Two months ago I wrote about this case here. I am not at all a fan of Kaiser Permanente, and I know that Kaiser turns a profit by failing to provide life-saving treatments. It achieves its billions of yearly profit through "treatment guidelines" that cause practitioners to fail to appropriately diagnose and treat illnesses.
But I am suspicious of this particular case. I suspect that some charlatan in Arkansas offered hope to Mr. Afshar in exchange for $2 million dollars.
I did a little research and found this information on the American Cancer Society website:
"Infection with HIV is the only clear-cut risk factor for CD. Castleman disease is much more common in people with this infection, particularly in those who have developed the acquired immunodeficiency syndrome (AIDS)...The cause of Castleman disease (CD) is not known for sure, but doctors suspect it is related to problems with the way a person's immune system is working...A virus seems to be involved in at least some cases of CD. Human herpes virus type 8(HHV-8) is found in the lymph node B cells of many people who are HIV-positive and have multicentric CD. This virus is also known as Kaposi sarcoma-related herpes virus(KSHV) because it has also been found in people with Kaposi sarcoma (a rare type of cancer). In fact, some people with CD also have Kaposi sarcoma."
I suspect that Mr. Afshar will live exactly as long with his $2 million Arkansas treatment as he would have lived without it.
Man Files $2M Lawsuit, Says Kaiser Refused To Cover Life-Saving Treatment
May 13, 2013
CBSLA.com
A Pasadena man is suing Kaiser Permanente for $2 million alleging breach of contract and unfair business practices after he says they gave up on him and refused to provide or cover the cost of life-saving care.
Kaiser doctors diagnosed 58-year-old Jalal Afshar with Castleman disease, a rare and often deadly disease that targets the lymph nodes.
...A former Kaiser employee, Afshar said the non-profit medical group initially granted his request to see an out-of-network specialist in Arkansas.
“It was like, you know, finding your life again,” he said.
The lawsuit alleges that Kaiser ultimately declined to pay for his care, claiming that services were available within his existing plan to treat the disease.
“Kaiser, in bad faith, unreasonably denied medical care that Jalal needed to save his life,” said his attorney, Scott Glovsky.
Afshar continued his treatment out-of-network. Six months later, he is on the way to recovery, but owes $2 million in health care costs.
“He would be dead for sure because they had given up on him,” said his wife, Maryam.
[Maura Larkins comment: I have not seen any evidence that Mr. Afshar was given a prognosis of six months to live. Kaiser simply said it didn't have a treatment to offer him. This doesn't mean he was expected to die right away. It only means that Kaiser was not planning to interfere with the course of nature.]
“We should care about people more about their lives than making money,” said Afshar.
“When I was there, they were clearing a couple of billion dollars of pure profit every quarter,” he said.
Kaiser declined an interview, but released a statement Monday.
The statement reads in part:
“We dispute the allegations included in the lawsuit…We did not give up on our member. Respecting patient privacy, we cannot provide details about the treatment options which were made available and being pursued…We will fully address the lawsuit in the proper judicial forum.”
Showing posts with label abandoning treatment. Show all posts
Showing posts with label abandoning treatment. Show all posts
Tuesday, May 14, 2013
Friday, June 10, 2011
Cancer costs put treatments out of reach for many
Cancer costs put treatments out of reach for many
By Debra Sherman
Jun 6, 2011
Reuters
The skyrocketing cost of new cancer treatments is phttp://www.blogger.com/img/blank.gifutting advances in fighting the deadly disease out of reach for a growing number of Americans.
Cancer patients are abandoning medical care because the costs are simply too high and medical bills -- even among the insured -- are unmanageable and risk bankruptcy, studies show.
"There's a growing awareness that the cost of cancer treatment is unsustainable," said Dr. Lee Schwartzberg, an oncologist who did a study examining the factors that contributed to patients quitting their oral cancer drugs.
Cancer is one of the most costly diseases to treat, largely because many patients are treated over a long term, often with expensive new drugs that are complicated to produce and not available in generic form. And as insurance companies cut all benefits, reimbursements on cancer treatments have also declined.
"When it's an expensive drug, we have to have the hard discussion about a very substantial out-of-pocket payment. I ask: 'Do you want to spend this money for an average improvement of just a few months of life?' I'm very uncomfortable having those discussions because I want to focus on the patient getting better," Schwartzberg, medical director of the West Clinic in Memphis, Tenn., said in an interview.
Schwartzberg's and other cost studies presented at the American Society of Clinical Oncology (ASCO) annual meeting come as U.S. lawmakers battle over ways to reduce the national debt, including cuts in healthcare funding. For full ASCO coverage see [nN05141382]
ASCO president Dr. Michael Link, a pediatric oncologist, said access to healthcare should be a national priority.
INSURMOUNTABLE BARRIERS
"We're thrilled with what we consider to be breakthroughs and wonderful new therapies ... yet the barriers for some patients to get them is insurmountable. It is an indictment of how we take care of patients in the United States," Link said.
Cancer is the second-leading cause of death in the United States, after heart disease. The incidence is expected to increase with an aging population.
The costs for cancer care topped $124 billion in 2010 in the United States, led by breast cancer, according to the National Cancer Institute (NCI). That number is expected to rise as more advanced treatments -- targeted therapies that attack specific cancer cells and often have fewer side effects -- are adopted as the standards of care. The NCI projects those costs to reach at least $158 billion by 2020.
Until recently, almost all cancer drugs were administered intravenously. Today, about a quarter of them can be given orally, which means fewer visits to the doctor. But pills are often more expensive, have higher co-payments, and are reimbursed by insurers at lower rates than IV drugs, he noted.
Using a database of pharmacy claims paid by private insurers and Medicare, he found, not surprisingly, that those with higher co-payments quit their drugs more often.
Patients with co-payments of more than $500 were four times more likely to abandon treatment than those with co-payments of $100 or less, Schwartzberg said. Claims with the highest co-payments had a 25 percent abandonment rate, compared with 6 percent for co-payments of less than $100...
By Debra Sherman
Jun 6, 2011
Reuters
The skyrocketing cost of new cancer treatments is phttp://www.blogger.com/img/blank.gifutting advances in fighting the deadly disease out of reach for a growing number of Americans.
Cancer patients are abandoning medical care because the costs are simply too high and medical bills -- even among the insured -- are unmanageable and risk bankruptcy, studies show.
"There's a growing awareness that the cost of cancer treatment is unsustainable," said Dr. Lee Schwartzberg, an oncologist who did a study examining the factors that contributed to patients quitting their oral cancer drugs.
Cancer is one of the most costly diseases to treat, largely because many patients are treated over a long term, often with expensive new drugs that are complicated to produce and not available in generic form. And as insurance companies cut all benefits, reimbursements on cancer treatments have also declined.
"When it's an expensive drug, we have to have the hard discussion about a very substantial out-of-pocket payment. I ask: 'Do you want to spend this money for an average improvement of just a few months of life?' I'm very uncomfortable having those discussions because I want to focus on the patient getting better," Schwartzberg, medical director of the West Clinic in Memphis, Tenn., said in an interview.
Schwartzberg's and other cost studies presented at the American Society of Clinical Oncology (ASCO) annual meeting come as U.S. lawmakers battle over ways to reduce the national debt, including cuts in healthcare funding. For full ASCO coverage see [nN05141382]
ASCO president Dr. Michael Link, a pediatric oncologist, said access to healthcare should be a national priority.
INSURMOUNTABLE BARRIERS
"We're thrilled with what we consider to be breakthroughs and wonderful new therapies ... yet the barriers for some patients to get them is insurmountable. It is an indictment of how we take care of patients in the United States," Link said.
Cancer is the second-leading cause of death in the United States, after heart disease. The incidence is expected to increase with an aging population.
The costs for cancer care topped $124 billion in 2010 in the United States, led by breast cancer, according to the National Cancer Institute (NCI). That number is expected to rise as more advanced treatments -- targeted therapies that attack specific cancer cells and often have fewer side effects -- are adopted as the standards of care. The NCI projects those costs to reach at least $158 billion by 2020.
Until recently, almost all cancer drugs were administered intravenously. Today, about a quarter of them can be given orally, which means fewer visits to the doctor. But pills are often more expensive, have higher co-payments, and are reimbursed by insurers at lower rates than IV drugs, he noted.
Using a database of pharmacy claims paid by private insurers and Medicare, he found, not surprisingly, that those with higher co-payments quit their drugs more often.
Patients with co-payments of more than $500 were four times more likely to abandon treatment than those with co-payments of $100 or less, Schwartzberg said. Claims with the highest co-payments had a 25 percent abandonment rate, compared with 6 percent for co-payments of less than $100...
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