Insurance VP talks on new treatments

Some patients argue that a new breast cancer treatment is a breakthrough, but a health care expert said last Thursday that politicians and insurance companies are having a hard time dealing with the new treatment. "There is no hotter issue in insurance than the issue of whether we should cover therapies that are supposed to help the patients but are considered to be experimental," Myers said. Myers presented three cases featuring patients who wanted the controversial treatment, but their insurance companies intially denied them coverage. One patient eventually received insurance coverage after a high profile legal battle. Many terminally ill patients cannot afford the costly treatment unless their insurance will cover it. But some insurance companies have refused to grant coverage under a clause which denies money for "experimental and investigational" treatments -- the official classification for the transplant. Some patients have taken their case into the courtroom and, after winning a battery of lawsuits, several companies have been ordered to foot the bill. "Remember that we are talking about a $100,000 therapy whose demand is increasing," said Myers. "Besides, the therapy may or may not help the patients." Myers suggested that the rulings may cause insurance companies to rework the phrasing in their contracts and increase charges to the clients that want the extra coverage. Myers added that the media has helped patients get coverage from the companies by bringing their cause to the public's attention. "If the patients pushed the right buttons, like contacting media groups, governors and senators, the likelihood of being covered by the insurance companies increases," Myers said. "Newspapers love this kind of issue . . . the good and evil, the life and death -- politicians cannot stand this kind of heat." Kevin Volpp, a PhD candidate in the Medical School said the seminar, organized by Center for Health Policy, was informative. "I thought it was a good overview of some of the principle issues involving experimental therapies," he said. "It is a good example of how our society needs to catch up to the level of technology we've achieved."

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