To Chemo or Not to Chemo: Does the choice belong to HMO?

Health insurance is just not important until you need it. Right? When my father turned 65 years old, and was eligible for Medicare, he felt it was enough. It wasn’t until many years later, when I realized he’d be penalized for not having supplement health insurance, did he get active about finding secondary insurance. He found one. He checked the box. He enrolled in automatic payment withdrawal. He had only been to the doctor… maybe twice… in his first 71 years of life. Did he stop to think, “Hmmm…is this the best insurance for stomach cancer?”  Probably not.  Does anybody think of the long list of diseases, illnesses that one might potently acquire one day in the future? Probably not. Little did we know that life could change with just three words:

 You Have Cancer 

And man do I wish he unchecked that box—the one next to HMO—and checked the one next to PPO back in December 2013. How life would be so different right now. My dad would be done with his port-a-cath surgery, and first session of chemotherapy. I would be sipping Guinness with a little Irish whiskey taking in the festiveness of St. Patty’s week. Instead, I have been dealing with hospitals, insurance, procedures, confusion… all because my dad’s HMO—Healthcare Partners decided to “take it back.” They cancelled everything… everything at hospital while being admitted to surgery… without one shred of care for my dad’s future because “they can.”

Healthcare Partners LLC is a FOR-PROFIT network of “700 doctors in the medical group and around 8,300 affiliated independent physicians” based in Torrance, CA. In 2011, they had revenue of $2.4 billion, and were bought in 2012 by DaVita, for $4.42 billion. Healthcare Partners is my dad’s medical group and they have a “capitated flat fees that are supposed to cover nearly all of a patient’s care” system. They approve or disapprove every doctor, test, procedure or treatment. Their main goal is to keep patients with in-network doctors even if patients require out-of-network care from specialists that insurance will cover. (Others have claimed that Healthcare Partners bill insurance at high rates, while providing patients will the lowest cost effective services as possible. The more I dig into Healthcare Partners, review pending or/past lawsuits, the more I’m convinced that this LLC is criminal. I will have to write a separate blog later.) Every encounter we’ve had with Healthcare Partners isn’t about the cost of what my dad needs, it’s about keeping the business inside their organization.

But stomach cancer doesn’t care about any of that.  In 2012, stomach cancer was the top 3 most common causes of cancer death worldwide. In USA, American Cancer Society predicts 22,230 new cases of stomach cancer will be diagnosed, and more than half of those cases will die from it. As much as I hate statistics, the truth is stomach cancer is under-funded and under-researched in the United States.

And Healthcare Partners doesn’t care either.  They aren’t throwing money at research. They aren’t conducting clinical trials or publishing articles in the journal of medicine.  They are just a bunch of doctors willing to take any measure possible to keep patients in-network. When my father was first diagnosed with gastric cancer, they held the final pathology back from us for two weeks; despite us calling for lab results on a daily basis.  Guess when they finally decide to inform us of this life changing diagnosing—the DAY OPEN ENROLLMENT CLOSED. They got us. That report sat on the desks of three different doctors, all part of the Healthcare Partners, and nobody had the audacity to let us know. The main doctor who performed all the tests even gave us the fake “all clear” cancer negative prognosis.  Disgusting.

For the next month, they treated us like a huge dollar sign.  We went from doctor after doctor… their doctors, getting tests done… running around town like circus rats… nobody within the medical group could agree on what the correct course of action to cure my dad of stomach cancer would be. The only solution, I could think of, was to get a 2nd opinion from a GI oncologist well researched and acclaimed. Surprise!  Healthcare Partner immediately denied that request. After a fight and an appeal, we were granted that wish and a glimmer of hope appeared. We had a treatment plan. The GI oncologist referred us to a super doctor in GI oncological surgery, and quickly, the ball was in motion and we were in a fight to win.

Suddenly, it was very apparent that we had two battles… one with cancer and one with the medical group.  Any progress that was made, the medical group threw a curve ball. They approved the surgery at UCLA (out of network), the pathology and the 9 day hospital stay, but not the surgeon. On the day after my father had a total gastrectomy, Healthcare Partners referred us to a general surgeon in-network.  It made for a good laugh. There was yet another fight to get the 2nd opinion doctor to be my father’s oncologist; after all, he was the one to set the treatment plan in motion. The persistence paid off because we got the green light from Healthcare Partners and my dad was considered an “established patient”. It’s the official billing code that says… THIS IS YOUR DOCTOR. It was victory. Winning!

The 5th week post-surgery is a very critical time. Typically, if the patient is healthy enough (which my dad is), this is when chemotherapy begins. For some, surgery alone is the cure. But for others, chemotherapy is needed to ensure the tiny cancerous cells that may have been left behind get zapped and killed off.

And on the day (not a minute sooner) of my father’s port-a-cath procedure (it’s a chemo thing) at the hospital after checking in with Hospital Admissions, HealthCare Partner took it back. They what??? They took it back. They were okay with my dad seeing the oncologist, but they drew a line when it came down to oncology treatment.  He was not to receive any life-saving treatment; we were only allowed to visit the doctor.  I don’t get it. Where they not anticipating oncological treatment to follow? They re-directed the port surgery to Torrance Memorial Hospital and they cancelled the chemotherapy treatment completely. Honestly, what good is a port if you cannot get the chemo?

Healthcare Partners’ tactic was shady. I spend the next two and a half days on the phone…calling healthcare partners… calling the insurance company. Both were spinning us around in circles. The insurance company didn’t understand the situation. They kept explaining to me that when a person is granted oncological treatment, it is expected that he get oncological treatment. “No”, I would scream, “They are only allowing my dad to see the oncologist. That’s it. See him, talk to him, and ask questions.  The oncologist is not allowed to treat the cancer.” Then Healthcare Partners would say, “We aren’t denying him treatment. We are only denying him treatment from his doctor.  The doctor that he has been going to for the last three and a half months. You can build a relationship with an in-network doctor. Wait a month or two for an appointment. Wait another week for the chemo to be ordered… and there you go.” Around the 32th hour, I started freaking out…like really freaking out.  I turned crazy. My dad could actually get no treatment as opposed to getting bad treatment. I was starting to consider getting chemo treatments from an inexperienced Healthcare Partner doctor.  And then I remembered that my dad had no stomach; he retired his position as a circus rat—and I couldn’t give up now.

I turned to Tom, handed him the baton, and on Wednesday morning, Healthcare Partners un-did their take back. We scheduled my dad for an emergency port surgery at UCLA, and squeezed him into chemo the following day. I lost 2 nights of sleep, but my dad only got delayed in his treatment by 2 days. Winning!

My dad is very fortunate because he has “Aki and Tom” in his fight to beat stomach cancer. What about all the other people asking for the same chance? I’m not saying that all Healthcare Partners doctors are terrible.  I’m just pointing out that Healthcare Partners should know where their weakness lies and give patients a fighting chance. “Take backs” should be limited to children in 2nd grade. They should put patients ahead of money… because life is worth more than a couple billion dollars.  Well, at least for me. My dad means the world to me… so there! Still Winning!

A blog about stomach cancer gastric cancer adenocarcinoma chemotherapy FOLFOX radiation therapy surgery Total Gastrectomy caretaker stage 3 cancer

With Stomach Cancer: The Blog

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