Saturday, April 4, 2009

Humana: The Power Over Life

The strength and determination of these young people fighting cancer is on a level that I could never have imagined. I have watched these kids, including my own son, stare directly into the flames of Hell .

The most agonizing aspect of cancer is that most of the battle is fought alone. We are beside our children, but we can not take on their cancer. However there are times when the fight goes beyond cancer. It is at those times that the responsibility falls squarely on everyone of us. The only question is will we accept the responsibility.

Mason McLeod is 10 years old, and fighting Burkitt's Lymphoma. For over a year he has beaten it down several times. He went into kidney failure, and won that battle. His little brother Gavin provided bone marrow for the transplant, and he won that battle. His parents, Travis and Amy, have fought everything else, managing the incredible financial burdens of a home and job in Georgia, along with the apartment at Duke University Hospital in North Carolina where Mason is being treated.

But now they are facing a power greater than cancer, greater than kidneys and bone marrow. It is Humana Healthcare's power over life and death. Dr. Martin at Duke University, Mason's oncologist, needs to perform a DLI (Direct Lymphocyte Infusion). Little brother Gavin is back at Duke as the donor. Mason is strong, and is beating the cancer. But he will not survive without this procedure. Humana has decided enough is enough. They will not pay for the procedure. Dr. Martin stepped in, saying the treatment is critical, and therefore will do it at no charge. But there are other costs, and Humana will not pay a dime. Humana, like most insurers, uses an undisclosed formula to place a dollar value on life. Mason has reached his "quota".

Travis McLeod has maintained his job, made all his payments, covered all the deductibles...all with his family spread across two states...only to maintain the insurance for his oldest son. But it appears none of that is more important than Humana's shareholder profits and corporate bonuses. (although the policy presumably changes for children of Humana executives).

So what can you do?

1. Call Humana headquarters at 1-800-486-2620 and complain. Just say something like this, "Mason McLeod is 10 year old cancer patient at Duke in North Carolina. He is a Humana policy holder, and needs a DLI (Direct Lymphocyte Infusion). Humana refuses to pay for this necessary procedure. I would like to protest Humana's decision, and ask that the procedure be approved. Mason is fighting for his life."

2. Call and media you can think of and tell them the story.

Can your calls make a difference? Here are two examples from a year ago:

17-year-old Nataline Sarkisyan was fighting leukemia, and CIGNA refused to pay for the needed kidney transplant. Doctors, nurses, and other supporters staged a sit-in at the insurer's offices. After CIGNA heard Nataline lapsed into a coma, they finally agreed to pay. But Nataline passed away a few hours after the announcement.

17 year old Nick Columbo was denied treatment for his cancer by PacifiCare, a division of UnitedHealth. After a flood of media attention and protests, including doctors and nurses, PacifiCare reversed their decision and approved the treatment. It treatment was successful and Nick is doing well. In the process, California state officials announced they are investigating PacifiCare for over 130,000 alleged violations, including wrongful denials, mostly since being acquired by UnitedHealth.

Is this a one time occurrence with Humana?

"As Good As It Get's", staring Helen Hunt, is a movie about a little girl who died waiting for treatment. It's based on the true story of Caitlyn Chipps, a child in Florida denied treatment by Humana. In the real case, the court found Humana actively participated in the following practices common among insurance providers:

1. Coverage is based on undisclosed, cost-based criteria and financial incentives unrelated to medical necessity.

2. Direct cash bonuses and other financial incentives are given to reviewers to induce them to deny claims or limit hospital admissions and stays regardless of medical necessity.

3. Humana gives bonuses and incentives to case managers, nurses and physicians if they discharged patients from hospitals earlier than what the treating physician recommended.

4. Humana contracts with third parties to review claims for some medical conditions, thereby using less restrictive guidelines than stated in their benefit manuals. In case of a woman with cervical cancer denied a hysterectomy, it was learned at trial that it was the policy of Humana’s contractor, Value Health Services, to automatically deny one of every four requests for a hysterectomy, regardless of the patient’s medical condition, saving $67.5 million a year.

5. Outside accounting firms are hired to recommend how notice requirements can be made more difficult, increasing the likelihood that policy-holders will not follow the "rules" and therefore can be denied coverage.

6. Hospitalists/Interventionists are used to hire physicians to oversee patients’ care in local hospitals. Their primary purpose is to discharge patients as early as possible, making these decisions without seeing the patients.

7. Humana practices of method of systematic delay or outright denial of payments for treatments that were previously approved. Humana often waits over six months to pay for treatments provided to its catastrophically ill or injured policy-holders.

At the conclusion of the wrongful death trial, Humana responded in typical fashion, "We will vigorously pursue an appeal."

We had battled insurance. We have been lied to about available treatments. I have seen treatments delayed and kids sent home because the parents insurance have reached the annual cap. I have watched as friends are sent home to die, never being told of available options. Did you know this happens every day? I did not, but I have seen it.

I understand that there are situations when decisions must be made. I understand there can be a point to ask "How long do we fight". But who has the right to answer that question? Only the family. No one else. And no one has the right to judge their decision.

This is a child. A 10 year old boy, begging for only one thing...hope. As Miles Levin said, "So when is it over? Not yet."

Mason, with father and brother

12 comments:

Anonymous said...

I will be calling monday and will be telling everyone I know to call also!!! Any parent of a child sick or not sick should be calling. Thank you so much for letting us know what we could do..your family site is wonderful for the way it honors alot of children!!!

Anonymous said...

Amazing!
I called and left a message. I will be calling again when they open on Monday.

Fight for our children!

Karen and Rob

Anonymous said...

Kyle - have you considered posting this over on Pac2? I think there are a lot of readers over there who would be outraged enough to make some phone calls.

Anonymous said...

Thank you for tell us about this. We are calling first thing in the morning.

Anonymous said...

I will be calling on Monday and emailed all my friends!

Anonymous said...

I am calling!

Anonymous said...

I called----and will keep calling---and will tell everyone to call

Anonymous said...

Kyle-

I saw this on PAC-2, and have already called. I have forwarded you post though our church, asking them to call and pray.

Thank you for letting us know about this.

Anonymous said...

Kyle....I am assuming you won't mind if I cut and paste this and put on Kelsie's site...hope it's ok! Thanks.
Kathi
www.caringbridge.org/visit/kelsiemckune

Kyle Alfriend said...

Absolutly-past it everywhere you can!

Anonymous said...

These people are unbelievable!

I made my call.

Anonymous said...

Has anything came forth with this? I had the opportunity to meet this child at Duke and after reading this I am so outraged. What else can I do to help?