New year, new denied claim

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A year ago, I wrote in these pages about my battles with Blue Cross over coverage of periodic positron emission tomography scans to monitor a GIST tumor, a lethal type of cancer, for which there is a very high risk of recurrence. The company ultimately agreed to coverage, acknowledging that the PET scan is the primary way to evaluate such tumors.

Surprise! This year, when my oncologist requested another PET scan, Blue Cross denied it, now claiming it is an experimental procedure. Why would they reverse their own position from a year earlier? Of note is the fact that the Blue Cross medical reviewer is a nephrologist — a kidney specialist — not an oncologist. How is he possibly qualified to review my situation?

Perhaps Blue Cross didn’t like the negative press they received when my article was published June 11, 2006, in The Star. Is this retribution? I’ve had coverage with Blue Cross since the early 1970s. I remember when they were known as a not-for-profit company offering superior health coverage. The current Blue Cross owners have betrayed their members‚ trust and defiled the name of a once-respected company.

My horror story is just one of many such tales across this country. The for-profit health insurance racket is a complete conflict-of-interest because the companies only make money by denying patients the care they need. There is no free market choice for the consumer.

There are encouraging signs the public and at least some state governments, California included, are awakening to the reality of the healthcare crisis. The issue is a top priority already for millions, and, as employer-provided health coverage continues to diminish, more and more Americans will learn firsthand just how expensive sick can be.

— Ursula Britton, Ventura

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