• August 10, 2015

Aetna, the Connecticut-based health insurance company, made over $2 billion in profits at the close of 2014, a 6.6% increase from the previous year. Analysts are confident profits will be even higher this year—a likely trend given that Aetna’s stock prices have grown by 309 percent since 2010. According to financial records, the company’s success in creating such staggering wealth for its corporate shareholders and top brass is in large part due to the recent acquisition of Coventary Health Care, to major growth in its Medicare and Medicaid plans, and interestingly enough, to “low medical-cost trends.”

Mounting medical debt is the leading cause of bankruptcies in the US, affecting about 2 million Americans this year. And beyond bankruptcy, some 56 million Americans are currently struggling with medical bills they cannot pay. Yet, Aetna, one of the nation’s foremost health insurance companies, cites low-medical cost trends as a major contributor to its lucrative share of the healthcare industry. What exactly do these low medical-cost trends look like and more importantly, are patients better off for them?

One in 7 sick patients in the U.S. will face a denial of treatment from their insurance company. Non-covered charges, out of network providers, unnecessary treatments, non-medical procedures, experimental drugs—these are all excuses commonly cited by insurance companies in rationalizing their denial of treatments. Yet not all denials are created equal. What happens when insurance companies refuse a medical treatment which could save a patient’s life?

Bobby Bean Allen, a 60-year-old resident of Newton, Texas, was forced to confront this very question. Bobby was diagnosed with advanced prostate cancer. Specialists at Houston’s MD Anderson Cancer Center recommended that Bobby undergo Proton Radiation Therapy—a type of radiation treatment, first developed in 1946, that uses protons rather than x-rays to treat cancer. The use of this treatment has proven to be notably valuable for treating localized, isolated, solid tumors that may spread to other areas of the body. The noninvasive treatment does not require surgery to remove the cancer, making it ideal for inoperable tumors.

Yet, despite the treatment’s proven efficacy in combating prostate cancer while leaving other healthy tissue unharmed, Aetna denied Bobby’s claim. The insurer alleged that the treatment, proposed by specialists at one of the country’s foremost cancer institutes, was experimental. Not only was this claim blatantly false, but it also ignored the fact that doctors determined the other options to treat the cancer were too risky because Bobby also suffers from insulin-dependent Type 2 diabetes. Without Proton Radiation Therapy, Bobby would face certain death.

“It is ridiculous that some person behind a desk at Aetna, without a medical degree or experience in fighting cancer, let alone experience in treating Bobby personally, is allowed to second guess the sound judgment of renowned doctors at the single best cancer center in the world and their patient who is battling an aggressive and deadly form of cancer," said Bob Hilliard, Founding Partner at Hilliard Muñoz Gonzales. Mr. Hilliard recently took Aetna to court and obtained a restraining order, forcing the insurer to do the right thing and provide Bobby the vital life-saving treatment he so desperately needs.

We hope this win has sent the health insurance industry a message which has been long overdue: the wellbeing of patients should be placed far-above corporate profits. Treating patients as nothing more than expenses on a spreadsheet to be minimized at all cost undermines the basic human decency that should be the guiding principle of any healthcare determination. Perhaps the refusal of Bobby’s life-saving medical treatment based on bogus claims, is an example of what Aetna refers to as the “low cost-medical trends” underpinning its record-breaking profits. "It's time that we take a stand against medical insurance companies who ask: how can we save a dollar, instead of how can we save a life," said Mr. Hilliard.

Bob Hilliard Comments: Judge Tells Aetna to Pay for Life-Saving Cancer Treatment - Source KRIS News

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