When I Needed Hope, My HMO Gave Me A Denial

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Bill Beaver – Pollock Pines, CA

As told by Bill Beaver:

One morning in 1993 I was out running and I began to have problems with one of my legs. I went to my HMO to have it checked out but was told it was nothing serious. But my leg problems persisted. I began to have trouble walking and I could no longer run. Five months later, my HMO concluded that I must have had a stroke on the morning when I first noticed my leg problem. In my mind though, I just didn’t fit the profile of a stroke victim.

My problems with my legs and nerves worsened over the next two years and my HMO wasn’t able to develop any remedy. After more extensive testing, doctors finally discovered that my problems were due to a deadly brain tumor that had been misdiagnosed two years earlier. I had difficulty understanding this new diagnosis and why it had taken so long to come to light.

They told me the tumor was inoperable and predicted that I would live two years at best. They told me normally they would perform a biopsy of the tumor to confirm the diagnosis and order treatment, but in my case the procedure was much too risky and would most likely leave me paralyzed, comatose or dead, and regardless of the findings there were no known treatments that could prove beneficial.

Essentially they were saying take two aspirin, go home, and die. What was taken from me that day was hope. In a very few minutes I was cast from the herd, of no more use to the well being and future of my peers. I felt like a sickly gazelle left as prey outside the protective circle because it is not economically feasible to do otherwise.

I could not believe there wasn’t anything that could be done. I spent many years acquiring and teaching positive outcomes from negative circumstances. I could not give up.

My wife and I drafted a list of family and friends to find some answers, our army of faithful I called them.

One afternoon I received a telephone call from my sister-in-law. While sitting in a waiting room she read an article about a young man who had the same condition as me and was being treated successfully at John Hopkins Hospital. The article went on to reveal the compassion and competence exhibited by John Hopkins and how they have earned the distinction of being the leader in health care and wellness.

I used all of my savings and began traveling to this prestigious teaching hospital. They contradicted the opinion of my HMO doctors by performing a biopsy and recommending radiation therapy for treatment, and then the doctors at John Hopkins convinced my HMO to administer the radiation treatment.

More than three years have passed since I was given a death sentence from my HMO and I am grateful for the fortunes during this time. While I am not well, I now have a good chance to get well. I do not know what the situation would be if I had the best possible care from the onset.

I do know that my HMO still refuses to pay for my life-saving treatment at John-Hopkins. The Employment Retirement Income Security Act (ERISA) makes it impossible for me to collect damages from my HMO for denying me my life-saving treatment. The ERISA loophole must be closed so that HMOs that make medical decisions to withhold care can be held legally liable for their cost cutting decisions.

There is no incentive for an HMO to give treatment to a patient that only has a small percentage of a chance to live. When I needed hope, my HMO gave me a denial. When I needed support, my HMO gave me the door. Until HMOs are forced to give quality care, they will continue to deny costly treatments that can prolong, or in my case, even save a life.

Consumer Watchdog
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