Insurance Company Won't Pay For Child's Leukemia Treatment

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.

con_paxtenmitchell.jpg “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]

(Photo of Paxton Mitchell: Citizen-Times)


Edit Your Comment

  1. bohemian says:

    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.

  2. am84 says:

    This makes me sick to my stomach. What is wrong with the world?

  3. NickRB says:

    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?

  4. apotheosis says:

    Paul Tate, a spokesman for Primary Physician Care, said the company is not authorized to discuss Paxten’s case.

    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.

  5. heyimbobo says:

    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.

  6. quail says:

    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. []

  7. sirwired says:

    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.


  8. Geekybiker says:

    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.

  9. Bladefist says:

    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.

  10. yasth says:


    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.

    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.

  11. ohiomensch says:

    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?

  12. whatdoyoucare says:

    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.

  13. Bladefist says:

    @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.

  14. GC says:

    @Geekybiker: Maybe it should be when your kid is dying of Leukemia?

  15. MrMold says:

    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.

  16. EBounding says:

    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.

  17. myasir says:

    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.

  18. MissPeacock says:

    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???

  19. apotheosis says:


    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.

    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.

  20. Buran says:

    Wow, that PR asshole really doesn’t want to do his job does he?

  21. Bladefist says:

    @MissPeacock: If their business tanks (and it probably wouldnt) a lot of people would be without insurance. Thats a risk too.

  22. SuperJdynamite says:

    @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.

  23. lakuma says:

    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!!

  24. ohiomensch says:


    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.

  25. Amy Alkon000 says:

    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.

  26. myasir says:

    @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.

  27. SuperJdynamite says:

    @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.

  28. sirwired says:

    @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.


  29. Amy Alkon000 says:

    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.

  30. Tallanvor says:

    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.

  31. Life is a limited resource problem. All horror in the world stems from that simple fact.

  32. Triborough says:

    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.

  33. mwdavis says:

    Welcome to the American -Death- Health Care System . . . our profits are taken very seriously.

  34. sketchy says:

    @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.

  35. sirwired says:

    @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.


  36. llcooljabe says:

    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.

  37. misteral says:

    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.

  38. timmus says:

    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.

  39. morganlh85 says:

    How can these people sleep at night?!?!

  40. dorkins says:

    @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 []

  41. Carencey says:

    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…

  42. dorkins says:

    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.


  43. tahamaki says:

    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?

  44. misteral says:

    @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.

  45. infinate812 says:

    Just how many Insurance Company reps do we have commenting today? Raise your hands, please.

    One nation, of the corporations, for the corporations…

  46. se7a7n7 says:

    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.

  47. dorkins says:

    @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!

  48. peepytweep says:

    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?

  49. bravo369 says:

    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.

  50. vdragonmpc says:

    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.

  51. camille_javal says:

    @dorkins: You don’t know how right you are – small cities with two hospitals will both get an MRI machine – which raises the costs of health care – because they are competing for patients, despite the fact that they don’t need that many for the number of people being served. They also spend a lot of money on advertising.

  52. timsgm1418 says:

    wow this really is a tricky one, if it was my kid of course I would want to try everything possible. However insurance companies are not non-profit. They could end up paying for this experimental treatment which ends up doing nothing, and they are still out all the money. When you look at a case by case basis yes, it gets personal and for every sick person, there’s probably at least one person that loves them and wants them to live. How much more do we want to spend on insurance to cover everything? From the loved ones perspective it’s a life, from the insurance company’s perspective it’s a loss of money. I don’t know what the answer is. But as someone mentioned earlier, healthcare is not endless, there is a lifetime limit. Say they pay for this treatment, which caps out their insurance, and then 3 years later the child needs something else experimental to save his life? The insurance companies do say no sometimes. What about that St Judes hospital commercials that say they take all children regardless of the ability to pay? Couldn’t that be an alternative to going through insurance? Personally I hope they find a treatment that will cure this child, but I’m not sure it’s the insurance companies responsibility to say yes to every experimental treatment.@MissPeacock:

  53. llcooljabe says:


    The insurance company has a fiduciary responsibility, not only to its owners/shareholders, but to its other policyholders.

    If an insurer starts paying for every experimental (note: unproven) treatment out there on the advice of every physician, then these companies wouldn’t be able to pay for regular procedures for you and me.

    In this specific instance, we don’t know all the facts, whether the procedure was experimental or not. So let’s reserve judgement until we do.

  54. B1663R says:

    @misteral: in the east coast provinces i would agree… in Ontario, for sure that kid would have been treated. next time stop by Sick Kids in Toronto and take a ride up to the 8th floor and look around.

  55. johnva says:

    @Carencey: This is why there needs to be strong governmental regulation and rapid enforcement (ie, not through the courts while you or your kid are dying) if you’re going to use a private insurance model to fund healthcare.

    The real, underlying problem is that insurance just doesn’t work very well at providing healthcare equitably to most of the population. Financing healthcare should be viewed as a shared cost to society rather than a profitable industry. Otherwise, there is too much of an economic incentive to place profits over people’s lives and over the equal delivery of care to everyone. I’ve said this before on here, but insurance works when it’s spreading the risk of low frequency, high cost events (like car wrecks, or house fires, or maybe even catastrophic health events for otherwise healthy young people). It does a worse job when the events it’s paying for are not low frequency, like with the elderly or with a chronically ill person. And unlike many other things we insure against, the cost of health insurance doesn’t really do much to change people’s behavior to reduce risk (and thus cost). Much disease is not lifestyle-oriented. You can’t choose not to get cancer.

    That being said, I don’t believe insurance companies should be forced to pay for truly experimental treatments; if they are actually experimental, then that should come out of research money. A government healthcare system probably wouldn’t pay for that either. The problem comes in when the insurance companies try to define things that really are not experimental as experimental in order to avoid paying for them. They frequently do this with new treatments that are often better than older methods but with less of a track record. That’s when the government needs to step in…the insurers should probably be forced to pay for whatever the government deems non-experimental. Unfortunately, a lot of the people who advocate for private insurance solutions also are rather anti-regulation and anti-enforcement.

  56. llcooljabe says:

    @se7a7n7: Universal healthcare is not the answer, unfortunately. I had that in Canada, and having experienced both systems, I would take the american in a heartbeat. As another commenter has posted, even in canada, most experimental procedures would be denied.

    The problem with US healthcare is medical malpractice. Specifically the mad cycle that is perpetuated by medical malpractice.

    1. Doctors, afraid of medical malpractice suits prescribe way too many tests just to cover all angles, even those he/she doesn’t believe to be true. Cause a missed diagnosis is just as bad as a wrong diagnosis.
    2. Insurers pay for these myriad tests increasing their costs.
    3. Insurers water down their insurance plans and/or make premiums more expensive to employers and insureds.
    4. Employers pass these costs to employees.

    Make no mistake, it’s the out of control litigious “lottery” system that we need to reform before we need to reform how healthcare is paid for. Once we put a cap on non-economic damages (things that can’t be quantified, like punitive), our healthcare system will start to become controlled.

  57. llcooljabe says:

    @B1663R: treated yes. If an experimental procedure is involved, I doubt OHIP would pay for it.

  58. Peeved Guy says:

    @timsgm1418: Agreed.
    From a cold-hearted business perspective: for whatever reason, the insurance company decided that they could not spend more money on this child; already over the cap, experimental treatment, etc. I’m sure that someone in a office somewhere denied the coverage for jollies. You think that the cost of healthcare is high now? What do you think it would be like if the insurance companies approved treatment for people based on emotions? WOW! As for the government health care route, I sincerely believe that the government would have stopped coverage sooner than the private insurance company. Is there a reason that people think the government would be more compassionate than any private company?
    However, from a father’s perspective, I would move heaven and earth to get my kid treatment in this case, so I certainly do not blame the parents for appealing to the newspaper to try to sway the decision of the insurance company. I wish them luck.

  59. johnva says:

    @camille_javal: Yep, competition actually increases global costs of healthcare in many cases. But don’t try to argue that with the free market dogmatists. They believe on faith that free markets solve every problem. In reality, free markets make some things more efficient and other things more inefficient and inequitable. And in any case our healthcare system bears no resemblance to a free market.

  60. DrGirlfriend says:

    Life is a limited resource problem.

    Succint and very true.

  61. johnva says:

    @llcooljabe: You’re making a mistake that I see a lot and that is very easy to fall into. The fact is, there is no one cause of the out of control cost of healthcare in America. There are, in fact, many causes that need to be addressed via serious reform if we want to make healthcare affordable and equitable. Medical malpractice is one cause of spiraling costs, onerous insurance company administrative requirements are another, duplication of services and equipment caused by competition is another, the problem of providing charity care to the uninsured is another, etc.

    Basically, our system is being pressured from a lot of sides at once, to the breaking point. There’s too much government regulation in some areas, and not nearly enough in others. There are frivolous and expensive lawsuits. There are abusive insurance companies, and deadbeat scamster patients. There is the fact that a large portion of the patient population in some places is on Medicare or Medicaid.

  62. Peeved Guy says:

    @Peeved Guy: “I’m sure that someone in a office somewhere denied the coverage for jollies.”
    should read:
    I’m sure that someone in a office somewhere DID NOT deny the coverage for jollies.

  63. johnva says:

    @Peeved Guy: Well, government at least does not have such an economic incentive to deny coverage of reasonable care. Insurance companies do – it’s called profit. So while obviously a government-run healthcare system would need to control costs by drawing lines as well, they don’t have as much reason to try to cheat and move the line backwards continually. And hopefully, if your government is functioning as a healthy democracy, it is accountable to the people ultimately. Insurance companies are accountable mostly only to their shareholders, who have wholly different interests than the people of the nation as a whole. A good government healthcare system has as its goal the provision of healthcare for all the citizens of the nation. A good private insurance company has as its goal maximization of profits…patients are merely the means to do that and a cost center to be minimized. In an ideal free market like that envisioned by starry-eyed libertarian zealots, insurance companies would be accountable to competition and would have to provide good service to their customers as a result. In the real world, insurance companies function as an oligopoly (with extensive barriers to customer mobility). Moreover, even in a functioning free market for insurance, there would be patients “left out” of the system. No for-profit insurer would want to cover people with genetic diseases, the chronically ill, or the elderly if they could identify those groups in advance and teh government didn’t force them to accept them as patients.

  64. misteral says:

    @dorkins: True, but what cheeses me is that they operate 8-4, you would think with a waiting list they might, oh I don’t know, extend their hours so people could get treated or something?

  65. tinmanx says:

    Anyone know where all the money actually goes? I heard from a friend who had a family member in the ICU for a week that it would have cost them over 250k for a 7 day stay if they didn’t have health insurance.

    I mean, what exactly is costing so much? The drugs? Doctors? Nurses? Rent for the space and equipment? And here’s what I’ve come up with:

    Nurse 24x7x7 @ $500/hr: $84000
    Equipment & Space Rental 24x7x7 @ $500/hr: $84000
    Drugs (say every 2 hours) 24x7x7 @ $500 a pop: $42000
    Doctors (the hour or two from the 7 day stay): $40000
    Total: $250,000

    I don’t think nurses make $500/hr, maybe $100/hr? Equipment and space rental at $500/hr, that’s nuts! I don’t know how much drugs cost either, but from what I understand the guy was hooked up to sugar water most of the time because he was in a coma, and if it cost $500/pouch, someone is getting ripped off. As for the doctor, I don’t think they make $20,000/hr. They never stay more than a few minutes, so I assume they total maybe a couple of hours for the 7 day stay.

    So then my question is, who’s pocket is the money going into? Or maybe I just don’t get it since I don’t think in dollar amounts that big.

  66. Angryrider says:

    This is sick, and it’s legal! AAAARGH! Curse you for profit healthcare!

  67. Thomas Palmer says:

    @NickRB: Possibly and the sad thing is doctors always give the worst chance scenario, because if they are wrong its good, but if they give the best chance scenario and they are wrong, they are going to get sued.

  68. Peeved Guy says:


    And hopefully, if your government is functioning as a healthy democracy, it is accountable to the people ultimately.

    MY government? Where are you posting from? Just out of curiosity.

    While you make good points, I have just as many doubts of a well-functioning government run health care system as you have valid points of a free market system. While I am not a “starry-eyed libertarian zealot”, I am also not a “starry-eyed liberal” that needs to have the Nanny-State manage every aspect of my life for me. More government oversight, maybe (but that just means more laws that the government has to foist upon us). Certainly not a government run health care system, that just seems like an all around bad idea (higher wait times, a la some stories out of the UK and Canada as well as lower quality care leap to mind).

    In the end, I think our system needs a serious overhaul, addressing each of the item you mentioned before, but not state run, thank you.

  69. johnva says:

    @tinmanx: Well, care for one patient doesn’t actually cost that much money. In healthcare, costs have become almost completely decoupled from prices. Providers raise their “list” prices in part because it’s the only way they can get reasonable reimbursement from insurers, who pay only a “negotiated” percentage of the amount billed. Then, because hospitals treat a lot of patients who can’t pay the bills they owe to the hospital (even when they have insurance, out-of-pocket expenses can be enormous), the hospitals are forced to write off a lot of bad debt. They have to make these costs up by raising prices on people who can pay for their care. Unfortunately, this then means that even more people can’t afford to pay their bills, and you get a spiraling situation that ends in out of control prices, hospitals going bankrupt, and tens of millions of people who cannot afford insurance. The basic funding model for healthcare is broken.

  70. picardia says:

    I know a lot of people, for some reason, find fault with every aggrieved/inconvenienced person who writes in to or is featured on the Consumerist, just because — I don’t know why. They think corporations only want to make everyone happy, or something like that.

    But the people tying themselves in knots to figure out some REALLY GOOD REASON a small child should die of cancer are just completely revolting.

  71. johnva says:

    @Peeved Guy: I’m in the U.S. I was just pointing out that a lot of people have a dogmatic belief that free markets can solve this problem when in fact the evidence shows that they will not.

    I suggest you read more about the government-run systems in various other countries before just assuming it’s a bad idea. There are many different implementations of socialized healthcare; different countries have struck different public/private balances. Many provide as good or better care than the U.S. healthcare system does, ESPECIALLY if you’re one of the people who cannot afford private health insurance. While the U.S. system does very well at providing quality care for some people, it does very poorly for others. Wait times in the U.S. can be just as bad as in countries with socialized care, and our system is very cost-inefficient (with huge administrative overhead and a lot of people taking profit out of the system in various layers).

    We MUST have at least some government-run healthcare or health insurance for the people the for-profit insurers do not want to cover (like the elderly, the poor, and those with genetic diseases). But that just drives up the cost to taxpayers of the government system since it just allows the insurers to take all of the profitable healthy young people and dump all the expensive people on the government.

  72. Logan26 says:


    MAy you get a life ending sickness and then have your insurnce company tell you, “Sorry, we will no longer pay for your treatments.” MAybe then you’ll understand that it shouldn’t matter, they are to provide a service you are paying for.

  73. Peeved Guy says:

    @johnva: OK. I think we are in agreement, believe it or not.
    While you cite examples of some superlative government-run health care in other countries, I would wager you could find just as many horror stories.

    I like your idea of government provided health insurance for the under-insured. I have no problem with that, but when you start talking about some of the proposed solutions that I have been hearing about (mandatory enrollment, taxing the crap outta me to pay for “universal” insurance, etc.), I get chills down my spine.

    In reality, this problem is so massive and complicated that no one solution will be the ultimate cure (no pun intended), there really needs to be a flexible solution. Unfortunately, I’ve not really heard any politician state they have one, and if they did, I wouldn’t believe them…

  74. satoru says:

    From the article itself I think this is the real reason

    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.

    Basically the doctors are doing an unproven medical treatment on him because regular treatments are not working. So I believe the logic here would be that the insurance company is not underwriting a clinical trial for a drug cocktail to be used in pediatric chemotherapy. Basically the child is under an experimental drug treatment, which no insurance company will cover because it opens them up to liability for essentially ‘approving’ the treatment.

  75. wsycng says:

    Why are we even buying health insurance these days when scums like PPC don’t even pay up for essential care services?

  76. Amy Alkon000 says:

    Not all “unapproved” treatments are invalid. But people complain about the high cost of medical care, and then don’t realize that something has to give. There are cancer drugs that keep patients alive for a few more months, but at a cost of, say, $18,000 a month. Okay, let’s preserve all life as long as possible! If that’s your take on health care, please don’t complain about high premiums. Personally, I have no intention of being a costly turnip in a bed, and if that comes to pass, I will either kill myself or, if the law permits, arrange for somebody to do it for me. (Dr. Kevorkian is a hero.)

  77. Amy Alkon000 says:

    Sorry – my comments don’t seem to be going through. This one never showed up.

    Just because a treatment hasn’t gone through the approval process doesn’t mean it won’t work.

    But, people complain about the high cost of medical care, and then don’t realize that something has to give. There are cancer drugs that keep patients alive for a few more months, but at a cost of, say, $18,000 a month. Okay, let’s preserve all life as long as possible! If that’s your take on health care, please don’t complain about high premiums. Personally, I have no intention of being a costly turnip in a bed, and if that comes to pass, I will either kill myself or, if the law permits, arrange for somebody to do it for me.

  78. powerjhb says:

    I was told that insurance companies usually have much better negotiated rates (usually about 1/3 the cost). So 250k goes down to ~75-85k. It is sort of like bill padding. If you can afford the 250k, you pay it. If not, most hospitals will negotiate with you both payment plan options and overall cost depending on your financial situation if you do not have insurance. For the hospital, it is better than dealing with having to cover it all because the patient declares bankruptcy.

  79. llcooljabe says:

    @Amy Alkon: There’s a huge difference between assisted suicide and refusing treatment. Huge.

    BTW, if you don’t want to artificially extend your life, it’s best to put that in a living will, so your family is not faced with a Schiavo like dilemma, God forbid.

  80. Glaven says:

    Lately, it is becoming clear that patients who are dying (especially when it comes to cancer) want in on clinical trials. Current laws and rules surrounding clinical trials don’t always let them. Some kind of solution needs to be found for this, to let that wall down.
    But I didn’t realize that a chemo drug protocol could even fall under this heading.

  81. MommaJ says:

    Impossible to intelligently analyze this case without knowing the terms of the insurance policy and the stated basis for the denial. This may fall into the category of experimental treatment, which usually isn’t covered. Health insurers are a business, not a charity. They shouldn’t be vilified any more than the hospital is for charging for the treatment.

  82. @NickRB: Yes, let us allow people to die so your rates don’t go up.

  83. greensmurf says:

    Dont you just love how some health companys can pretty much hold a perverbial gun to the head of its patients and pull the trigger when costs get too high?

    Wait a second isnt the human race supposed to be intelligent?

  84. Fidel on the Roof says:

    This Insurance Company: Greedy MFs

  85. selianth says:

    Insurance companies will classify a lot of treatment options as “experimental” even though they’re really not. Hubby had an eye procedure a couple years ago which can’t technically be approved by the FDA, because large enough studies haven’t been done. Why not? Because the incidence of his eye condition is so low that there aren’t enough people to actually do the studies. BUT, the FDA did give the procedure what’s called a “humanitarian exemption.” This means they acknowledge it can’t be approved under normal rules but that it’s still safe and effective as far as they’ve seen. (After an initial denial, we managed to get the insurance company to pay for the procedure after an appeal letter.)

    The point being, a lot of these types of procedures are still classified as experimental by the insurance companies, when it’s really because the condition is too rare. It sounds like this kid’s leukemia is a particularly rare type, so I wouldn’t be surprised if something similar is going on.

  86. egoebelbecker says:

    Read the liked article: “but the company that administers the city’s self-insurance plan refused to pay for it.”

    If it’s self-insurance the city can tell the insurance company to pay…I wonder that hasn’t happened?

  87. hills says:

    Problem is the child has a RARE form of leukemia – Insurance companies are set up to auto deny lots of treatment for rare diseases and bank on people not fighting it. The dilemma with the “experimental” treatment is that due to the RARE nature of the disease, there has surely not been enough research to prove effectiveness – nature of the beast, but insurance companies need to accept this and be reasonable, instead of using this as a reason to deny, deny, deny…..

    I am super sick of insurance companies trying to make my medical decisions instead of my physicians.

  88. FLConsumer says:

    Just another interesting figure to throw out there: The costs of administering health insurance in America adds 30-45% to the cost of health care. Just took a course in U.S. Healthcare, quite enlightening to hear the story from actual doctors and insurance co’s. BOTH are to blame. Can’t forget about the trial attorneys either, they’ve certainly caused more of a mess than helped.

  89. hills says:

    My hubby, a doctor, is amazed that most of the $$$ goes to the hospital – less than you would think goes to the physician etc….

  90. HOP says:

    the bottom line in all this is a human life…i read a lot of rationalization in the above comments….it still boils down to a life, not dollars….dollars can be recovered, the life can’t….and as i understand, medical people are supposed to fight for life to the last breath…..swo fight, worry abolut the money later….

  91. HOP says:


  92. failurate says:

    @johnva: With the MRIs and CT Scanners, if you have them, you have to use them. So in past situations, when a standard x-ray has worked, now CT Scans are ordered, driving up the cost of care.

    I am pretty sick of the CYA excuse for over use of incredibly expensive services and machines. It’s not CYA, it’s padding the bill.

  93. KJones says:

    Like any other situation nobody pays any attention until somebody dies. In the case of HMOs, it will probably take the killing of an HMO’s CEO by a “John Q. Public” movie copycat before anyone does anything. The politicians sure as hell aren’t doing anything despite the endless number of cases of people being dumped out of hospitals and left to die.

    No, I am not advocating violence, explicitly, subtly or otherwise. I’m saying that it’s inevitable that somebody is going to go overboard because legal means aren’t working.

  94. Cycledoc says:

    The leukemia that this child has, Acute Lymphoblastic leukemia is the commonest form of the disease occurring in children. It is curable and it is criminal that an insurer refuses coverage.

  95. gradjohn says:

    It’s amazing how quickly everyone has an expert opinion on this.

    Cycledoc is right, ALL is a very common form of childhood leukemia. Unless it’s a clinical trial there should be no reason to deny the coverage. In fact, decent insurance companies will even cover clinical trials.

    One of the reasons hospital/doctor bills are so high is because insurance companies argue these bills down. It’s like a very large game of back market haggling. Another reason, at least with cancer patients, is that many patients never make the payments to the hospitals because they die.

    The hospital is trying to recoup money lost through insurance companies, and other avenues by billing extremely high prices and then taking what they can get.

    We can argue about this all day, but think about this for a second:

    One month of induction chemotherapy for Leukemia cost between $150,000-$200,000. If you’re lucky, you have health insurance and you’ve got some coverage for this. Now your coverage might be 100% or might be less, but all plans have caps and you’re coverage will run out eventually.

    I’m 23 years old and my fiancee was diagnoised with Acute Myeloid Leukemia on January 3rd of this year. It’s similar to ALL that was mentioned in the story.

    Her insurance is 80/20 coverage. Her total treatment costs, including a bone marrow transplant will reach into the millions of dollars. If we’re very lucky, she will survive a bone marrow transplant and we’ll be in dept a few hundred thousand dollars. Enough dept for a few graduate degrees and a very nice house.

    We’ll be financially destroyed by 25.

    But if she lives, it doesn’t matter.

    Which is probably why you don’t hear so many families of cancer patients vociferously calling for healthcare reform.

    Just having their loved one survive leaves them so thankful.

  96. kable2 says:

    I am quite serious when I say that this would not happen in Canada.

    /Damn our universal health care.
    //Its much better to put profit ahead of a kids life.
    ///American health care sucks and blows at the same time

  97. JustIcedCoffee says:

    This is not the insurance companies fault. Self insured means that the city decides what it covers, and has final say on what it pays out — Self Insured means the insurance company charges the city an administrative fee to process the claims, and provide access to it’s network of providers, as well as provide initial decisions, but final say is always reserved for the employer who purchases the service of the insurance company… or the city.

  98. jprawn says:

    I think it is important to understand the particular issues of this boy before we can intelligently discuss whether his insurance company has done something wrong

    While ALL is the most common childhood cancer, this boy’s disease has an unusually low number of chromosomes (hypodiploid). This in and of itself indicates a poorer prognosis, with a overall survival of about 50% at 8 years.

    In the largest study of these particular patients, “Outcome of treatment in children with hypodiploid acute lymphoblastic leukemia” (Blood, 15 August 2007, Vol. 110, No. 4, pp. 1112-1115.), the few patients who actually received bone marrow transplant saw no difference in event-free survival or overall survival.

    The experimental treatment in question (a Children’s Oncology Group protocol) calls for a pretty rough treatment regimen AFTER induction. The chemo agents in question are cytoxan, high-dose cytosine arabinoside, VP-16, and high-dose methotrexate. This combo is basically intented to knock out his bone marrow to allow for a transplant.

    In the article, his doctor says he failed induction. Before he will even be eligible for BMT, they must induce remission. Until we know what actual regimen his doctor is utilizing, we can’t really say whether the insurance company has done anything unusual. In my experience, neither an American insurance company, nor the Canadian or British Health Services would cover non-traditional chemo regimens.

  99. ClankBoomSteam says:

    Paying for insurance is institutionalized gambling. I used to nearly bankrupt myself every month, paying Kaiser nearly $500 a month for services I rarely used (I’m self-employed, so no health benefits for me), all because I previously had a health condition I feared would return. The sum total of what I paid into my “coverage” for five years, before switching to a temporary plan that cushions the blow for a few years? Roughly $28,000.

    The value I got out of paying this amount? Give or take: probably 10-15 doctor visits, maybe two pairs of eyeglasses (which I still had to pay for, in addition to my monthly membership fees), a single prescription (for a drug which caused me temporary kidney damage and that it turned out I did not really need). Wow, THAT was money well spent.

    I have grave concerns about the fact that every time I leave my local Kaiser Hospital, I am shaking off the very real sense that I am considerably smarter than the medical staff therein. I draw cartoons for a living, and I dropped out of college. Anyone see a serious flaw with the math, here?

    My younger brother was born with a birth defect in 1976 — on that day, the doctors t the hospital bluntly told my parents not to “get attached”, then tastefully inquired as to whether they would like for the nurses to feed their newborn baby or not. My brother is alive and well today, coming up on middle age, no thanks to the asses that were working that day. The medical industry didn’t know what the hell it was talking about, and they had all the bedside tact of Doctor Mengele. Things have hardly improved in the thirty-one years since.

    FUCK the medical industry, FUCK the surgical industry, and FUCK the pharmaceutical industry.

    There is no such thing as a “good” medical insurance company; the truth is, they’re only interested in surgically removing your money from the bank.

    Hippocratic Oath my ass.

  100. Tzepish says:

    @myasir: Huh? I’m not sure what article you were reading…

    “But then his doctors heard from doctors at Duke University Medical Center about a treatment protocol that has proved effective in cases like Paxten’s. The Mitchells agreed to go ahead with it, but the company that administers the city’s self-insurance plan refused to pay for it.”

    “Proved effective” is hardly the same thing as “experimental”. I’d go so far as to say they are opposites.

  101. guevera says:

    @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.

  102. guevera says:

    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” :)

  103. delfuego says:

    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.


    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.

  104. Silversmok3 says:

    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.

  105. SteveBobo says:


    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.

  106. ClankBoomSteam says:

    @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…

  107. aldentwc says:

    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

  108. Charlotte Rae's Web says:

    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.


  109. redhand32 says:

    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 ?

  110. cisbill says:

    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.