reply to post by jude11
I’m left with several doubts because of some of her statements & believe her inferences to eugenics are definitely misplaced. I won’t be
any harsher than that.
1. I immediately noticed she choose to exclude the name of her insurance carrier or the RX to which she was referring. It is not slanderous to accuse
an insurance carrier of denying lifesaving of life-improving treatment if this is your true belief. Her lack of specifics made me suspicious & she
only seems to divulge information sympathetic to her cause.
2. She perpetuates the notion that her carrier sought out information from Caris in an effort to deny her claim (via some nefarious "Caris
Report"). I could find absolutely no evidence that Caris has consultancy arrangements with any specific carriers which probably means that she or
her doctor sought the advice of a medical provider within Caris' organization. They recommended an FDA approved RX for her specific condition over
her "chosen medications", which she admits are not the traditional treatment for her condition.
For the most part, carriers follow FDA guidelines when it comes to approved drugs for any given medical condition and this is clearly stated in all
insurance policies. I'm not saying that the FDA doesn't have its own set of problems & conflicts of interest, but that really has no bearing here.
One of the largest insurance providers in the country, United Healthcare, follows the guidelines set forth by the National Comprehensive Cancer
Network (NCCN) when it comes to empirically proven therapeutic efficacy of oncology drugs, but if you listen to her words, she is not talking about
oncology drugs. She never mentions the words “oncology” or “chemotherapy” but she does mention “brain tumor” which makes one think that
her insurance carrier is insisting she use one chemotherapy RX with potentially toxic side effects over another RX proven seven years ago to be safer
than 30% of the other drugs available at that time for her particular condition. Additionally, in cases of life threatening illnesses where oncology
drugs are used, most states have laws that set criteria by which the insurance carriers must consider coverage for alternative "investigational"
treatment - even drugs not yet approved by the FDA for the specific cancer. Due to the proliferation of lawsuits by family members who have lost
loved ones because of callous insurance company decisions, most carriers would rather cover this type of drug, as long as the qualifying criteria is
met, over risking the cost of a lawsuit which could potentially cost them millions. I've negotiated many of these exceptions myself as a patient
advocate & found the carriers to be selfishly accommodating.
3. If you listen closely to her choice of words, she is not referring to an RX to treat or cure her brain tumor – she’s referring to a medication
therapy she has elected herself to use to combat “THE SYMPTOMS & PROBLEMS related to her brain tumor". She consistently says that her current
chosen drug therapy provides quality of life & alertness. I find the term alertness to be very interesting but I'm not a doctor & would prefer to
not hypothesize on this point or come off as seeming unsympathetic to her medical condition. I’m sure it’s terrible & she deserves all due
sympathy; however, the fact is that she is voluntarily choosing an RX regiment that she likes; not one that has been empirically proven to be the most
effective in combating these symptoms & problems.
Whereas I'm not a fan of the insurance or pharmaceutical industry, if every patient is allowed to choose their own drugs because they LIKE those
drugs for whatever reason, our insurance premiums would be even more astronomical than they already are, not to mention that we would probably have a
significant number of addicted zombies walking around. Heck, I myself suffer from a disease called Lupus which causes debilitating migraines when
it’s in flare mode. The FDA approved treatment is an RX called Prednisone which not only makes me feel like I want to climb the walls, but it's
only purpose is to alleviate the symptoms of my disease (which is does). I suppose that a good ole' narcotic pain killer would do just as good a job
at relieving my symptoms (and then some), but that doesn't make it right that I should be able to dictate an RX for the pain killer, which is
potentially addictive (leading to even more medical problems) & definitely more costly.
Every argument has two sides & I'm sympathetic to anyone who has to choose medication over rent; this should never be allowed to happen. But she had
a choice of insurance covered RX and chose instead to pay for another she liked better over paying her rent. This goes back to a sense of
entitlement in my opinion.