My Health Insurance Company is Risking My Life

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Last month I was diagnosed with a melanoma inside my right eye. I had some vision blurriness, so immediately went to my optometrist. He spotted what he called a “freckle” in my eye, and gave me an emergency referral to an ophthalmologist.

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

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

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

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

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

Treatment involved installation of the radiation plaque in my eye, and then removal a week later. The installation went off without a hitch. The day before it was supposed to be removed, the hospital called and said “Insurance hasn’t approved removal.” I said “Uh, what?”

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So, we called insurance. They told us they need three weeks for such an approval. The hospital said I would have to sign a waiver to go through with the surgery, indicating I am financially responsible if insurance doesn’t pay. Insurance told me if we sign the waiver, then they won’t pay because I would have done the procedure without their approval.

The doctor told me “That source has to come out immediately, because it will destroy your vision if left in too long.” And, this was a regulated nuclear source in my eye that prohibited me from being around other people. So, I had no choice but to sign it. And, just before the surgery — like literally an hour before as we were in the waiting room — insurance denied the surgery to remove it. If that seems insane, 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 whether the cancer has spread. That really is the biggest factor in whether I have a good outcome or bad outcome. He ordered a full body PET scan. Insurance denied it. They said “This melanoma was in his eye. We don’t see a need to check the rest of his body.” Again, crazy.

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

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

I have lived in Germany, Scotland, and the Netherlands. I have directly experienced universal healthcare in these countries. What we have in the US is an abomination.

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