Primary Physician Care, a privately-owned insurance company based in Charlotte, North Carolina, has now twice refused to pay for a 3-year-old’s special leukemia treatment recommended by doctors at Duke University Hospital—even after the child’s mother called the insurance company and spoke personally to the president. The child, Paxten Mitchell, suffers from a rare form of the cancer called acute lymphoblastic leukemia, or ALL.
“The fact is, my kid has leukemia, and if he doesn’t get this treatment, he will die,” Robert Mitchell said. “The way they made me feel was that they were pressuring us to take him home and let him die. We’ll try anything that has a chance of succeeding, and I will not give up fighting for it to be covered.
“Go to their Web site, and their mission statement says they treat each person with compassion,” he said. “I think that’s a bunch of hoopla.”
Paul Tate, a spokesman for Primary Physician Care, said the company is not authorized to discuss Paxten’s case.
Aw c’mon, PPC, at least say you’re taking the lives of your customers’ children very seriously or something. Don’t you know how PR works?
(Thanks to Adam!)
“Insurance won’t cover child’s critical leukemia treatment” [Asheville Citizen-Times]
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www.primaryphysiciancare.com
(Photo of Paxton Mitchell: Citizen-Times)
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Wow. Won’t even give the kid the chance to pull through it. They need to get the hospital, state insurance board and the media all over these kinds of cases.
This makes me sick to my stomach. What is wrong with the world?
Maybe the doctors told the insurance company there is no chance of beating it? We don’t know the whole story here. Often times people have no chance to live and the doctors tell that to the insurance company. The family freaks out and calls the press who tell half truths to make the insurance company look bad and then they get pressured into providing the treatment. Everyones rates go up and the doctors are taken away from treating patients that might have a chance.
I wonder if this is the case here?
Perhaps, but somebody in their public relations department better get out front and start answering general questions about exactly what they will and won’t pay for, and why.
Yeah, we’re not having any problems in the country with respect to Healthcare. Perhaps if the drug companies didn’t have to run one 240-second commercial every commercial break on every station in this country, healthcare wouldn’t be so expensive and this poor kid could live.
I watched Michael Moore’s “SICKO” this weekend. And as I watched it I kept thinking about the book THE RAINMAKER. In essence, health insurance companies make their money by refusing treatment whenever they can. It’s their business model. Even those that “do well” by their clients still require the insured to escalate their case before they’ll pay. In the end they make their money and hand out bonuses based on money saved.
It looks like Michael Moore is already on this case a bit. [www.michaelmoore.com]
Most insurance companies do not cover experimental treatments. Insurance companies do not exist to cover anything like clinical trials. There is not enough detail in the article to tell how much of a hail-mary treatment this is.
This article is illustrative of a larger point that will only become more common as time goes on: Where do we draw the line for healthcare spending? Healthcare is only getting more expensive, and it is doing so at a rate far faster than inflation and economic growth. There will eventually come a point where we simply cannot afford to give everybody state-of-the-art treatment. People’s lives most certainly will be cut short because nobody is willing to pay for all possible care.
SirWIred
Well they also have a maximum value that they will pay on most policies. Its quite possible they have exceeded this. Health insurance isn’t unlimited.
obviously this comment section is going to get political. I’m against all forms of government healthcare. However, obviously this story disgusts me. I’m certain we dont have all the facts, but regardless, this kid should get all the care he needs. While I am for private health care, I am also for somebody, I guess the government, forcing them to pay out for this stuff. If his premium has been paid, they owe him every dollar he needs.
@apotheosis:
They have to be asked those questions. They honestly could get in trouble for volunteering, and they would have to be very careful in their response. The rules are pretty specific. Also one has to be really general, not just pretend general.
One of the things that stood out during this presidental campaign is that it was said that in this country, no person who needs medical treatment to save their life is turned away based on ability to pay. (Their reasoning for why we do not need a govt healthcare system) Why then do these stories continue to dominate every other week?
What ever happened to doctors making sick people well?
Why do insurance companies continue to dictate to doctors/hospitals how someone is treated medically?
Upon graduation, many medical students take a modern version of the oath written by Louis Lasagna in 1964.
Hippocratic Oath-Modern Version:
I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required…
Insurance companies need a similar oath.
@sirwired: valid points. Many people here are dreaming of a world that can pay for all this. Like them, I wish it were so. In reality, it won’t happen.
@Geekybiker: Maybe it should be when your kid is dying of Leukemia?
Sometimes there is no hope and the conclusion is to go home and die surrounded by loved ones. It’s difficult, especially with kids. But, at times, there is no other solution. The treatment will not prolong life and the suffering is not in the child’s best interest.
Not that I trust an insurnace company to tell the truth.
It sounds like it’s treatable, but I think we’re only getting half of the story here.
When it comes to healthcare, everyone always talks about whether or not they’ll be “covered”. There’s never any discussion on lowering the actual costs.
I just read the article and it states that the insurance company isn’t paying for an experimental treatment. I hate to play devil’s advocate, especially for an insurance company, but that’s usually not covered by their policies. That being said, with all the bullshit I had to go through with United Healthcare and Blue Cross over my wife’s pregnancy, I can’t feel bad for the insurance company if they were forced to pay.
I know the treatment might be experimental (not sure how much so, since the article doesn’t say) and not cost-effective for the company, but WTF is wrong with us when we decide that cost-effectiveness determines whether or not someone can potentially get a life-saving treatment???
@yasth:
It seems a bit silly to expect them to make no statement in their own defense whatsoever. Surely the parameters for payment are written down and available somewhere; even a distillation of that, demonstrating that they’re not just arbitrarily saying “screw this kid, he’s a goner anyway,” would be something.
Wow, that PR asshole really doesn’t want to do his job does he?
@MissPeacock: If their business tanks (and it probably wouldnt) a lot of people would be without insurance. Thats a risk too.
@NickRB: “Maybe the doctors told the insurance company there is no chance of beating it?”
No, that didn’t happen.
“We don’t know the whole story here.”
It’s in the article.
“Often times people have no chance to live and the doctors tell that to the insurance company.”
That’s not what’s going on. The treatment is proceeding and early indications are that it’s effective. The insurance just doesn’t want to pay for it.
Maybe the poor kid should move to France, England, Canada or Cuba so that he CAN and WILL receive the proper treatment with out all the Private Healthcare red tape!! We need Universal Health in the US ASAP!!
@Geekybiker:
max value on most policies is 2 million.
Upped from 1 million a few years ago, around the time my mother died less than $100,000 away from the cap.
As I posted on the newspaper’s site:
Of course, we all feel for these poor parents.
But, what is the “treatment protocol” that has “proven effective”? And has the reporter read the studies or did she just hear that from the parents. I can’t say whether this is right or wrong, denying coverage for this, but people with cancer often grasp at straws, stuff that may have little effectiveness (like all the quack treatments cancer surgeon Orac writes about on the blog Respectful Insolence). Few regular people or reporters can read studies adequately anyway, and tell if numbers have been fudged or data have been improperly collected, etc. A solution would have been to get the studies and bring them to one of the epidemiologists in this country who can see the flaws in the study and the numbers, or determine whether the parents actually seem to have a case.
In short, little reporting in the reporting would be nice.
@MissPeacock: Cost effectiveness is what kept Ford from recalling the Pinto. The unfortunate truth is that this is how businesses are run these days and it won’t change until we get people who truly represent the interests of the electorate instead of the corporations in Washington.
@myasir: “I just read the article and it states that the insurance company isn’t paying for an experimental treatment.”
No, it doesn’t. The word “experimental” doesn’t even appear in the article.
@MissPeacock: Nothing is “wrong” with us when we, as a society, put a monetary price on human life. To use an easy example, cars could be made far more safe than they actually are, but at a cost few would be willing to pay. The streets could be absolutely safe and free from crime, if we could afford that many cops. Houses could be made from fireproof material, at a cost of being ugly and expensive. Airline security could be ironclad, but at price so high, nobody could afford to travel.
The only thing different here is that the price is obvious on an individual level, instead of some hard-to-grasp general cost.
As I stated in an earlier post, somebody, somewhere is going to have to pay for healthcare as it gets more and more expensive. A point will eventually be reached where we, as a society, can no longer afford state-of-the-art healthcare for everybody. Mere mortals will get inexpensive care, while those with more resources will get pricier care.
SirWIred
Of course, we all feel for these poor parents.
But, what is the “treatment protocol” that has “proven effective”? And has the reporter read the studies or did she just hear that from the parents. I can’t say whether this is right or wrong, denying coverage for this, but people with cancer often grasp at straws, stuff that may have little effectiveness (like all the quack treatments cancer surgeon Orac writes about on the blog Respectful Insolence). Few regular people or reporters can read studies adequately anyway, and tell if numbers have been fudged or data have been improperly collected, etc. A solution would have been to get the studies and bring them to one of the epidemiologists in this country who can see the flaws in the study and the numbers, or determine whether the parents actually seem to have a case.
In short, little reporting in the reporting would be nice.
Well, I guess the question is this:
If doctors say someone has a meaningful chance of recovery using a specific treatment, should insurance companies be able to deny that treatment, when their denial of care will definitely cause the person’s death?
To me, it is unethical and immoral to deny treatment, even if the insurance company deems it “experimental”. In the U.S., more than any other country, we have no excuse for not giving people every possible chance at a meaningful life.
Insurance companies are more interested in profits than in the welfare of their customers. Of course, it’s not just their fault. Stockholders also demand profits. I’m sorry, but insurance companies shouldn’t be trying to earn profits, they’re supposed to be there so that when we get sick, we don’t have to worry about losing everything we have in order to pay for treatment.
Life is a limited resource problem. All horror in the world stems from that simple fact.
Insurance companies care about one thing – making money. When they don’t have to spend money it is a win for them in their eyes, even if a real live human being has to suffer.
The logical thing to do would be to get rid of insurance companies.
Welcome to the American -Death- Health Care System . . . our profits are taken very seriously.
@Tallanvor: What’s really funny is that many of the people who are railing against the insurance company have pensions and investments which only pay out if insurers (like PPC) can turn a profit.
@myasir: Yes, cost-effectiveness is what kept Ford from recalling the Pinto.
Do you want to know what near-absolute safety costs? Check out prices for airplane safety. Guess who pays the costs for it? It ain’t Boeing. When the FAA finds a systematic defect in an airplane design, and the airplane is out of the fairly short warranty period, each plane owner is required to perform the fix at their own cost. As in, the plane often cannot be flown if the fix is not done by the deadline.
To use another example. The Cessna 172 uses fairly standard wheel bearings in the landing gear. In fact, they are so standard, you can get the same bearing in any auto parts store for about $17. How much does the FAA-certified part you are required to use cost? About $150. It’s the same part, from the same company, at the same time, and is no better, than the auto parts version. The difference is that the FAA part bills you back for the cost of FAA inspections, certifications, and paperwork.
Safety is so damn expensive that that Cessna 172 still costs hundreds of thousands of dollars to buy, despite the fact that everything except the instrument panel is largely based on designs that have literally been in use since the ’60′s.
SirWired
Two points:
This heartbreaking emotional story is told one sided. We don’t know anything about the treatment being proposed, the alternatives, etc. It’s easy to rush into judgement about the big bad insurer when we don’t know all the facts.
That’s a good segue into my second point: Don’t believe everything on Sicko or Michael Moore blindly. Sure some things he brings up are true, but most aren’t. He relies on sensationalistic “entrapping” interviews and moviemaking. Short on facts, high on drama.
Does anyone know what the cost of this experimental treatment is? I’m not looking to condone the insurance company’s position either way – just wondering.
According to OpenSecrets, Primary PhysicianCare CEO David Tate seemed to have no problem giving $5000 in campaign contributions to legislators Sue Myrick and John Keadle. I don’t know if that has any relevance, but I don’t like seeing any business gaming the political system.
How can these people sleep at night?!?!
@quail: “Michael Moore ends the movie saying that every European country offers “free” health coverage to their citizens and every European country provides such coverage through a “single payer” system.
“Both statements are untrue. … Most European countries directly charge their citizens for their health coverage. It is not “free” anywhere. Some nations require people to buy coverage from health insurance companies that look very much like American health insurance companies. Other countries use a payroll tax on everyone’s paycheck to pay for health coverage. …
“Also, when the government of the Netherlands deducts that 9 percent, or when Germany deducts their 14 percent — they do not use, as Mr. Moore incorrectly claims, a “single payer system” like Canada to provide the actual health insurance for each citizen. Each of those countries has multiple health plans – or “sickness funds” — that people choose among. Citizens of Switzerland and the Netherlands choose between competing health plans to purchase their coverage.”
Moore is a nutcake, and a liar. Not my opinion; just the facts. More at [acuf.org]
the problem is, with insurance companies that decide they’re going to deny “experimental” treatments, who gets to decide what’s experimental? they do.
I suppose there’s always binding arbitration…
And as for Moore’s take on Cuba:
“The second health-care system is for Cuban elites – the Party, the military, official artists and writers, and so on. In the Soviet Union, these people were called the “nomenklatura.” And their system, like the one for medical tourists, is top-notch.
Then there is the real Cuban system, the one that ordinary people must use – and it is wretched. Testimony and documentation on the subject are vast. Hospitals and clinics are crumbling. Conditions are so unsanitary, patients may be better off at home, whatever home is. If they do have to go to the hospital, they must bring their own bedsheets, soap, towels, food, light bulbs – even toilet paper. And basic medications are scarce. In Sicko, even sophisticated medications are plentiful and cheap. In the real Cuba, finding an aspirin can be a chore. And an antibiotic will fetch a fortune on the black market.
A nurse spoke to Isabel Vincent of Canada’s National Post. “We have nothing,” said the nurse. “I haven’t seen aspirin in a Cuban store here for more than a year. If you have any pills in your purse, I’ll take them. Even if they have passed their expiry date.”
Took me many years to discover there’s – gasp – two sides to most hot-button issues, and that sometimes the other side has a point. Hope this helps others to find the same.
[www.nationalreview.com]
I’d suggest travelling to Memphis and taking their child to St. Jude? It may put less of a financial strain on the parents if the insurance won’t pay up?
@dorkins: Canada is anything but a single-payer system. Sure, our taxes pay for you to go to the doctor, but (1) The range of services varies from province to province; and (2) For whatever your province doesn’t cover you will likely need additional coverage.
Make no mistake – if this kid was in Canada, he’d likely be denied coverage by the provincial system. They do not take kindly to experimental coverage.
Just how many Insurance Company reps do we have commenting today? Raise your hands, please.
One nation, of the corporations, for the corporations…
So according to what some people here are saying, insurance companies shouldn’t have to pay for treatment if the person is just going to be dying anyway?!?!?
We’re all going to die eventually. With that reasoning, why does anyone get medical treatment?
If treatment gets to a point where only certain chosen people can afford it, then we have a big problem.
Universal Healthcare should be one of our priorities. How many billions of dollars have been shoved into the pockets of Haliburton and Blackwater? How much money is squandered by the government in countless other places? I’m sure that just a fraction of these wasted dollars could fix the health care situation. Wouldn’t that be a MUCH better was to spend taxpayers money?
Medical treatment shouldn’t be a luxury and shouldn’t be an uphill battle.
@misteral: Yeah but Canada only has about 4.5 MRIs per million people; the US has 19. So the US is more clearly aligned with the evil MRI-manufacturing corporations!
My grandfather was a doctor in West Virginia. He actually got in trouble for accepting payment in the form of chickens. It didn’t stop him though. He took payment by whatever means the person had available. Of course, this was over 50 years ago. What happened to doctors fixing you and then talking about payment?
insurance companies should take this as a selling point. I am not sure how much insurance companies cover in major situations such as cancer, disease etc but how about they institue an agreement that they will cover 25% of experimental treatments i.e. something not approved in the medical community. The person’s doctor should be the one to make the call whether it is approved treatment or experimental. Insurance companies can use that as a selling point and as extra coverage so they can charge you more but at least you won’t be left completely without help.
I honestly dont care what the insurance company’s side to the story is. As long as they are cashing the checks they take from the parents they need to pay the bill. The doctor decided the treatment that is in the best interests of the child. An insurance company should have some kind of mechanism in place to provide for new treatments.
After hearing some of the treatments United Healthcare considers experimental I find the term ‘experimental’ dubious. It seems anything my wife, son or I went to get treatment for in a 2 year period was either experimental, specialist or tier 3 prescription. I was the person paying for freaking insurance and I couldnt use it as we were paying for my wife’s treatments out of pocket. They tried a fast one on my son when he got sick and was in the hospital but his pediatician knows their game and schooled them.
Where is this family’s local senator or representative? Oh yes on the golf course paid with money from the insurance company… They need a good lawyer.