Stage 4 Cancer Patient loses coverage plan

Tsing Tao

Tsing Tao

You Also Can't Keep Your Doctor

http://online.wsj.com/news/articles/SB10001424052702304527504579171710423780446


By
Edie Littlefield Sundby
Nov. 3, 2013 6:37 p.m. ET

Everyone now is clamoring about Affordable Care Act winners and losers. I am one of the losers.

My grievance is not political; all my energies are directed to enjoying life and staying alive, and I have no time for politics. For almost seven years I have fought and survived stage-4 gallbladder cancer, with a five-year survival rate of less than 2% after diagnosis. I am a determined fighter and extremely lucky. But this luck may have just run out: My affordable, lifesaving medical insurance policy has been canceled effective Dec. 31.

My choice is to get coverage through the government health exchange and lose access to my cancer doctors, or pay much more for insurance outside the exchange (the quotes average 40% to 50% more) for the privilege of starting over with an unfamiliar insurance company and impaired benefits.

Countless hours searching for non-exchange plans have uncovered nothing that compares well with my existing coverage. But the greatest source of frustration is Covered California, the state's Affordable Care Act health-insurance exchange and, by some reports, one of the best such exchanges in the country. After four weeks of researching plans on the website, talking directly to government exchange counselors, insurance companies and medical providers, my insurance broker and I are as confused as ever. Time is running out and we still don't have a clue how to best proceed.

Two things have been essential in my fight to survive stage-4 cancer. The first are doctors and health teams in California and Texas: at the medical center of the University of California, San Diego, and its Moores Cancer Center; Stanford University's Cancer Institute; and the M.D. Anderson Cancer Center in Houston.

The second element essential to my fight is a United Healthcare PPO (preferred provider organization) health-insurance policy.

Since March 2007 United Healthcare has paid $1.2 million to help keep me alive, and it has never once questioned any treatment or procedure recommended by my medical team. The company pays a fair price to the doctors and hospitals, on time, and is responsive to the emergency treatment requirements of late-stage cancer. Its caring people in the claims office have been readily available to talk to me and my providers.

But in January, United Healthcare sent me a letter announcing that they were pulling out of the individual California market. The company suggested I look to Covered California starting in October.

You would think it would be simple to find a health-exchange plan that allows me, living in San Diego, to continue to see my primary oncologist at Stanford University and my primary care doctors at the University of California, San Diego. Not so. UCSD has agreed to accept only one Covered California plan—a very restrictive Anthem EPO Plan. EPO stands for exclusive provider organization, which means the plan has a small network of doctors and facilities and no out-of-network coverage (as in a preferred-provider organization plan) except for emergencies. Stanford accepts an Anthem PPO plan but it is not available for purchase in San Diego (only Anthem HMO and EPO plans are available in San Diego).

So if I go with a health-exchange plan, I must choose between Stanford and UCSD. Stanford has kept me alive—but UCSD has provided emergency and local treatment support during wretched periods of this disease, and it is where my primary-care doctors are.

Before the Affordable Care Act, health-insurance policies could not be sold across state lines; now policies sold on the Affordable Care Act exchanges may not be offered across county lines.

What happened to the president's promise, "You can keep your health plan"? Or to the promise that "You can keep your doctor"? Thanks to the law, I have been forced to give up a world-class health plan. The exchange would force me to give up a world-class physician.

For a cancer patient, medical coverage is a matter of life and death. Take away people's ability to control their medical-coverage choices and they may die. I guess that's a highly effective way to control medical costs. Perhaps that's the point.
 
White House Spokesman Sparks Outrage Over Comments About Cancer Patient

Twitter lit up over White House spokesman Dan Pfeiffer's statement blaming a Stage 4 cancer patient and insurance companies — instead of the president's signature legislation — for the woman losing the coverage that has kept her alive despite a dire prognosis.

Late Monday, Pfeiffer — under his Twitter tag @pfeiffer44 — tweeted a link to a story posted on the ultra-liberal blog "Think Progress," titled "The Real Reason That The Cancer Patient Writing in Today's Wall Street Journal Lost Her Insurance."

Ignoring the mandated changes under Obamacare, the story blamed United Healthcare for Edie Littlefield Sundby's problems, saying the company has struggled for years in California's individual-policyholder market and that it no longer wanted to foot the bill for the sickest patients.

Pfeiffer's is an official Twitter account, used to speak on behalf of the administration.

Californian Sundby became a poster child for Obamacare's ills when The Wall Street Journal published her letter about how she is on the cusp of losing her life-saving coverage — provided by a world-class team of doctors from three hospitals — despite the president's repeated promises to the contrary.

Her plan does not meet Affordable Care Act standards.

"My grievance is not political; all my energies are directed to enjoying life and staying alive, and I have no time for politics," Sundby wrote. "For almost seven years I have fought and survived Stage 4 gallbladder cancer, with a five-year survival rate of less than 2 percent after diagnosis. I am a determined fighter and extremely lucky. But this luck may have just run out: My affordable, lifesaving medical insurance policy has been canceled effective Dec. 31."

She is one of thousands across the country receiving similar letters from their current insurance carriers, despite President Barack Obama's assertions that under Obamacare, "If you like your insurance, you can keep it" and "If you like your doctors, you can keep them."

Over the years, Sundby has undergone chemotherapy and high-intensity radiation that helped eradicate an inoperable liver tumor. She had a large portion of her right lung removed. The treatment bought her seven years.

But now Sundby worries her time is up.

Her options: Get coverage through the government healthcare exchange and lose access to her cancer doctors, or pay 50 percent more for insurance outside the exchange and start over "with an unfamiliar insurance company and impaired benefits."

United has paid out $1.2 million for Sundby's care since 2007, according to the International Business Times. Sundby is one of 8,000 Californians who will be impacted when United pulls out of the individual health insurance market.

Sundby can enroll in an Obamacare plan but she can say good-bye to the successful treatment that has kept her alive, Forbes reports.

"Her treatment program involves doctors at both the Stanford and UC San Diego medical centers, and the M.D. Anderson Cancer Center in Texas — but there is no plan in the California exchange that includes both Stanford and UCSD centers in its network, much less M.D. Anderson. In fact, UCSD has joined only one provider network, and it's a heretofore almost unknown type called an "Exclusive Provider Organization" (EPO). The "exclusive" means that in an EPO, coverage is provided exclusively within the network — there is no out-of-network coverage, except what uninsured people get at the emergency room."

http://www.newsmax.com/newswidget/P...t&utm_campaign=widgetphase1#ixzz2joKhfeoA
 
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