Cancer Patient Dying, Health Insurance Denies Coverage

[Guest guest]

Health Care Crisis: Cancer Patient Dying, Insurance Denies Coverage

Reported by: So

The health care crisis is hitting home for one County family. Everyone

wants to be covered when there's an unexpected illness. But that doesn't always

happen.

Ricky Spencer is fighting her insurance company for coverage. It's a follow up

to a story we first told you about last week regarding the promising cancer

treatment featured on Grey's Anatomy that's saving lives right here in

Baltimore.

Ricky was looking forward to her golden years. She wanted to spend time with her

husband and two sons, live to see her grandchildren. But time is not on her

side. Ricky has a serious form of stomach cancer and needs surgery right away.

Ricky says, " I had started sort of losing my appetite and not eating as much

which is not like me at all. "

Her doctor said her only chance for survival is getting a certain type of

surgery that involves heated chemotherapy. It's when doctors remove the cancer

and then pour a heated chemo solution directly into the abdomen. Doctors say the

heat kills cancer cells more effectively.

Ricky was supposed to get the procedure done last week, instead she's waiting.

She says her insurance company, Coventry Health Care of Delaware is refusing to

pay for the treatment because they claim it's experimental. Ricky's husband Art

says, " If this were some fly by night herbal procedure, I'd understand why an

insurance company would not want to cover it. But when you look at all the data

it's just hard for us to understand why in this case Coventry wouldn't approve

it. "

The Spencers appealed Coventry's decision. They put together a packet full of

information containing research and evidence proving the treatment works and is

medically necessary. But their appeal was denied twice. Ricky says, " The point

is that many other people have had this operation and other insurance companies

cover it, lots of them do. "

Ricky's sister Kathi Hahn says, " It's not experimental if you speak to these

doctors. It's just not. I spoke to the people at the dinner that night who had

the surgery that are two years out, five years out, multiple years out and I

asked everyone did your insurance cover it and they said yes, what insurance was

that and they told me. "

ABC2 made repeated attempts to get a response from Coventry. But their only

comment was " no comment. "

Desperate for help, the Spencers turned to the land Insurance

Administration, a state agency that works on behalf of consumers. The acting

commissioner says everyone has the right to appeal their insurance company's

decision. If they still deny the claim, you can file a complaint with the

land Insurance Administration. The agency will review your case and has the

power to overturn the denial if the treatment is considered medically necessary.

Acting Commissioner Beth Sammis says, " My advice to health insurance companies

is to continually ask whether or not they really need to make that denial. "

Ricky's husband is trying to stay optimistic, but knows his wife doesn't have a

lot of time. He says, " You just feel that after going through all of this, the

final door has been closed off. "

Ricky's surgery has been rescheduled for February 16th. She's hoping something

will change by then. Since the interview, Ricky's condition has gotten worse and

she had to be admitted to the hospital.

http://www.abc2news.com/news/local/story/Health-Care-Crisis-Cancer-Patient-Dying\

-Insurance/ElCkQNcyNUCfGZJwPfItRg.cspx?rss=702