Cancer Knows No Party, and Neither Does Blue Cross of CA

Elizabeth Edwards' acknowledgement of the recurrence of her breast cancer (which I hope is not more serious than the Edwardses made it out to be, but which I fear is) was but one story of cancer attacking prominent political figures. Tony Snow will have surgery for a small growth under his abdomen; he had colon cancer two years ago, so we hope that it's nothing more serious. And most tragically, conservative commentator and blogger Catherine Siepp succumbed to lung cancer. Cancer is not a disease that picks between political affiliations for who it afflicts, that much is clear. And so a problem affecting everyone must be solved with a universal solution.

Before she died, Catherine Siepp wrote about her experiences with Blue Cross of California. It was a bit shocking to hear a committed conservative talking about the failures of our health care system in such a frank and direct manner, but when a health insurance conglomerate acts so dishonestly, anyone in that position would be offended regardless of their politics.

By law, insurance companies aren't allowed to adjust your monthly premiums just because you get sick. But they can raise the out-of-pocket cap for all of their members anytime they like, which amounts to the same thing because it affects only the unvalued sick members. (And, of course, getting sick means that even while one's medical costs go up, the ability to pay goes down -- earnings potential is curbed when life becomes a series of treatment appointments.)

Lucky you, if you don't know what your out-of-pocket cap is. And if you're like every single healthy person I've queried, you probably don't. But you should know, because the out-of-pocket cap is the most important part of your policy, meant to stave off financial disaster in case of catastrophic medical expenses [...]

Another thing working in insurance companies' favor is that cancer patients rarely have the energy to argue about such nickel-and-diming. I recently managed to spend a morning forcing my way through multiple disconnects and transfers on the Blue Cross 800 number, but I was eventually told that the company would probably reimburse me for the extra $90 a month I was paying for that weekly anti-nausea drug if I filled out the right forms. My far bigger worry is that out-of-pocket cap, which is essentially what insurance is for. To drastically raise it seems the definition of bad faith.

Or so I thought -- until I began getting letters from Blue Cross in February announcing that it was retroactively disallowing the anti-cancer drug Avastin treatments it had been paying for since October, at $5,000 a pop every other week. It seems Blue Cross decided this new and expensive targeted therapy is experimental. (It looks as if Blue Cross is not asking to be repaid for my relatively unexperimental chemo, which had been costing about $2,500 every single week, but who knows?)

To decide after a therapy has proved beneficial that it's merely "investigational" and therefore should not be covered -- that, actually, seems the definition of bad faith.

Today, the LA Times reported that Blue Cross of CA is being fined a million dollars for illegally dropping the policies of sick clients for trumped-up reasons. Recission is harsher, but generally of a piece with what Siepp had to put up with near the end of her life. That fine is embarrassingly low (they made three billion last year) and won't make a dent in Blue Cross' policies. But at least the state of California has publicly stated that this health insurer is motivated solely by greed and will gladly let their customers suffer rather than carry out their responsibilities. As an individual policyholder with Blue Cross, exactly the profile that they dishonestly drop as a matter of routine, this scares the heck out of me.

I am truly sorry for Catherine Siepp and her family, along with any other family out there who has had to deal with the scourge of cancer. We need to ensure that these families get the best medical attention and all the support they need; it ought to be an inalienable right of this country not to have to suffer due to some corporate balance sheet. The current insurance system will never get us to such a goal.