Pretty much the same thing happened to my dad. He was diagnosed with a rare type of blood cancer. The insurance company denied monoclonal antibodies (as recommended by his oncologist) and would only pay for a complete bone marrow transplant, which would have been highly traumatic at his age. All based on a "standard of care" that at that point was 15 years old... and which was originally written by a committee chaired by my dad's oncologist (who presumably knows something about the best way to treat this condition in 2022.)<p>They didn't reverse the decision until we got a lawyer who knew the ins and outs of the appeals process. Thankfully, we were able to work through that fast enough for treatment to be effective... there's no way we could have paid out of pocket.<p>The ability of an insurance company to unilaterally deny treatment, or determine what type of treatment a patient receives, is obscene and should be categorically illegal. There is no instance in which a medical bureaucrat should should be able to, sight-unseen, overrule a patient's own doctor.<p>It's so frustrating.
I remember the mention of "Death Panels" that were claimed would appear if there was federal insurance. I'm not sure, but isn't that what's happening today as is?<p>* <a href="https://en.wikipedia.org/wiki/Death_panel" rel="nofollow noreferrer">https://en.wikipedia.org/wiki/Death_panel</a>
Kind of demoralizing story (but a good read). Even a renowned litigator with the right friends and plenty of money was only able to secure (potentially partial) payment for the treatment? The system doesn't even allow for damages?<p>Almost made me even more frustrated. I was hoping they'd have to pay up big time, or that some legal precedent would be set in his victory that would help millions in the future avoid this mess.<p>Also title could use a 'treatment' added to it.
Didn't expect to see Skeeter Salim on Hacker News. Like, ever, much less in this context.<p>Trial attorneys have a very peculiar reputation in Louisiana. They get incredibly wealthy on the backs of lawsuits against the state's oil and gas businesses and their insurers, then turn that money into political lobbying power. This creates a populist dynamic where trial attorneys try to rally voters to oppose tort reform laws in the legislature that are often backed by insurance companies.<p>For instance, in the Louisiana gubernatorial election, where Salim shows up in this article: <a href="https://www.nola.com/news/politics/jeff-landry-is-collecting-big-donations-from-trial-lawyers/article_ae9755b0-4394-11ee-b5b5-0b41f4b6fc3f.html" rel="nofollow noreferrer">https://www.nola.com/news/politics/jeff-landry-is-collecting...</a>
Here is the fun part that most people don't know...universal healthcare systems wouldn't have paid for this either.<p>However, the patient never would known about it because it wouldn't have been on the list of "approved therapies", so the doctor never would have suggested it.<p>The article dances around it, but for this particular cancer, proton beam therapy has little evidence supporting it. The current treatment guidelines like NCCN list a number of evidence-based therapies for first line, second line and subsequent line treatments. Proton beam thereapy is a "hail mary" and universal healthcare systems are less expensive than the US because they don't pay for "hail marys".<p>So in places like Canada (whose patients, it's important to note, need to travel to the US because there are no proton beam centers) the doctor wouldn't have even considered it as a treatment option in this case.
Honestly, a really good story well written. Should be read by more people. It's really quite strange how opaque most of these processes are. How they are handled and documented is also quite nuts.