Last June, when the American Medical Association announced its finding that nearly one out of every five health insurance claims had been processed incorrectly, it had probably hoped it was giving the insurance biz a much needed kick in the pants. But one year and another AMA report card later, that statistic remains virtually unchanged.
Earlier this week, a Congressional investigation revealed that several insurance companies rely on a database from Ingenix that deliberately underestimates the cost of medical services, reports the Associated Press. The result is that “American consumers have paid billions of dollars for health care services that their insurance companies should have paid.”
In the hours leading up to a planned protest outside PacifiCare offices, the health insurance reversed its decision and decided to provide coverage for 17-year-old Nick Columbo to undergo an additional cancer procedure recommended by his doctors, provided the family finds a doctor to perform it. VP of PR for United Health Care, Tyler Mason, told me the coverage for the CyberKnife procedure was initially denied after three review boards, one at Stanford, the USC Cancer Center, and UNH’s California regulator, recommended against it because the cancer was too large, too involved with nerve endings and wrapped in nerves, and because of the potential side effects. Mason said that this information was omitted from the California Nurse’s website because they wanted to use the Columbo case as a political tool. The side effects include Nick needing to use a bag for his bowel movements and the skin on his tailbone falling off. When I asked if the bone cancer, Ewing’s sarcoma, could kill Nick, yes or no, Mason said, “It’s a very challenging situation, I’m not a physician.”
Pacificare, owned by UnitedHeatlh, has decided to deny coverage for Nick Columbo, a 17-year-old dying from bone cancer. Nick has been unresponsive to chemo and his doctors recommend the “CyberKnife” treatment (read their letters here). Nick’s family is holding a protest outside the Pacificare today to try to get the insurance company to change its mind. UnitedHealth is ranked as the worst insurance company in the nation, is being investigated by the state of California, and has been fined over $3.5 million for negligent claims practices. Inside, a plea for help from Nick’s brother.
THE QUOTE:“”Our integration issues and challenges shouldn’t affect our providers, and they shouldn’t affect our members,” he said. “We’re very regretful about that.”