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]
RELATED
www.primaryphysiciancare.com
(Photo of Paxton Mitchell: Citizen-Times)
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@Amy Alkon:
You sort of question the validity of the reporting in the citizen-trib’s article — but I don’t see where you find fault.
The relevant sentence regarding the treatment protocol comes toward the end of the article, when reporter cites kids doctors:
“Dr. Douglas Scothorn, a pediatric hematologist-oncologist who is caring for Paxten, said the chemotherapy regimen is unusual for leukemia, but all of the five drugs in the mix are common chemotherapy drugs, and all are approved for use in children.”
That’s a pretty well sourced statement. In a perfect world, reporter would get names of all five and check to verify doctor’s statement, either using PDR or something or an outside expert (academic type would be good).
But this is a day turn story at a small paper in the triangle region — good paper, but not exactly the New York Times. They’ve got if they’re lucky a dozen street reporters covering two or three counties. You’re lucky everything is spelled right.
From what I read, this is not an experimental treatment. I think the distinction could have been more clearly illustrated, but I think a more valid issue would be what “experimental” means in this context.
Apparently we’re not talking about some new unproven procedure — just using approved drugs in slightly unusual fashion. Maybe I’m missing something, but if that kind of treatment is too experimental to cover than THAT’s an issue worthy of public debate.
Every time I hear a story like this I wonder why more insurance execs aren’t getting gunned down by grieving survivors.
I can imagine parents feeling that those responsible for denying life saving treatments should be held personally responsible. I mean, people get shot over parking spaces in this country, why aren’t CEO types getting capped left and right? I’ll bet a real determined parent could take out most of a board of directors before the cops caught up with them.
For the record: I’m not a parent, I hate kids, I plan to remain child-free, and I have no particular animosity toward the scumbags who run my HMO. I just hear so much talk from parents about how they’d “kill anyone who hurt my kids” that I wonder why this sort of thing doesn’t happen with some frequency.
As George Carlin says: “these are the questions I ponder when I’m home alone and the power goes out”
Cycledoc et al, it might inform this discussion to know that (a) yes, he might have ALL, but he has a very rare subtype of ALL — and more importantly, (b) he actually *received* the therapy despite all the insurance wrangling, but it appears to not have worked. That’s just awful.
[www.caringbridge.org]
Just to make sure this doesn’t inflame things further, the insurance company’s deliberations about coverage *HAD NOTHING TO DO WITH HIS TREATMENT NOT WORKING*; it just didn’t work, and his family appears to have opted to go with palliative care at this point.
Very sad.
The above points are well and good, but lets consider something far scarier:
How many tens of thousands of other people has this insurance company denied life-saving coverage for?
Whats worse, how many have perished because the families/doctors didn’t have the $$ and the time to play World War Three with the insurance company?
For every case that makes it to the ‘mass media’, likely thousands of cases like this happen (and are unfolding as I write this) every day, and for those ignored masses, the story ends with a rejection letter ,a furious legal battle,and a loved one’s funeral.
@am84:
I think the person(s)who are in charge of making the decision on this must look at those pics on this website before the go to sleep.
[www.caringbridge.org]
@guevera: Truth is, if I had nothing to live for (especially if, say, if I was dying of a terminal illness my HMO wouldn’t pay to treat), I’d seriously consider it. Luckily for the execs in question, I’m a reasonably happy, well-adjusted, healthy individual who doesn’t own a weapon. Still, not everybody is so well-adjusted and weaponless, and it’s bound to happen eventually. If I were one of these execs, I’d keep this in mind and keep a heavy security detail on hand…
for the insurance company it is a simple formula. If the treatment cost more than the payout for a death then they let the patient die. it’s as simple as that if you are willing to create enough fuss they will pay for treatment just to save face, insert weekly story here to get them to pay out…
sucks, but it’s the truth
paste from their family website:
Hello Family and Friends of the Mitchell’s! This is Beth Riddick, Minister with Children, at First Baptist Church Asheville, NC. Rob and Amy asked me to send this update. After much talking, praying, and consulting with doctors Rob and Amy decided to take Paxten home for as they said, “There are no more treatments in the medical world.” In a matter of a few hours, plans were in place for a Make a Wish trip to Disney World and to have supportive care once they are back home in Asheville. They will be leaving for Disney World first thing Tuesday morning, 3/18, and will return Tuesday, 3/25. Several folks are also working on a party for Paxten for Thursday, March 27. Once those plans are finalized I will send another update with all of the details.
Before leaving the hospital, the nurses and staff gave Paxten a Scooby-Doo Party with cake, balloons, streamers, and games. Paxten had a great time with all of his hospital friends! Paxten is still a little irritable, but that is from all of the steroids still in his system. Hopefully, he will be feeling much better in the next day or so and will enjoy being at Disney World out in the fresh air and sunshine!
Over the next few days and weeks, Rob and Amy want to focus their attention, care, energy, and love on Paxten, Arie, and being at home as a family. For that reason, they will be limiting their correspondence and they have asked me to send updates through Caring Bridge. They are so appreciative of all of the support, love and care that they receive, for that is giving them strength for these days. Please feel free to continue posting words of encouragement and prayer here and they will read them as they are able.
~Beth
The Catch 22 of self-insured entities. As 1 poster correctly pointed out. Self-insurer companies just pay the name brand health insurance for administrative services as the self insurer is not itself in the insurance business. They are merely providing contractually obligated health plans as an employee benefit.
The rub is that the self-insurer (one’s employer usually) gets to decide eligible claim payments, co-pays, etc. thru its own literature. If an employee insured member has a dispute about a given claim what does he or she do ? Go up against his/her employer who puts food on their table. It is a not so subtle form of legal blackmail. Sure, I’ll sue (appeal decision) my employer in a protracted dispute and still have a job, right ?
I certainly feel very bad for the mother and the family that has to go through this. Clearly our system is broken but i dont believe that anyone really has the awnser to fixing it. Does anyone really beleive that “if” the treatment the child needs is classified as experimental that under a national healthcare plan that the procedure would be paid for?
Think about it! There is no way that the governement is going to pay for anyting and everything that is submitted. Its sad, but most insurance companies will not pay for experimental coverage, this will not change under a single payor system either.
Of course the angels of mercy at the hospital could just perform the procedure as a gesture of good will. After all they are so certain that it will save the childs life. Think of all the great PR they will get by saving the life of this child and assuming the care is classified as experimental it just adds to the case that the procedure should no longer be considerd experimental.