"If it's more than three lesions, that's too many…"
This is why our health care system is an epic fail. via cbs5.com
In late April, Shelly Andrews-Buta was scheduled to undergo treatment for breast cancer that had spread to her brain, threatening her life…. But instead of having doctors working to remove her brain tumors on the day the surgery was scheduled, she sat in a San Francisco hotel room… Blue Shield, decided it wasn’t going to pay for the treatment her doctors at UCSF Medical Center had recommended.
Andrews-Buta was stunned. “I mean this is my life, this is my life, this isn’t, gee, if we don’t do it you’re just going to have a cut that doesn’t heal, this is you’re going to die,” she said.
Without treatment, her doctor told her she in fact would die: tumors had invaded 15 separate areas in her brain…. But the doctor said when it came to getting Blue Shield’s approval for the procedure; she was surprised to learn that the company’s policy lays out that a patient who has more than three brain tumors, what doctors call lesions, would not be covered for the gamma knife procedure.
Dr. Sneed felt the policy was unreasonable. “What I was up against was just a rule: ‘Well, if it’s more than three lesions, that’s too many,’” Sneed said.
Meanwhile, Congress continues to pander to the insurers.
