Cancer Patient's Treatment Determined By HMO, Not Doctors

Main Category: Health Insurance / Medical Insurance
Article Date: 10 Oct 2008 - 4:00 PDT

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"I am a 49 year old female and am currently being treated for colon cancer, stage 4. I was initially diagnosed last year, February 2007, and have been undergoing chemotherapy ever since," said Andrea Bates of Indianapolis, Ind. My initial prognosis was not good, but now is looking very good and I am thankful for that. I currently have insurance through my husband's employer and have been receiving great care, which again, I'm grateful for.

"I recently inquired about another treatment center, Cancer Treatment Centers of America, which has a lot more available options to treat my cancer that my current hospital does not provide. I was informed that because I have an HMO, I cannot pursue treatment outside my network. If I had a PPO, insurance would most likely cover the cost of me going to the Cancer Treatment Center of America though.

"Since the insurance I have is through my husband's work, we were only given two options to choose from for insurance for the 2008 year - Advantage HMO or Anthem PPO. For obvious reasons, we had to take the Advantage HMO route because it was more than half as cheap than the Anthem PPO. Why should we have to choose in the first place and why only these two types of insurances?

"But they finally did allow me to go to another hospital to have my final major surgery, and I was grateful for this since this last surgery was the one that probably ended up saving my life. I had 65 percent of my liver removed that had cancer on it.

"I don't know if the insurance company would have eventually allowed me to go to the Cancer Treatment Center of America. They might have if I would have continued to pursue it, but I guess that's part of the problem - why should I have to justify my intentions of going somewhere else where better treatment is offered that could save my life?

"It simply is not fair that we have to choose between 'affordable' healthcare versus 'not-so-affordable' healthcare and only being given limited choices of insurance plans to choose from. These choices obviously can make a difference between life and death. I'm sick to death with increasing premiums year after year and receiving less coverage, year after year."

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