Jewett: How health insurance companies can harm your health

Editor’s note: This op-ed is by Willem Jewett, a state representative from Addison County who is also Assistant Majority Leader. If you would like to share your (good or bad) health care story with him please e-mail to [email protected]

I am a cancer survivor.

When I was diagnosed with non-Hodgkin’s lymphoma four and a half years ago my doctor said that this was the best bad news he could give me because non-Hodgkin’s is one of only a couple cancers that can be cured.

The treatment for this cancer is pretty straightforward. The standard chemotherapy is a cocktail of five drugs (affectionately called “R-CHOP”) administered four to six times, once every three weeks or so. I don’t recall all the drug names but I will never forget the “R” — Rituxin. Rituxin is, by all accounts, a miracle cancer fighting tool. It shrinks tumors and it costs something like $5,000 per dose.

Midway through my course of chemotherapy I got a notice from my insurance company indicating that they had denied Dr. Nunnink’s request to administer Rituxin the following week. I made a couple of calls but figured this would work itself out as they had already approved a couple prior treatments.

Sitting in the drip room with an IV in my arm I started to get a bit worked up when the nurse told me that Dr. Nunnink was still arguing with my insurance carrier.

What followed was a bit surreal. Feeling some pressure to get the chemotherapy started (Rituxin takes several hours to administer) I made some phone calls. I called my friend Steve Maier, then chair of the House Health Care Committee. Steve called the lobbyist for the insurance carrier who called me back. Miraculously, the bag of Rituxin appeared within minutes. Later, I learned from Dr. Nunnink that the insurance carrier’s pharmacist was questioning how often he was giving me the Rituxin.

Steve called the lobbyist for the insurance carrier who called me back. Miraculously, the bag of Rituxin appeared within minutes. Later, I learned from Dr. Nunnink that the insurance carrier’s pharmacist was questioning how often he was giving me the Rituxin.

A few questions linger from this experience. Is it fair that I was able to use my contacts in order to cut through the insurance approval haze? What about all the other patients in the drip room who didn’t have access to the folks I called? Lastly, what is an insurance company pharmacist doing questioning my oncologist’s chemotherapy protocol?

Fast forward to a couple of weeks ago. I stopped in at Porter Hospital for what I hope is my last post-treatment CT scan. Chelsea at Dr. Nunnink’s office mentioned that the insurance carrier (a different one this time) had denied the chest CT.

Enter Roberta, the CT tech. She also mentions that the chest CT wasn’t ordered even though we’d done several previously. When she told me that Dr. Nunnink wouldn’t get a CT image of the area just above my heart (where the largest of my five tumors was) I got a little upset.

In my johnny, I strolled out to the curb of the hospital (no cell service inside) to call my insurance carrier. The call taker was smart enough to put me on with a supervisor who insisted that they had not denied anything. Cell phones being what they are these days, I conferenced Chelsea who confirmed both that the chest CT was denied and that Dr. Nunnink had argued (perhaps loudly) with the carrier to no avail. When the supervisor dug into the “correspondence” she found a subsequent approval that was never sent to Dr.Nunnink. An hour or so later Roberta did the chest CT.

By now, everyone knows that Americans pay more than anyone else on the planet for health care. And we know that Americans are no healthier for all that spending. These stories may help to explain this contradiction. It turns out that your health insurance carrier may not be working to promote your health. As we build a new system this must change.

Comment Policy

VTDigger.org requires that all commenters identify themselves by their authentic first and last names. Initials, pseudonyms or screen names are not permissible.

No personal harrassment, abuse, or hate speech is permitted. Be succinct and to the point. Comments should be 1000 characters or fewer. If your comment is over 500 words, consider sending a commentary instead.

We personally review and moderate every comment that is posted here. This takes a lot of time; please consider donating to keep the conversation productive and informative.

The purpose of this policy is to encourage a civil discourse among readers who are willing to stand behind their identities and their comments. VTDigger has created a safe zone for readers who wish to engage in a thoughtful discussion on a range of subjects. We hope you join the conversation. If you have questions or concerns about our commenting platform, please review our Commenting FAQ.

Privacy policy
Thanks for reporting an error with the story, "Jewett: How health insurance companies can harm your health"