Insurers refuse, patients lose

When insurance companies and medical providers have one of their frequent wars over money, what too often happens is that you and me –– so often referred to as either a cherished policyholder or a cherished patient –– end up as collateral damage.

In other words, if we want to go to the doctor we’ve been seeing for years, we’ll have to pay our own way: The insurance plan we pay more for every year no longer covers treatment by that physician.

We’re so cherished we often get a cherished form letter saying that another cherished doctor will have to cherish us if we want our cherished insurance to pick up what the insurance/medical establishment always seems to cherish most — the tab.

Cherished crap aside, far more often than not, the war begins with an insurance company trying to squeeze every nickel out of a system that affords the insurance industry far too much power –– so much, in fact, that it’s able to negotiate rates that are often not economically feasible for the doctors they reimburse.

A worst-case result of how such power can corrupt became clear recently in a lawsuit brought against Health Plan of Nevada as an outgrowth of the 2007 hepatitis outbreak in Las Vegas. A Clark County jury ordered the company to pay three people $524 million in damages for acting in bad faith in its obligation to provide safe health insurance coverage to its policyholders.

Testimony revealed that HPN dropped Dr. Dipak Desai, the central figure in the hepatitis outbreak, from its network of doctors in 1992 because of quality concerns, only to reinstate him five years later because he was willing to work far cheaper than anyone else. By doing 30 minute-plus procedures in just three minutes he made a profit. (Desai long bragged he did the fastest colonoscopies around, which other practitioners said were “assembly line” unsafe.)

It’s that kind of “unholy relationship” between a doctor and an insurer that bladder cancer patient Cyrus Gardner prays he doesn’t join. His ladylove, Sarah Wallace, called me Wednesday when the insurance he used to see Dr. Scott Slavis couldn’t be used now that the doctor, who used to be in private practice locally, joined the Cleveland Clinic’s new urology practice in Las Vegas.

Turns out there was a war going on between the Government Employees Health Association, or GEHA, and the Cleveland Clinic. That’s not a good thing when Gardner, 64, needs a cystoscopy procedure every 90 days to determine whether the cancer has returned, with a regular bout of chemotherapy soon following.

“I called in around 9 in the morning to reconfirm my appointment for 11 a.m. Wednesday, and that’s when I learned it had been canceled because my insurance wouldn’t cover it,” the North Las Vegas resident said. “There was no apology.”

Later Wednesday, I talked with Kristin McLarty, the Cleveland Clinic’s local public relations rep, who said she would get in touch with Cleveland headquarters. What I heard from Gardner — that the people who work for Slavis were uncaring — didn’t square with what I knew of the culture of the Cleveland Clinic, which both President Barack Obama and former Republican presidential candidate Mitt Romney also saw as patient-centric.

I called the doctor’s office and asked for Slavis. I explained why I was calling, was told I didn’t know what I was talking about, and then the woman abruptly hung up. I called back, and a manager said she’d look into Gardner’s situation.

Karen Schuler, GEHA’s marketing director, said she didn’t know that Slavis was now with the Cleveland Clinic but she’d look into it.

Early Thursday, I received a phone call from a horrified Eileen Scheil, a spokeswoman at Cleveland Clinic’s main office in Ohio. This, she said, wasn’t the Cleveland Clinic’s way of doing things; she’d look into it. From what I knew of the work done at the Cleveland Clinic Lou Ruvo Center for Brain Health, I believed her.

Soon Slavis, who received calls from Cleveland, called me. He, too, said that what happened to Gardner wasn’t indicative of the clinic’s culture.

“Our culture is we’re going to take care of the patient in a situation like this,” he said.

At noon Thursday, Slavis saw Gardner. Scheil said that the doctor also will see Gardner for chemo treatment and that she expects the insurer and the clinic to soon have an agreement ironed out.

If I hadn’t interceded, Gardner said, he doubts Slavis would have seen him, even though he’s a cancer patient who simply had the bad luck to be caught up in a bureaucratic war .

I hope he’s wrong.

Contact reporter Paul Harasim at
pharasim@reviewjournal.com or 702-387-2908.