'Would he have lived?' When insurance companies deny cancer care to patients

[ck4829]

Angela Pike’s husband, Tracy, had just celebrated his 45th birthday when he was diagnosed with Stage 4 stomach cancer. A father of three and the maintenance chief of a Louisville, Kentucky, skyscraper, Pike immediately started chemotherapy, which reduced the size of the tumor his doctor had discovered.

After MD Anderson agreed to provide Pike with the treatment, he and his family traveled to Texas in 2023. The night before the first procedure, Pike’s surgeon called to let the family know Blue Cross and Blue Shield of Illinois, Pike’s health insurer through his employer, had declined to cover the roughly $40,000 treatment.

The insurer ruled Pike’s treatment was “not medically necessary” because it was “experimental, investigational and unproven,” documents show.

Angela said the last straw came when she learned that one of the insurer’s physicians who had rejected the treatment was not a cancer doctor at all. He was an obstetrician-gynecologist. In January 2024, Tracy Pike died, leaving behind his wife of 22 years and their three children.

https://www.nbcnews.com/news/investigations/-lived-health-insurance-companies-deny-cancer-care-patients-rcna182611

[Silent Type]

1. Even traditional Medicare will disallow "experimental, investigational and unproven" treatments.

As the linked article points out-- "And this year, Medicare began denying claims for breast cancer imaging needed to identify cancers among many women."
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I believe one reason Congress doesn't approve Medicare-for-All is that they'd rather people who are unfortunately likely to die/suffer anyway (ie, Stage 4 cancer) blaming them, rather than insurance companies for not wanting to spend every possible dollar on treatment that has little chance of success.

Of course, the example in the OP is an employer based insurance plan, not Medicare or Medicaid.

And, MD Anderson could have continued the treatment. They make good money, have big cash reserves, have a well funded foundation, sponsor research, etc.

So, until Congress decides to do something (even if not perfect), we are stuck with this mess.