My health insurance is risking my life

My health insurance is risking my life

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Last month I was diagnosed with melanoma inside my right eye. I had some vision blur so I immediately went to my optometrist. He noticed what he called a “freckle” in my eyes and emergency referred me to an ophthalmologist.

The ophthalmologist diagnosed a “great melanoma” in my right eye. Dr. Google told my wife that survival with a large melanoma in the eye is less than 50% at five years. It fell apart. I was sent to an ocular oncologist and arrived the next day. He diagnosed melanoma as “small,” which is a function of thickness, and said I have a much better chance of long-term survival than we thought.

The recommended treatment was a radiation plaque sewn directly onto the eyeball. Everyone moved quickly. Two weeks after the diagnosis I was in the operating room. Things had to happen quickly because every day the risk of metastasis increased and when that happens a negative outcome is much more likely.

But the fact that insurance companies are involved also increases my risk of a negative outcome.

Other developed countries have a hard time understanding our health care system in the US Here, we decided it would be a good idea to put a for-profit entity – health insurance – between us and our medical care. As might be expected, this creates a huge conflict of interest for insurance companies. They make money by collecting rewards from you and then denying you coverage.

Here are two situations that have already happened with my current health scare. When I was diagnosed with melanoma, all the doctors said “Everything will be covered”. Soon I received letters from the insurance company reassuring me about coverage. (Incidentally, this is the largest health insurance company in the United States)

Treatment involved installing the radioactive plaque in my eye and removing it a week later. The installation went smoothly. The day before the removal, the hospital called and said “Insurance has not approved the removal.” I said “Uh, what?”

So, we called insurance. They told us they need three weeks for such approval. The hospital said I would have to sign a waiver to complete the surgery, indicating that I am financially responsible if the insurance does not pay. The insurance told me that if we sign the waiver, they will not pay because I indicated that I would pay.

The doctor told me “That spring has to come out immediately, because it will destroy your sight if left on too long.” And this was a regulated nuclear source in my eyes that forbade me from being with other people. So, I had no choice but to sign it. And, just before the surgery, like literally an hour before, while we were in the waiting room, the insurance denied the surgery to remove it. If it sounds crazy, it is. So, we have to fight them. Just another stress in this whole thing.

Second thing. My medical oncologist said the most important thing now is to determine if the cancer has spread. This is really the most important factor in determining if I have a good result or a bad result. He ordered a full-body PET scan. Insurance denied. They said “This melanoma was in his eyes. We don’t see the need to control the rest of his body.” Again, crazy.

In fact, the woman who checked me out for surgery to remove the plaque was from Canada. She said, “I just don’t understand this system. I pay health insurance every month, but do I still have to pay deductibles and copays? What is it?”

I hate this system with a burning passion. And I’m lucky. At least I have insurance. It’s hard to imagine someone without insurance going through all of this.

I have lived in Germany, Scotland and the Netherlands. I have directly experienced universal health care in these countries. What we have in the United States is an abomination.

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