Insurance runaround/access to care

[jlpopo]

Jurisdiction

Pennsylvania

My husband was diagnosed w/colon cancer on 9/1/15. Referred to a cancer center. Found out a couple weeks later that B Cross wouldn't cover. Referred to Geisinger 10/6. They copied the insurance card that day. He was seen several times with no mention of network problems. Surgery scheduled for 11/6. Found out around 10/20 Geisinger and surgeon are out-of-network. Referred to UPMC around 10/30. Scan showed cancer had grown into rectum in those two months. Course of treatment changed to neoadjuvant chemoradiation, then surgery. He passed away on 7/4/16. I know he would have died from the cancer, but I feel that the lack of medical care in the 2 months after being diagnosed, hastened his death. He made me promise to "sue those b*****s.... I don't know if it would be worth the effort.

 

[cbg]

I'm so sorry for your loss.

What kind of insurance do you have? HMO, POS, PPO, indemnity?

 

[adjusterjack]

Condolences.

I don't know if it would be worth the effort.

Every medical insurance policy or plan booklet says that it is absolutely the insured's responsibility to determine whether or not a provider is in network and/or a procedure is covered by first contacting the insurance company or health plan and never rely on the providers for that information.

I really don't see any grounds for a lawsuit here.

 

[army judge]

My husband was diagnosed w/colon cancer on 9/1/15. Referred to a cancer center. Found out a couple weeks later that B Cross wouldn't cover. Referred to Geisinger 10/6. They copied the insurance card that day. He was seen several times with no mention of network problems. Surgery scheduled for 11/6. Found out around 10/20 Geisinger and surgeon are out-of-network. Referred to UPMC around 10/30. Scan showed cancer had grown into rectum in those two months. Course of treatment changed to neoadjuvant chemoradiation, then surgery. He passed away on 7/4/16. I know he would have died from the cancer, but I feel that the lack of medical care in the 2 months after being diagnosed, hastened his death. He made me promise to "sue those b*****s.... I don't know if it would be worth the effort.

Having been diagnosed with colon cancer back in 2000, I understand the urgency of treatment, especially if a bowel resection is indicated. Luckily, things worked out for me.

Please accept my sincerest condolences upon the loss of your husband.

If I were you I'd visit three medical malpractice attorneys. The initial consultation is offered at no charge. You can discuss your concerns, receive professional legal advice, which will allow you to live with what you're told, knowing you've fulfilled his last wish.

 

[cbg]

There are some insurance models where the provider holds responsibility for checking who is in or out of network, or at least shares responsibility. There are also multiple networks available even within a single carrier. Before we say conclusively that it's the poster's responsibility, we may as well find out whether their coverage may have such a provision.

 

[army judge]

jlpopo: One more thought. I'm no physician, just a simple, redneck, Texas hill country lawyer.

I learned during my bout with colon cancer many things. I reread your post, because your story touched me. I suppose it's because of my near fatal diagnosis 16 years ago, when I coincidentally learned of my disease on Sep 1, 2000.

My surgeon was quite helpful, gave me reading materials on cancer, and colon cancer in particular. The rapidity with which your husband's disease progressed is the troubling factor.

You might find it helpful to research the disease, more than you've probably already done. Talking to a couple medical malpractice lawyers will hopefully be revealing for you.

I'm sure it'll be comforting, because I've had to carry out the last wishes for two people I loved dearly, too. It was a heavy burden for me to wear until I had properly done as I had promised.

God bless and comfort you as you seek peace with what has transpired in your life and your loss.

 

[ElleMD]

I am very sorry for your loss. Cancer is a very tough diagnosis to receive and it can be difficult to think rationally.

If Geisinger is the provider (as opposed to the insurer), they do have a list of plans they cover on their website. They also have a number of resources if payment is a hardship and to help figure out costs. It is not clear if you received incorrect information from them or if you just didn't check into it. It is also unclear why there was a delay in treatment. Having gone through this with a spouse and parent, Oncologists don't schedule a month or two out after a positive diagnosis.

Much also depends on how much difference other care in those two months would have made. Has any doctor actually told you that his outcome would have been different had he treated sooner?