Last month I was diagnosed with melanoma in my right eye. I had some blurry vision so I went to my optometrist immediately. He spotted what he called a “freckle” in my eye and gave me an emergency referral to an optometrist.
The ophthalmologist diagnosed me with a “large melanoma” in my right eye. dr Google told my wife that the five-year survival rate with a large melanoma in the eye is less than 50%. She fell apart. I was sent to an eye oncologist and came the next day. She diagnosed the melanoma as “small” — which is a function of thickness — and said I have a much better chance of long-term survival than we thought.
The recommended treatment was a radiation patch sewn directly onto the eyeball. Everyone moved quickly. I was in the operating room two weeks after the diagnosis. It had to be done quickly because the risk of metastasis was increasing every day, and when that happens, a bad outcome is much more likely.
But the fact that insurance companies are involved also increases my risk of a bad outcome.
Other developed countries have difficulty understanding our healthcare system in the US. Here we decided it would be a good idea to put a for-profit entity – health insurance – between us and our medical care. As you might expect, this creates a huge conflict of interest for insurance companies. They make money by collecting premiums from you and then denying you coverage.
Here are two situations that have already occurred during my current health crisis. When my melanoma was diagnosed, all the doctors said, “Everything is covered.” I soon got 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 installing the radiation patch in my eye and having it removed a week later. The installation went smoothly. The day before it was supposed to be removed, the hospital called and said, “Insurance didn’t approve the removal.” I said, “Uh, what?”
So we called the insurance company. They told us that it would take them three weeks to get such a permit. The hospital said I had to sign a waiver to have the surgery, which means I’m financially responsible if insurance doesn’t pay. The insurance company told me if we sign the waiver they won’t pay because I did the procedure without their consent.
The doctor told me, “This source needs to come out immediately because it will destroy your vision if left in too long.” And this, in my mind, was a regulated nuclear source that prohibited me from being with other people. So I had no choice but to sign. And right before the surgery – literally an hour before while we were in the waiting room – the insurance company refused the surgery to remove it. If that seems crazy, it is. So we have to fight them. Just another stress in this whole thing.
second thing. My medical oncologist said the most important thing now is to determine if the cancer has spread. It’s really the biggest factor in whether I get a good score or a bad score. He ordered a full-body PET scan. The insurance refused. They said, “This melanoma was in his eye. We see no need to examine the rest of his body.” Madness again.
In fact, the woman who checked me in for plaque removal surgery was originally from Canada. She said, “I just don’t understand this system. I pay for health insurance every month, but I still have to pay deductibles and co-payments? What’s that?”
I hate this system with a burning passion. And I’m lucky. At least I’m insured. It’s hard to imagine someone going through something like this without insurance.
I have lived in Germany, Scotland and the Netherlands. I experienced firsthand the universal health coverage in these countries. What we have in the US is an abomination.