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Medical Forum / General / General / February 2006

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Man Dies After Insurance Co. Refuses To Cover Treatment

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KT - 11 Feb 2006 04:19 GMT
Tracy Pierce, 37, lived a full life. He grew up with family and faith.
He went to a Catholic school, got married, had a son, and he even had
the car of his dreams. It was the perfect life.

"He's been strong. He has," his wife, Julie Pierce, said.

Two years ago, Tracy Pierce's life changed dramatically when he was
diagnosed with kidney cancer.

"I have no treatment. Three months has gone by and I haven't had any
treatment," Tracy Pierce told KMBC's Jim Flink in May 2005.

When Flink talked to Tracy Pierce, his cancer was attacking his body.
Despite being fully insured, every treatment his doctors sought for
him was denied by his insurance provider. First-Health Coventry deemed
the treatments were either not a medical necessity or experimental.

"I don't know what else to do but just wait," Tracy Pierce said last
May.

As he waited, his doctors appealed again and again, including a
27-page appeal spelling out that Tracy Pierce would die without care.
Coventry dismissed each request.

"It's purely economical. You never see an insurance company try to
block an inexpensive test," said William Soper.

Soper leads a group of doctors who filed a lawsuit last year against
insurance providers. This week, Soper went to Jefferson City to lobby
legislators for change.

"And you know, it's not going to get better anytime soon. It's going
to get worse," said Myra Christopher, who is the president and chief
executive officer of the Center for Practical Bioethics.

Christopher told Flink that change won't happen until there's a change
in the entire medical model.

"I just believe strongly that we need to start being honest about
what's going on here," Christopher said.

What is going on is that some insurance companies deny even routine
treatments because insurance companies treat their patients as costs,
not as clients, Christopher said.

"Some of these companies are just unethical the way they treat both
subscribers and providers, doctors and hospitals," Soper said.

Two weeks ago, Tracy Pierce talked with Flink again.

"Just holding a lot of anger in," Pierce said.

Cancer ravaged his body, moving from his kidney to his lungs and to
his brain.

"Now, we're just to the point where we're trying to make him
comfortable," Julie Pierce said.

Even as he was dying, for more than a week, his insurance company
denied him oral morphine, which had been prescribed to reduce his
pain.

"That's unacceptable because in this day and age, no one should be in
pain," Pierce said.

"I just hope we can get something done about it, that's all. We just
have to get something done," Tracy Pierce said.

An hour and a half after Tracy Pierce talked to Flink, he took a nap
and never woke up. His family calls his case death by denial.

"They just wrote a prescription for him to die," Julie Pierce said.

The family is begging for change.

"The reality is the blame-and-shame game isn't going to get us
anywhere. We are all at fault," Christopher said.

Insurance companies, hospitals, doctors, patients and politicians all
need to work together, she said.

"We have to have the moral will. We have to have the intelligence. We
have to have the political leadership to change this," Christopher
said.

For Julie Pierce, it was 15 months of watching her husband die slowly,
painfully and helplessly with no chance at lifesaving treatment, Flink
reported.

"My mother always told me to get a good job with insurance. For what?
It hasn't done anything," Julie Pierce said.

Julie Pierce said that she understands that we will all die. What is
expected, she said, is that if you have health insurance, you'll be
given every fighting chance. She said that is not happening.

Leukemia Story

Last fall, 12-year-old Nathan Crabtree was an outgoing child getting
ready for a new school year. But his father says Nathan often played
sick to extend summer vacation by a day or two.

To prove a point, his dad took Nathan to a doctor for test, which
showed that Nathan had an aggressive form of leukemia -- one that
needed immediate treatment.

Flink reported that a hospital room has become Nathan's classroom. He
spent just two days of his sixth-grade year with classmates; mostly,
he's been at Children's Mercy Hospital.

"It's not going away, so they were going to send me to Minnesota,"
Nathan said.

Doctors wrote to Nathan's insurance company, urging it to send him to
the nation's foremost research hospital. Nathan's bags were packed,
when his father's insurance company, Coventry, refused to pay for that
care, calling it "experimental."

"You don't have anyone to fight for you," said Lee Crabtree, Nathan's
father.

Lee Crabtree said he's desperate.

"I have to go out and find private grants, because for all intents and
purposes, I have to assume I have no medical coverage," Lee Crabtree
said.

"I think they expect or depend on people giving up after the first
phone call," said Dr. William Soper, the executive director of
Mid-America Medical Affiliates.

Soper said his group is so upset with insurance companies that it has
filed a lawsuit alleging insurers block patient care.

"We have patients who say, 'I want a complete physical,' and we'll
look at their insurance coverage and we have to say, 'Sorry, but your
plan doesn't cover a complete physical,'" Soper said.

Flink reported that many people don't realize what isn't covered by
health insurance until it is too late.

Lee Crabtree said he has a helpless feeling when he looks at his son
and tries to explain why he can't help him live.

"The feeling of this is beyond words. It makes you feel hollow," Lee
Crabtree said.

Late Friday, KMBC learned that Nathan's mother found out she could
apply for coverage with Blue Cross Blue Shield at her workplace, and
so she had applied. What Coventry spent months denying and calling
experimental, Blue Cross Blue Shield approved on the first request.

Nathan Crabtree leaves for Minnesota on Sunday morning.

<http://news.yahoo.com/s/kmbc/3257367>

----------------------------------------------------------------------------

"There's never been a better time to be an insurance company than
right now," said Dr. William Soper, with Mid-America Medical
Affiliates.

Studies show that insurance companies have doubled profits in just
four years.
(PeteCresswell) - 11 Feb 2006 14:42 GMT
Per KT:
>"It's purely economical.

Some years back, Consumer Reports cited a treatment for prostate cancer that was
blocked by insurance companies.

The regimen cost less per treatment that the approved one, but extended the
patient's life so much that the number of treatments times cost/treatment came
out higher than the approved regimen - so it was denied.

Since remedied, but it exposed one mentality that healthcare recipients are up
against.
Signature

PeteCresswell

Shawn Hirn - 12 Feb 2006 00:49 GMT
> "We have patients who say, 'I want a complete physical,' and we'll
> look at their insurance coverage and we have to say, 'Sorry, but your
[quoted text clipped - 8 lines]
> "The feeling of this is beyond words. It makes you feel hollow," Lee
> Crabtree said.  

How does Lee Crabtree know this isn't his god's way of telling him its
time to meet Him? I am not Christian, but I heard their god works in
mysterious ways.
jsmith989 - 24 Feb 2006 16:57 GMT
> > "We have patients who say, 'I want a complete physical,' and we'll
> > look at their insurance coverage and we have to say, 'Sorry, but your
[quoted text clipped - 12 lines]
> time to meet Him? I am not Christian, but I heard their god works in
> mysterious ways.
jsmith989 - 24 Feb 2006 16:59 GMT
If you want to know more about Tracy, look at his web site.
www.helptracyjr.com
J - 24 Feb 2006 18:46 GMT
> Tracy Pierce, 37, lived a full life. He grew up with family and faith.
> He went to a Catholic school, got married, had a son, and he even had
[quoted text clipped - 61 lines]
>
> [Leukemia Story snipped - not enough info]

What's the fuss about?
Looks to me that he received appropriate treatment for kidney cancer.
Surgery, then a re-surgery for a bowel blockage, then RT to the brain.
http://www.helptracyjr.com/
They seem to even have covered two rounds of Interleukin even though there's no
evidence that it will cure nor extend life. People and/or news reporters need to
know each cancer before writing alarmist articles.

The pain meds issue is unclear - not enough info.
J
John A. Weeks III - 24 Feb 2006 23:56 GMT
> > Tracy Pierce, 37, lived a full life. He grew up with family and faith.
> > He went to a Catholic school, got married, had a son, and he even had
> > the car of his dreams. It was the perfect life.

> What's the fuss about?
> Looks to me that he received appropriate treatment for kidney cancer.
> Surgery, then a re-surgery for a bowel blockage, then RT to the brain.
> http://www.helptracyjr.com/

I don't think Tracy wanted to live very badly.  If he did, he
would have sold that "car of his dreams" and paid for his own
medical bills to save his fricking life while his lawyer went
after the insurance company.  It is pretty hard to feel sorry
for someone who will no do anything to help themselves.

-john-

Signature

======================================================================
John A. Weeks III           952-432-2708            john@johnweeks.com
Newave Communications                         http://www.johnweeks.com
======================================================================

Lawrence Glickman - 25 Feb 2006 00:07 GMT
>> > Tracy Pierce, 37, lived a full life. He grew up with family and faith.
>> > He went to a Catholic school, got married, had a son, and he even had
[quoted text clipped - 12 lines]
>
>-john-

My take is there was nothing Tracy could do to stop the Cancer.  It
had metastasized and spread to all parts of his body.  Once it gets
into your liver and/or brain, you've got weeks or days to live.  Have
seen it happen more than once.  IOW, IMO, there was nothing that could
have saved him.  Maybe he could have bought a few more days, or a few
more hours, but once "the disease takes over," its curtains.

Lg
John A. Weeks III - 25 Feb 2006 14:57 GMT
> >I don't think Tracy wanted to live very badly.  If he did, he
> >would have sold that "car of his dreams" and paid for his own
[quoted text clipped - 10 lines]
> have saved him.  Maybe he could have bought a few more days, or a few
> more hours, but once "the disease takes over," its curtains.

Agreed.  I was guess I'll point my rant and rave to be a more
general statement.  I hate it when people make themselves fully
dependent on others, especially a corporation or insurance
company, and then complain when things don't go their way.
Each person has a responsibility to try to save their own life,
wether they have a medical condition and are having a hard time
getting insurance to pay for it, to the people who are facing
a category 5 hurricane and refuse to evacuate.

-john-

Signature

======================================================================
John A. Weeks III           952-432-2708            john@johnweeks.com
Newave Communications                         http://www.johnweeks.com
======================================================================


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