Sunday, August 12, 2007
Your Application for Healthcare Treatment is Rejected
The Kansas City Star chronicles the story of Julia Slaven, who was fighting multiple myeloma, a cancer of the immune system’s plasma cells. She also was fighting her health insurer, Coventry Health Care of Kansas Inc. Coventry had refused to cover a second stem-cell transplant procedure for Slaven — despite the recommendation of her doctor — saying it would be “experimental or investigational.”
So how do insurance companies decide what to cover? “That’s the $64 question,” said Annis, who teaches at the Dartmouth Medical School in Hanover, N.H. “The insurance companies too often look at the cost and need a justification to deny a claim, and say it’s experimental.” Indeed, what is considered experimental in the United States might be a standard procedure in another country. That is why some patients who are denied coverage have joined the hundreds of thousands of Americans who travel overseas for health care. Since they are being forced to pay out of pocket, they go to countries such as India and Thailand, where medical procedures cost much less than in America.
So I checked out Coventry's home page, which says, "At Coventry Health Care of Kansas, Inc. we offer affordable health insurance plans that fit the needs of people and business today. We’re finding better ways to control costs and give members more choices."
Better ways to control costs - Tell sick people to bugger off
Give members more choices - Take it or leave it
The CEO of Coventry Health Care Inc., Dale B Wolf, has made a cool $7.46 million, according to Forbes. Maybe a tiny part of those millions could have been used to pay for treatment for people like Julia Slaven?
Update: Found another case where the same thing is happening. Michele Marron from Cranford, NJ, needs a stem cell transplant, proven to extend the life of cancer and lupis patients. Her insurance company will not cover the procedure, considered to be experimental in scleroderma patients, despite having positive results in some cases. The procedure and related medical bills would cost around $250,000.
In other news, Emily Dagostino, GoUpstate.com, writes about a Spartanburg, SC woman named Linda Moehlman, who went to Brazil for weight loss surgery. "Moehlman is one of a small but growing number of Americans embracing overseas surgical options. Her surgeon, Dr. Antelmo Sasso Fin, wrote in an e-mail that he does about 25 laparoscopic duodenal switch surgeries monthly for Brazilian patients. He said he operated on 15 foreign patients last year and has about 50 international patients overall.
"In Brazil we do WLS (weight-loss surgery) cheaper than worldwide, but we have (an) international quality," the e-mail said."
Brook Wilkinson, writing for the Conde Nast Traveler magazine, asks 'How safe is a surgical safari?' and lists some rules of thumb before you pack your bags and head to Rio for some nip and tuck.
Coming up next is an interview with Dr. Jason Yap, Director, Health Care Services, Singapore tourism Board. Also, some exiciting interviews are in the pipeline - One with a JCI representative, another one with a SAP Health business development executive who will explain the benefits of applying technology and software to medical travel, and another with a Professor who wants to explain what his future trend forecasts and analysis have to say about medical tourism. Going to be an interesting week, to say the least. Stay tuned.
So how do insurance companies decide what to cover? “That’s the $64 question,” said Annis, who teaches at the Dartmouth Medical School in Hanover, N.H. “The insurance companies too often look at the cost and need a justification to deny a claim, and say it’s experimental.” Indeed, what is considered experimental in the United States might be a standard procedure in another country. That is why some patients who are denied coverage have joined the hundreds of thousands of Americans who travel overseas for health care. Since they are being forced to pay out of pocket, they go to countries such as India and Thailand, where medical procedures cost much less than in America.
So I checked out Coventry's home page, which says, "At Coventry Health Care of Kansas, Inc. we offer affordable health insurance plans that fit the needs of people and business today. We’re finding better ways to control costs and give members more choices."
Better ways to control costs - Tell sick people to bugger off
Give members more choices - Take it or leave it
The CEO of Coventry Health Care Inc., Dale B Wolf, has made a cool $7.46 million, according to Forbes. Maybe a tiny part of those millions could have been used to pay for treatment for people like Julia Slaven?Update: Found another case where the same thing is happening. Michele Marron from Cranford, NJ, needs a stem cell transplant, proven to extend the life of cancer and lupis patients. Her insurance company will not cover the procedure, considered to be experimental in scleroderma patients, despite having positive results in some cases. The procedure and related medical bills would cost around $250,000.
In other news, Emily Dagostino, GoUpstate.com, writes about a Spartanburg, SC woman named Linda Moehlman, who went to Brazil for weight loss surgery. "Moehlman is one of a small but growing number of Americans embracing overseas surgical options. Her surgeon, Dr. Antelmo Sasso Fin, wrote in an e-mail that he does about 25 laparoscopic duodenal switch surgeries monthly for Brazilian patients. He said he operated on 15 foreign patients last year and has about 50 international patients overall.
"In Brazil we do WLS (weight-loss surgery) cheaper than worldwide, but we have (an) international quality," the e-mail said."
Brook Wilkinson, writing for the Conde Nast Traveler magazine, asks 'How safe is a surgical safari?' and lists some rules of thumb before you pack your bags and head to Rio for some nip and tuck.
Coming up next is an interview with Dr. Jason Yap, Director, Health Care Services, Singapore tourism Board. Also, some exiciting interviews are in the pipeline - One with a JCI representative, another one with a SAP Health business development executive who will explain the benefits of applying technology and software to medical travel, and another with a Professor who wants to explain what his future trend forecasts and analysis have to say about medical tourism. Going to be an interesting week, to say the least. Stay tuned.
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