on procedures that are established and proven so they're not just throwing away their money. Insurance companies aren't your friend. They're looking for ways to save money, NOT spend money. So when claims come in, they're highly scruitinized. They look for every possible way to deny the claim so they don't have to pay. This is just one way they do it.

Suburban Gal says

No. However, his doctor determined that these new procedures/surgeries would be more beneficial to him as the patient.

What "new procedures"? Did you read the article? It says he had the tumors removed. We're going in circles. I keep saying removing tumors is not an experimental procedure, and you keep agreeing, but then you keep saying this is experimental surgery. Does not compute.

Homeboy says

What "new procedures"?

Homeboy says

It says he had the tumors removed.

Homeboy says

I keep saying removing tumors is not an experimental procedure, and you keep agreeing, but then you keep saying this is experimental surgery. Does not compute

Whatever methods, techniques and/or devices/instruments the doctor used in the surgeries and whatever methods, techniques and/or medications the doctor is using and/or prescribing to the patient afterwards is considered "experimental" and "exploratory" in nature. Therefore, the procedures/surgeries are being classified in and of themselves as "experimental" and "exploratory," which then leads to them being denied by the insurance companies.

I don't know anything about this case, but you just can't fix a condition by surgically removing tumors. That's like trying to fix a roach problem by only killing them when they come out.

"treatments that doctors told him would stretch his life expectancy from one to two years to at least seven"

ah, yes. While I think the insurance company should just pay for this (and thus all our rates should rise), in a sane system giving this 45 yo guy 5 extra years has to be balanced against what other good those care dollars could go to.

It's always possible for medicine to give us another 5 years. Quality of those 5 years is the open question.

Bellingham Bill says

I don't know anything about this case, but you just can't fix a condition by surgically removing tumors. That's like trying to fix a roach problem by only killing them when they come out.

Well if I understand you, you are suggesting that the insurance company is refusing to pay because his condition is terminal and the surgery is not a "cure" for cancer. That doesn't make sense to me. There IS no cure for cancer. So could insurance companies declare ANY cancer treatment to be "experimental", since no treatments actually cure cancer? Again, I've heard of tumors being surgically removed before; I was pretty sure it's not a new, experimental thing.

Suburban Gal says

Whatever methods, techniques and/or devices/instruments the doctor used in the surgeries and whatever methods, techniques and/or medications the doctor is using and/or prescribing to the patient afterwards is considered "experimental" and "exploratory" in nature. Therefore, the procedures/surgeries are being classified in and of themselves as "experimental" and "exploratory," which then leads to them being denied by the insurance companies.

Not sure if you are being facetious now. That's just circular reasoning. You basically said it's exploratory because it's exploratory.

This is an end of life issue.

The guy went through seven months of chemo, and the cancer is still spreading.

This surgery is to remove a lot of his liver that has tumors. There is nothing to say that this will fix anything. It's just another thing to try in hopes it will slow his demise.

I applaud the guy for bringing this issue to the press, because insurance company denial is pretty common.

Nobody says

The total bill came out to more than $100K. I thought C-section was rather a simple procedure.

I don't believe a c section cost 100k. Including a long stay in the NICU, maybe. I've never seen one even close to that and I've done a lot of work in medical billing. Post the bill to show how this is possible.

Very poorly written article. The guy has stage 4 colon cancer which means it has spread outside the colon to other areas of the body. The 5 years survival rate is less then 10%, regardless of treatment. Colon cancer typically spreads first to the liver and liver resections are not uncommon or an experimental treatment. They can help extend life. We don't know what else is going on in his body but the claim of 5 to 7 years further life from the surgery is IMO pretty much bunk. He will almost certainly not be cured and while it is possible he could live another 7 years it is very very unlikely that will happen, surgery or no. Most people with stage 4 colon cancer go on 'permanent' chemo which damps down the disease but never cures it.

This post is one of those very common can't win situations that the bitchers and moaners love so much. If the guy gets denied surgery then it's heartless death panels. If he gets the surgery then it's wasting money on someone who is terminal anyway.

Homeboy says

Weird. Why would they consider removing tumors as "experimental surgery"?

Read the article more carefully. It doesn't say what the new surgery is going to be. It only says he had surgery in the past to remove tumors.

rdm says

Very poorly written article.

That's what I figured. It didn't add up the way it was written. I appreciate you actually explaining it rather than just going in circles and repeating what the article said.

bob2356 says

Read the article more carefully. It doesn't say what the new surgery is going to be. It only says he had surgery in the past to remove tumors.

Actually, I think I read it more carefully than YOU did. That's not what it says.

"Lewis' insurance carrier would not pay for the SURGERIES TO REMOVE HIS TUMORS, treatments that doctors told him would stretch his life expectancy from one to two years to at least seven.

Lewis and Blansit got that news just hours before Lewis' second surgery in October but decided to forge ahead with THAT PROCEDURE, as well as a third and final operation...

Lewis' insurance carrier declined to cover the operationS (PLURAL) because they were classified as "experimental" and "exploratory,"..."

Anyway, I think the problem is that it's just a poorly written article.