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Suck it up, kid. It’s just 400 miles.

Submitted by on Saturday, 9 May 2009 One Comment
Proof positive health-insurance executives are living on a different planet from the rest of us:

A company that covers federal workers tells a 5-year-old Reno girl with leukemia that she'll have to have chemotherapy in Oakland. That's a 400-mile round trip each week.

A a vice president with the company tells the girl that she's lucky.

"We are fortunate she has our coverage," GEHA vice president for claims Jan Overton told The Associated Press Friday.

The headline on the story in some media outlets reads "Insurance snafu."

Um, no. A snafu is a chaotic situation, something "fouled up," to sanitize the military version.

This is chaos all right, but it's also cruelty. It's callousness. It's arrogant disregard for  suffering. And it's one more reason why the American health care system will never work for the American people as long as the insurance companies are in charge. Between them and the drug makers, patients don't stand a chance.

Back to Ericka, though.

Two doctors from Oakland make weekly trips to Renown Medical Center in Reno to save patients like her weekly trips that last two years or more. It's an innovative workaround to the problem of the nationwide shortage of pediatric specialists.

Such medical-care patches - let's not call them solutions, because they exist only due to herculean efforts of doctors - are not an uncommon. For example, as of six years ago a single pediatric urologist covered a 366-mile stretch of Central California. He was based in Sacramento, smack in the middle of the swath, and affiliated with every insurance company he could in order to help as many people as he could. He also worked 18-hour days.

In the past, according to AP, insurance companies have readily agreed to cover pediatric cancer treatments at Renown in Reno because it is the only hospital in the region that handles such care.

That, too, makes sense. Why build expensive specialty units in every hospital in a city when one will do?

Except in this case, one won't do.

GEHA was willing to cover Ericka's care at Renown, but at its out-of-network rate. A rate that would cost the Schneiders $2,000 more a year. Maybe that's chump change to a company that does nearly $1.8 billion in sales a year, but for the average family, it's significant.

To GEHA's credit, it hasn't increased premium costs for federal workers as much as other insurers have in the past few years. Maybe that's why the company has to stick it to kindergarteners now.

One of Ericka's doctors says Renown has, in the past, negotiated temporary contracts with insurance companies that allow patients to be treated there at in-network rates.

In this case, though, GEHA refuses to budge. Everyone from the state insurance commissioner to the U.S. Senate majority leader has pleaded with the company, to no avail.

Overton told AP she doesn't believe GEHA is being unreasonable.

Based on bottom-line considerations, probably not. Rules are rules, after all, and the rules say Ericka can be treated at Renown only if her family pays the extra money.

Based on humanitarian concerns, most people not paid to shill for GEHA probably wouldn't think it's reasonable to force a sick child to commute 200 miles for treatment she could get 15 minutes from her home.

Copyright 2009 Debra Legg. All rights reserved.

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One Comment »

  • Karen Schuler said:

    I’m writing to let you know that GEHA is working with the doctors and hospital to minimize costs to the family. We are working quickly and are confident we will be able to work out arrangements.

    It’s our goal to provide our members with quality care at an affordable cost. As a health plan for federal employees, we work within a cost-plus contract, meaning we do not profit from benefit decisions. GEHA takes seriously our responsibility as a custodian of taxpayer dollars. We operate as a non-profit member association and our administrative (overhead) expenses are just 5%, which is very low compared with others in the industry.

    We certainly want to do what is right for this family. We understand their concerns and yours.

    Sincerely,
    Karen Schuler
    GEHA Communications Manager