Standing between a patient and health care - East Valley Tribune: Business

Standing between a patient and health care

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Posted: Sunday, January 20, 2008 9:41 pm | Updated: 11:18 pm, Fri Oct 7, 2011.

We’ve heard a lot from state and national political leaders recently about the need to reform the U.S. health-care system, and not least to extend coverage to the 47 million Americans who lack insurance.

But what about people who are fully insured and still struggle for coverage of necessary treatments?

Monica Blumenfield, a longtime employee of the Long Beach, Calif., Unified School District, is such a person. She was turned down for coverage of physical therapy for work-related nerve damage and for an MRI scan related to earlier treatment for breast cancer.

Her insurer, Blue Shield, said the decisions were reviewed by the company’s medical director. But this wasn’t a doctor experienced in either physical therapy or oncology. It was a Northern California osteopathic physician who lists his specialty as pulmonary disorders such as bronchitis and asthma.

“The doctor who reviewed my case wasn’t qualified to make these decisions,” Blumenfield, 50, told me. “Basically, Blue Shield tried to deceive me.”

The government reported that the United States spent an average $7,026 per person on health care in 2006. That’s more than double the amount spent in developed countries with single-payer insurance plans (where life spans are longer and infant mortality lower).

For every horror story, there are thousands more examples of insurers denying coverage for specific treatments and leaving patients holding the bag for their medical expenses.

Blumenfield always had enjoyed good health.

That changed in 2002, when she was diagnosed first with Hodgkin’s disease and then breast cancer. Blumenfield said this was when she received her first inkling from Blue Shield that her relationship with the insurer had changed.

Blumenfield said she’s fighting for Blue Shield to pay her back $2,000 in physical therapy costs. She also said she would be going in soon for her annual MRI to make sure her breast cancer had not returned. She believes it’s Blue Shield’s responsibility to cover the exam.

“Health care in America needs a lot of help,” Blumenfield said.

She should know.

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