NRLN Letter to HHS Secretary of Health and Human Services

Incredibly, his insurance company, Anthem, had deemed it unnecessary and said they would not cover it.

I watched Dan take that call recumbent in his hospital bed, PICC line in one arm, IV in another, a nasal cannula up his nostrils supplying 4 liters of oxygen, fluids and antibiotics hanging off the IV pole. And I became enraged all over again at this system that seems determined to kill him so that it can save another buck.

I am a doctor, and Dan’s daughter-in-law — his doctor-in-law someone joked — and even with all of my education, insights, advantages and resources, I can’t protect him from a health care industry whose only goal is to maximize profits by minimizing care.

The CEO of Anthem’s parent company Elevance, Gail Boudreaux, raked in $21.9 million in compensation last year, up from $20.9 million the year before, with a CEO-to employee salary ratio of 389 to 1. The headlines about the company’s revenue boasted: “Elevance controls medical costs to $6B profit in 2023.”

Think about that phrase. Ruminate on its precise meaning. What does that mean for an average American family dealing with a loved one undergoing a life-altering medical diagnosis?: delays and denials at every turn. Pushbacks for home health nursing, physical therapy, chemotherapy and imaging. Jumping through needless hoops and an endless rigamarole of fighting back, appealing and speaking to supervisors in a war of attrition that the insurance companies always, ultimately and inevitably win.

That’s exactly what Dan had to deal with.

Earlier that week, Anthem had called to deny him the eight sessions of physical therapy deemed necessary by a physical therapist. Anthem claimed he only needed three. The cancer had robbed Dan of over 30 pounds by then, leaving him deconditioned and a fall risk, made worse by a weakened leg after his bladder removal surgery. When we requested an expedited appeal with a 72-hour turnaround time — which we only knew to ask for after a prior rejection — Anthem decided it did not warrant the urgency of an expedited appeal. It would take up to 30 days.

Last month, when we had readied ourselves for the then-imminent chemotherapy,  Anthem denied it at the last minute. The company said it was because Dan’s metastatic cancer was not metastatic. When our doctor’s office asked for an expedited appeal, Anthem said the request missed the 24-hour window the company allows doctors to appeal decisions over the phone. This was Anthem’s position even though our doctor’s office said it never received a call informing it of the denial of coverage as is the supposed protocol. When asked where to fax the appeal, Anthem said it was experiencing a systemwide fax issue and provided a snail-mail address in Ohio. When I spoke to Christina, our authorization representative at one of the top 10 cancer hospitals in the nation, she assured me about the normalcy of the ever-increasing pushback of insurance denials, but she had never been given a physical address to send a paper chart.

That morning, white-hot anger coursing through me, I jumped the hoops to reach a supervisor at Anthem. The supervisor said she had no idea what the prior representative was talking about and had not heard of a systemwide outage.

Though Christina had documented all of the details, including the name of the representative, the time, date and details of the mysterious snail-mail conversation, Anthem didn’t seem the least bit interested in investigating and instead told us to start all over with an appeal that would take up to 30 days.

Of course, there is no recourse for any of this. No fines, no punishment, no comeuppance for the lies, the gaslighting, the putting of patients through the wringer. CEO Boudreaux likely will pocket another $1 million raise this year. They get to waste our time and shorten our lives, and we get to suffer. This is what controlling costs looks like to get that juicy $6 billion for your shareholders.

After delays, back and for this, wasted time and effort, and stress and anger to prove that metastatic cancer was, indeed, metastatic, we got the approval, but of course, the chemotherapy was delayed.

Dan has worked ever since he could pedal a bike on a newspaper route and proudly proclaims that he was never sick a day in his life until he was 75. He was the fun dad in the cul-de-sac who did a Halloween raffle with cash prizes, where one lucky kid could walk away with 100 bucks, the one who’d drop a 50 at your kid’s lemonade stand. He spent his entire career representing injured workers fighting, ironically, these very insurance companies for denying care and compensation deserved for on-the-job injuries.

The insight he gained resulted in a deep compassion for working people, one manifestation of which is the largesse of his 50% tipping. When he is hospitalized, he often chats up the staff about their rights to collect compensation for their cumulative trauma. He has paid into the system and has earned the right to receive the care he needs at his most vulnerable time, without having to fight and claw within an inch of his life

Though after story comes out about the despicable activities of insurance companies and their unconscionable denials, precious little is done and their profits continue to soar. Their CEOs continue to get paid in the tens of millions by denying an MRI here, a chemo drug there, a home health visit here. And they get rewarded for our misery, our lost hours of taking on this fight, and all of the ways they shorten our lives.

This is by design — a feature, not a bug. The impediments, the roadblocks, the inconsistencies, the red tape, the endless obstacles, sucking us dry till we finally give up and go home to die.

One day I spoke with yet another supervisor at Anthem, attempting to throw around my doctor-weight to get Dan what he needed. Unbeknownst to me, my mother-in-law had been observing. Once I was off the phone, she asked, “So what do regular people do when they are dealing with all of this?” I turned to her and said, “They suffer needlessly and die early.” The words hung in the air between us, as sharp and true as any uttered.

Five months after his diagnosis, after delays by infections and insurance, Dan finally started his chemo. My fervent wish is that he can spend the time and energy he has left fighting the bladder cancer trying to kill him instead of fighting the insurance company willing to do the same.