HMO = Shut Up and Die

I have an HMO rant burning inside of me, and I simply have to get it out. My friend has a rare form of bone cancer, and nothing was working to shrink the tumor. She researched day and night and came across a doc in another state who uses CyberKnife treatment, which is a robotic radiosurgery system designed to treat tumors anywhere in the body non-invasively and with incredible accuracy. She told her oncologist about it, and he wrote up the referral to her HMO. They turned her down for out of state treatment, but they did refer her to two CyberKnife programs in their network. Both turned her down.

My friend is one of those kick-ass, never take no for a final answer types and appealed the decision to California’s independent medical review board. But she didn’t stop there, after all, this was her life at stake. She also began raising money in case she had to pay for the treatment out of pocket. As she told me, “Screw those insurance weenies. I’m little more than a zit on their butts. It’s is all about the bottom line and acceptable losses. Plain and simple, I’m expendable in their eyes, and I’m not going to let them kill me.”

Her answer was to contact all of her friends and family to picket outside the insurance office. Newspapers and TV crews arrived to cover the event. We weren’t out there all that long before word came down that, magically, her treatment would be approved after all, and oh no, their sudden reversal had nothing to do with our makeshift protest. Hmm.

In an even stranger twist, a doctor from one of the original hospitals who’d turned her down saw the newspaper article and directed his office manager to call my friend. His thinking was, why have her travel across the country when she could have the same surgery in her own hometown? Indeed. He was even more puzzled that a doc from his own hospital had turned my friend down. Clearly, she was a very viable candidate.

Long story short, she had the treatments, and is doing so well it brings tears to my eyes. But I couldn’t help but think about the docs that turned her down. Was the insurance company pulling their strings? After some sleuthing, I discovered the appeals data from 2007 shows that of the state’s largest insurers, including my friend’s insurer, independent doctors sided with the patients in only one third of the cases. Why would that be? Can I really believe (or trust) that HMOs are so efficient that there is never any need for an appeal? Or is there collusion going on? I’ve heard horror stories about how doc’s feet are put to the fire by insurance companies if they ask for too many tests. Just how “independent” are these docs anyway?

I’m tickled pink that my friend is going to survive and live a long time. I’m devastated and bitter that she had to fight so hard and create a media circus to do it. Does anyone really believe socialized medicine will be any better? I certainly don’t.