Denied Coverage By an Insurer for Mesothelioma?

In the U.S., it happens more often than we want to think. A person has faithfully paid exorbitant premiums for private, for-profit health insurance, then one day, is diagnosed with malignant pleural cancer better known as mesothelioma. The person goes ahead with available treatment while the hospital and physician’s office process the claim. Then all at once, the insurance company denies the claim, and may even drop the patient, leaving him/her financially responsible for medical care that can easily top a quarter million dollars. The excuse is usually a claim that the disease isn’t really mesothelioma, or that it was a “pre-existing condition.” An insurance company may also reduce reimbursements, or require huge co-payments and deductibles. In the end, they will do whatever creates the highest level of profit for themselves. Such patients have the option of appealing the denial, of course. In addition, one can inform the State Insurance Commissioner in the state where one lives.

The Insurance Commissioner determines which companies can do business in the state and is charged with the investigation of consumer complaints against insurers. Patients can also request the service of a “case manager,” who is often a registered nurse. A case manager acts as a liaison between the patient and the company. As a last resort, patients can seek sources of financial aid, or may apply for Medicare benefits. Still, is it fair and reasonable for society to expect a terminally ill patient and his/her family, with all the stress that such a condition creates, to accept even more stress by having to spend hours on the phone battling high-paid insurance executives or filling out endless forms in an attempt to justify why they deserve assistance? On the average, polls in the U.S. indicate that 75% of all Americans think not. These Americans are even willing to pay higher taxes if it means that they will be able to see a doctor or receive treatment when they need it without having to fear bankruptcy. Incredibly, despite these polls and the increasing dissatisfaction with our current health care system, all but one of the 2008 presidential candidates of both major parties would, if elected, simply continue the current private corporate for-profit system. The one exception is Dennis Kucinich, and his plan to cover all Americans is contained in the Kucinich-Conyers Bill, H.R. 676. To be continued…