Friday, February 21, 2020

State Senator: It's Time to Hold Insurers Responsible on Cancer Care

This post is a guest column submitted by State Senator Angela Hill

A cancer diagnosis is devastating, no two ways about it. Every year in Mississippi, more than 15,000 people will find out they have cancer. Along with their families, they will face many health, financial, and emotional burdens. While fighting cancer is never easy, insurance companies are making things worse by improperly denying cancer treatment. My fellow legislators and I have an opportunity to step up and change that.

Nearly everyone I know has been touched by cancer in some way, and I am no exception. More than a decade ago, my husband, an otherwise healthy 44-year-old, discovered he had chondrosarcoma in his left knee. The preferred treatment for his cancer was surgery since chemotherapy and traditional radiation did not work on this type of cancer. He had his left leg amputated above the knee in 2006, and has been cancer free since.  BUT, I learned about proton therapy while researching his options. I learned that patients whose chondrosarcoma tumors were in the neck and jaw joints (basically inoperable), were having success with proton beam radiation.

Proton treatment is a form of radiation that specifically targets cancer cells while minimizing the impact on surrounding healthy tissue. It wasn’t necessary for my husband, but I learned that the treatment could be incredibly valuable for cancer patients with few other options. Unfortunately, insurers improperly deny many patients’ access to the treatment -- forcing them to shoulder emotional and financial burdens while fighting for access to the treatment their doctors recommend.

Now my colleagues in the State Legislature and I can make sure Mississippians have access to this advanced form of radiation treatment. I introduced Senate Bill 2558 that would require all health insurance policies in the state that include benefits for radiation oncology to cover proton therapy based on the latest recommendations by the American Society of Radiation Oncologists

Recently, I learned the story of a fellow Mississippian whose experience epitomizes the broken state of patient access to proton therapy. UMMC anesthesiologist Dr. Bryan Heirlmeie reached out to me for help after Bryan's insurance company repeatedly denied proton therapy.  Like many, he found himself on the losing end of an unjust power imbalance.  Bryan’s physicians at UMMC recommended protons to target the tumor in his brain because the treatment is so precise. They told the 36-year-old that traditional radiation could affect his vision, lower his IQ, and possibly end his medical career. Despite this recommendation from doctors at both UMMC and a leading cancer institution, Blue Cross Blue Shield of Mississippi (BCBS) called the treatment “experimental and investigational” and refused to pay -- based on outdated information no less. Left without options, Bryan took out $150,000 in loans from family and friends to cover his proton treatment at MD Anderson in Houston. At the same time that patients like Bryan who faithfully paid their insurance premiums are denied, Mississippi Medicaid is paying for adult patients to receive this treatment at out of state facilities as well as paying for their transportation to and from MS.

Beyond patient protection from improper insurance denials, another way the legislature can help Mississippi cancer patients is to explore the benefits of having a proton therapy center here in our state. There are 29 proton centers in the country today, and more are under construction. Florida, Alabama, Tennessee, Georgia, and Louisiana all have proton centers -- but not Mississippi. Traveling far away for long-term treatment increases costs and other hardships for cancer patients and their families.

Insurance companies must give patients access to the care they need and right now, they are failing. Mississippi patients, physicians, and doctors in training should have access to this technology. I am committed to providing Mississippians greater access to proton therapy, the best option available for treating many types of cancer. I hope my colleagues in the legislature will join me in this mission.

<Senator Angela Burks Hill is a State Senator for the 40th district representing Marion and Pearl River.
 

29 comments:

Anonymous said...

I hope you are successful in battling an insurance company that has totally strayed from its origins.

Anonymous said...

Is the right honorable lady willing to pony up eight figures to construct a proton facility? Where would such a facility be built? Certainly not in the flood plain that comprises the greater Jackson area...

And, while proton therapy may be "so precise" it is not pin-point. There is no additional benefit to be gained by proton therapy than cannot be achieved with GammaKnife SRS or highly conformal image modulated radiation therapy.

Proton therapy has real world applications, particularly in children with lethal midline malignancies where radiation tolerances could result in stunted growth. Outside of this narrow indication, proton therapy remains investigational and no more beneficial than what is currently available throughout the state.

Anonymous said...

"insurers improperly deny many patients’ access to the treatment"

Define "improperly." Were they not acting in accordance with the terms of the policy? If they were, what is improper about it? If they were not, couldn't/shouldn't they be sued for breach of contract instead of playing with the statutes?

bill said...

This move is walking up to the fine line between government protecting its citizens and government telling private business how to operate. Were health insurance companies independent and operating in a true competitive environment, I'd tell Senator Hill to butt out. However, that's not the case. BC/BS is the dominant insurer in the state, as they are in most states, and they are WAY more interested in collecting premiums than they are paying claims. I'd give them the opportunity to change their ways, but pass the law if that's what it takes to protect their subscribers from highway robbery.

Anonymous said...

Insurance companies are dictating care every day.
My relative was admitted to the hospital with pneumonia and on IV antibiotics for 3 days.
United Healthcare denied the claim even though we have health insurance.
Doctors said that was standard for UH to deny and for us to resubmit the claim.
Kiss my ass - resubmit.
We pay crazy high premiums for health care.
Doctors say admit- insurance better pony the hell up.

Anonymous said...

Just FWIW, I have heard several complaints and personally knew 3 who died of cancer within weeks of diagnosis. All had suffered from COPD for years and were on a regular program of treatment that seemed to be the SOP for doctors. But looking back it seemed to me that the doctors were happy just to keep the roster of COPD patients being regularly seen full and recognizing that as soon as the cancer was noticed the roster would immediately lose the name of a paying account.

When someone says that our healthcare system doesn't want to cure us when keeping us alive but ailing is so profitable don't laugh. They may be exactly right.

Anonymous said...

10:11 - Insurers have been, and there are some recent huge verdicts for this specific brand of denial. Don't be surprised to see this statute create a statutory immunity protecting against bad faith action as much or more than the stated interest of providing medical treatment to patients under existing contractual terms.

Anonymous said...

Insurers are out of control. Physicians will tell you that their medical decisions are consistently second guessed and denied by some desk jockey that receives the claim. Appeals are required which requires a full time employee in the clinic that handles nothing but PA’s and appeals. Too often this escalates, requiring the doctor to have a “peer to peer” conference with the insurer to plead on the patient’s behalf for required procedures/medicines. At the same time, reimbursement is being lowered requiring doctors to see a higher number of patients per day. You think they have time for “peer to peer” calls?! I still say allow patients to buy insurance across state lines. It is unbelievable the superior coverage that people can get in Louisiana or Alabama as a BCBS patient as compared to what they get with BCBS Mississippi. Premiums are just as high in MS but where does that $$ go? Not to the patients. Go by the BCBS campus on Lakeland Drive. All kinds of nutrition and holistic benefits for employees that are certainly not made available to the customer. And let’s not forget the headlining sponsorships that BCBS MS pays for with those premium dollars. BCBS employees and big wigs getting the VIP treatment by these non-profits at their preview parties and “free” attendance to said events while the customers are getting denied. Disgraceful.

Anonymous said...

Free markets not working for this Republican?

A tweak here and a tweak there and that health care will be all ok?

Will this law help some of those rural hospitals in Mississippi be great again? A proton beam here and a proton beam there will help keep those hospitals open and keep Mississippi healthcare great?





Anonymous said...

Not in the insurance business, but I am always amazed at the number of people that take out an insurance policy - health, home, auto - and are under the impression that the policy will cover every possible situation.

Anonymous said...

11:50 That is because the commission-hungry sales person often gives them that impression.

Anonymous said...

You can and have been able to buy “supplemental” cancer policies. It is expensive and I do not know how this uneducated legislator thinks she is inferring this will not cost more money. Uneducated legislators are the reason Mississippi is last in many categories.

Anonymous said...

It's also amazing how many provider organizations fail to uphold terms of their participation agreement by consistently performing basic functions like notification/authorization AND filing claims accurately. Very convenient to blame insurance companies for their own administrative failures.

Anonymous said...

Wasn't this same lawmaker all wee wee'd up about rising healthcare costs recently? Or will the proton beams save money?

Anonymous said...

Sounds like we need a Tea Party uprising to nip in the bud this attempt at government meddling in Health Care. Where are all the Conservatives to protest this assault on the Free Market? Worse than slavery, right? Isn't that what was claimed about Obamacare? We need more Boot Strapping & Rugged Individualism, not more government Nanny state involvement. Freedom!!!

Anonymous said...

10:08 - I sure would hate for my child to suffer from 'stunted growth' as a result of being cured from fatal cancer. Turn your cap around, Doc.

Anonymous said...

Insurance companies and baseball,I believe, are the only two entities not subject to anti-trust legislation. Trent introduced a bill after his house was whacked by Katrina, but the effort faded into the woodwork soon afterwards. So take this exemption away from the bastards and force the opening of their black box of ALL of their practices.

Anonymous said...

11:50 - Those of us who DO take out a policy and read it carefully, shouldn't be blindsided by the ever-present surprise of routine claims being denied.

It's become as routine as it was back in high school when dating. They always say no the first time.

Anonymous said...

Bill, Thanks again for blowing hot air and saying nothing. Typical.

Anonymous said...

Not sure why it is necessary to issue a press release or statement regarding your bill. Use that energy to get the damn thing passed. You need to be working other legislators not KF bloghounds. Another politician spending precious time saying, "look at me and all the good I'm doing" rather than focusing on the job at hand. (Shad White comes to mind.)

@10:08 AM is full of bovine scatology said...

@10:08 AM must represent the insurance industry, or has been force fed their kool-aid, or is an urologist with a scalpel who has a payment due on his yacht and/or jet, or all of the above.

I dealt with a urologist who told me that "proton therapy is new and experimental." Sure, new since 1954.

Proton radiation therapy is NOT NEW and is very effective. Yes, the equipment is very expensive, but it works.

I had proton radiation therapy in 2015 for prostate cancer, and my PSA score remains zero.

Fortunately, Medicare and my supplemental Anthem paid the bill in full.

This Senator is right and is trying to do a good thing.

Anonymous said...

Health Insurance in Mississippi is not Free Market. I bet with some investigative journalism, it would be found that certain insurance companies lobbied lawmakers to create a market where we only have two choices on the Affordable Heath Care Exchange and those policies are worth about 20K per family to the insurance company and there are so few situations that they will incur an expense that they are the most profitable policies in the history of health insurance.

Anonymous said...

@10:08 Well said. And the good Senator Hill knows all this. But that doesn't stop her from stirring up a shit-storm emotionally in voters. This is pure political pandering to an undereducated state constituency that doesn't even understand the nature of business, much less the business of healthcare provision.

@10:26 Get a grip on your entitlement. Doctors have a built-in conflict of interest by recommending treatment that is paid for by someone else. Those who have the gold, make the rules - on what they will or will not pay for. End of story.

Anonymous said...

God bless you Senator Hill. As a family member of a cancer patient who received proton radiation, I cannot tell you how wonderful it is. No collateral damage, no down time, so side effects. Nine years later, this cancer has not returned. It was difficult receiving treatment out of state for 10 weeks, but well worth it. Thank God we had Medicare and a supplemental policy. I pray Jackson could build a proton radiation treatment center. 10:08 - you have absolutely no idea what you are talking about!!!! Many cancers are treated successfully with proton radiation. I saw many infants and children with brain tumors treated daily because this radiation goes in at such a low intensity that it does not burn or destroy any other tissue. BCBS has routinely denied coverage for this treatment. BCBS sure knows how to charge for premiums AND HOW TO DENY coverage that works. Proton is NOT experimental and has been around for a long time. Its past time for BCBS to do the right thing.

Anonymous said...

So the doctor works at UMMC? As a state employee? If he’s a state employee (like me) then Blue Cross just handles the health insurance paperwork for the State health insurance. Mississippi would be the one telling Bluecross what they want to cover for their employees. I’d think a state senator would be able to fix that easier than going after the insurance company they hired to do the paperwork?

Anonymous said...

All insurance companies should operate as non-profits and should be audited annually by the insurance commission to make sure that they are held within certain financial expense rates. The rising costs of insurance is not only driven by increasing medical care and pharmaceutical costs, but also by the owner’s of the insurance company wanting a great return on investment, year over year. I’m all for a great ROI, but at the expense of people fighting for their lives, seems barbaric.

Anonymous said...

10:44 - to answer your opening FWIW, frankly its not worth much.

You "heard" of something, and while you "know 3 that died" you make no cause and effect connection EXCEPT FOR the fact that "it seemed to you" that this happened.

When I read that some anon blog commentator has heard of something that makes them think that it seems to be -- I'm always ready to take that to the bank as valuable information.

Anonymous said...

@2:54pm On who's dime dude? Entitled much?

bill said...

1:43, you're welcome. Didn't realize you were a fan. Shoot me your address and I'll send you a photo.

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