My health insurance company is risking my life

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I was diagnosed last month with skin cancer inside my right eye. I had some blurring of vision, so I immediately went to the ophthalmologist. He spotted what he called “freckles” in my eye, and gave me an emergency referral to an ophthalmologist.

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

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

But the fact that insurance companies are involved also increases my risk of bad outcomes.

Other developed countries have difficulty understanding our health care system in the United States. Here, we decided that it would be a good idea to put a for-profit entity – health insurance – between us and our Medicare. As you might expect, this creates a significant conflict of interest for insurance companies. They make money by charging you premiums, then denying you coverage.

Here are two cases that have actually occurred with my current health fear. When melanoma was diagnosed, the doctors all said “everything will be covered”. I soon received letters from the insurance company reassuring me about coverage. (By the way, this is the largest for-profit health insurance company in the US)

The treatment involved getting the radioactive plaque in my eye, then removing it a week later. Installed without a hitch. The day before it was removed, the hospital called and said “insurance did not approve of removal.” I said “Ah what?”

Therefore, we called it insurance. They told us they needed three weeks to get this approval. The hospital said I would have to sign a waiver to have the surgery, indicating that I was financially responsible if the insurance didn’t pay. The insurance told me that if we signed the waiver, they wouldn’t pay because I would have done the procedure without their consent.

“This source should be taken out immediately, because it will destroy your vision if left on for too long,” the doctor told me. And this was a nuclear regulator in my eyes that kept me from being around other people. So, I had no choice but to sign it. Right before the surgery – like an hour before we were in the waiting room – the insurance refused to have surgery to remove it. If this sounds crazy, it is. So, we have to fight them. Just another squeeze in this whole thing.

the second thing. My oncologist said the most important thing now was to determine if the cancer had spread. This is really the biggest factor in whether I will get a good result or a bad result. He ordered a whole-body PET scan. Insurance denied it. “This melanoma was in his eye,” they said. “We don’t see a need to examine the rest of his body.” Again, crazy.

In fact, the woman who signed me up for plaque removal surgery was originally from Canada. “I just don’t understand this system,” she said. “I pay for health insurance every month, but I still have to pay deductibles and co-costs? What is this?”

I hate this system very passionately. And I’m lucky. At least I have insurance. It’s hard to imagine someone without insurance going through this.

I have lived in Germany, Scotland and Holland. I have first-hand experience of universal healthcare in these countries. What we have in the United States is an abomination.