Buy a health ins. plan that excludes chemotherapy?

**disneysteve** · 10-26-2009, 09:33 AM

Chemotherapy is rarely "end of life" care today. It is very often effective treatment to eliminate cancer. I would never take insurance that didn't cover cancer treatment. Cancer is way to common a condition.

I have a friend who recently finished chemo for her breast cancer. She is now doing great with no evidence of disease. She is 42 years old with 3 children. I'm sure if you ask her if it was worth it, she'd say yes. In fact, she'd probably think you were insane for even asking.

The fact that insurance companies are even allowed to offer these policies is a disgrace.

**Scanner** · 10-26-2009, 10:14 AM

The link I read was a bit old. . .but these are "essential" insurance plans they were referring to (and one I was interested in).

I know cancer is common and I am not so cocky to assume, "Oh, I'll never get it." After all, I am male. . .so prostate, like breast and cervical CA for women, is always a concern. I haven't alwyas had the best diet so colon CA would be a lingering thought.

Also exposed to a lot of secondary smoke growing up as well as asbestos exposure (a little in my grandparent's house - they both died of mesothelioma) - I could be one of those "non-smoker" lung CA statistics.

I have to say, as far as I ahve seen - mesothelioma is the cancer to get if you are gong to get one. Once diagnosed my grandfather was dead in 3 months, no chemo, and my grandmotehr in 3 weeks. That seems to be a merciful one.

That being said, after seeing the public spectacle of Farrah Fawcett-Majors and Patrick Swayzee. . .not sure I'd do that even if I had the benefit, DS. I am 41 y.o. . .had a good life. . .why not just be made comfortable and use that time the best you can?

Hard call, I'll admit - do I want to buy into that "lifestyle" - the chronic cancer lifestyle (and cancer has become more of a chronic disease than a terminal one) where you are in and out of chemo for a good part of the rest of your life? Is this a model for Americans in general? I also personally think chemotherapy/cancer tx. is a "cash cow" as I notice many cancer tx. centers popping up around me. . .sorry to be cynical - but all those marble floors and beautiful serene waiting rooms have to cost something to provide and be funded with ins. $$$. To go up to a "non-essential" plan, I think the jump is to $600/month.

But yes, I am rather insane for even asking; I'll admit I turn things upside down when I examine them and don't always make normal decisions. I am sure a cancer doctor would be frustrated with me if I were ever in teh unfortunate place to making such a decision.

**Scanner** · 10-26-2009, 10:28 AM

DisneySteve,

I just looked at a plan document and it does say chemotherapy is covered. . .the quote I was given thru esurance ($240/month) was for an Essential EPO Plus plan.

However, on the document, beleive it or not, they have a lessor plan (doesn't have the "Plus" - just Essential EPO) -

No diabetes benefits
No rehabilitation center benefit (scariest IMO)
No chemotherapy benefit
No durable medical equipment
No casts, braces, prosthetic equipment (next scariest)

I wonder what the savings is for basically getting nothing, LOL.

Seriously though, I think it's important to ask questions like I ask, instead of just being assumed "insane" for differing on my healthcare/wellness values. I am not so cocky to think I wouldn't ever, never, ever ever want heroic measures. . .that being said, I think I fall somewhere in the middle of that spectrum.

These are the kind of discussion and choices Americans are refusing to make in the healthcare debate.

**EEinNJ** · 10-26-2009, 10:37 AM

Wow, if you're getting divorced it seems like you have enough of a problem without wondering if you're going to get cancer!

You're thinking ahead and shopping carefully, that's good. There are catastrophic policies and cancer care policies, too. I am with Dr. Steve, cancer is too common to not have all the treatment options.

You are correct, though- treating cancer is big business, and I've seen the marble floors, etc. at places like Fox Chase. It's part of the reason why insurance is so high, and it's a national disgrace.

**Scanner** · 10-26-2009, 11:02 AM

EEinNJ,

LOL. . .yeah, that's me. . .a "thinker." I do overthink matters a lot - it's a hobby of mine.

Well, luckily, it seems to be covered at a price point I am comfortable with. . .that being said, I think we have to start having these discussions on "self-rationing".

The marble floors aren't just at major places like FoxChase. . .even the local groups have small Taj Mahals erected. Hey, I am all for cancer patients having a relaxing, healing environment but I have to just wonder when all of them are going up, what's going on. . .is it worth it. . .etc.

It's like all the cardiac centers - hospitals zone in on them because they are generally 50+ year old males, financially stable, and with good insurance. Every hospital and their grandmother wants to take care of heart disease. Cancer now seems to be the new one and esp., you guessed it, prostate CA.

(50+ males with good health ins.)

**disneysteve** · 10-26-2009, 12:43 PM

Originally posted by Scanner View Post

Seriously though, I think it's important to ask questions like I ask, instead of just being assumed "insane" for differing on my healthcare/wellness values.

I think we have to start having these discussions on "self-rationing".

Scanner, I agree with you that some self-rationing, or even systemic rationing, needs to be part of the national debate. A lot of people get a lot of care that they could live just fine without: MRIs for every ache and pain, Viagra, sleeping pills, pain meds, cosmetic surgery, gastric bypass, etc.

I do not think this is one of those instances, though. To use the same friend's example, again, she had breast cancer. What were her choices? Take the chemo and live, very likely a normal lifespan, or refuse the chemo and die at age 42, leaving behind a husband and 3 children under the age of 14. Who in their right mind would choose death because it was cheaper?

If you don't consider life-saving treatment for a relatively young woman to be a reasonable choice, then I would have to disagree with you. Now if that same patient were 85 years old, I think it would be a different conversation.

**watsoninc** · 10-26-2009, 12:59 PM

I would never consider a policy without a chemotherapy benefit. I work in GI oncology, and the treatments can cost ten's of thousands a month. After one gets better, the financial havoc can be tremendous even with insurance.

Depending on when it is caught and what type of cancer one has, cancer can definitely be managed in many cases. There are several cancers that are treated very much like chronic illnesses rather than an life-ending event.

**zakity** · 10-26-2009, 01:08 PM

Who in their right mind would choose death because it was cheaper?

Me!! **waving my hand in the air** I would!! And, I am in my right mind.

I would choose death if it meant leaving my family with tons of medical debt. No sense in screwing the living over financially. I have sat and pondered it.

If I got cancer, I would probably ask what the cost was for the course of treatment and how successful it was and I would find out what part the insurance covered. Then, I would take that into consideration on deciding if I would do the treatment or not. If it is too spendy, I have my demise planned out also.

I got really lucky. My little trip to Hell in March (was in the hospital for two weeks-blood clot) only set me back $1500 for a $250,000+ medical bill. Apparently, we have really really really good insurance. I had thought that hospital visits were 80/20, which would have left us with a $30,000+ medical bill. We got super lucky because there is a $1500 out of pocket cap per year.

**disneysteve** · 10-26-2009, 02:02 PM

zakity, you are answering a slightly different question. If someone had no insurance, they certainly might opt out of treatment that they'd have to pay for out of pocket if they didn't have the money. I've had patients do that more than once. But we are talking about health insurance policies. If you could pick between a policy that covered cancer treatment and one that didn't, and you could afford either one, would you voluntarily pick the policy that didn't cover cancer treatment?

**Thrif-t** · 10-26-2009, 04:20 PM

Funny thing about death, when its starring you straight in the face all of sudden you don't want to go there anymore. I saw it with my own mother, always saying she was ready to go why live, but when she got cancer, she wanted treatment she wasn't ready to go at 78, maybe at 80 but she wanted a few more years. Sadly she didn't get them

...you'll want to live.

**Scanner** · 10-27-2009, 12:42 PM

After one gets better, the financial havoc can be tremendous even with insurance.

Natch. . .and there's the conundrum and thanks for pointing that out. I have a family to think about and I have to consider that if the chemo gives me a 50/50 chance of survival past 5 years but there's "uncovered" charges and then I am "indebted" to the Small Taj Mahals the rest of my 50% life. . .I consider myself in my right mind too and I still pose the question -

Is it worth it?

One thing for sure. . .none of us get out of this world alive, whether that's 42 or 82.

Death or being a Medical Debt Slave (or possible bankruptcy)?

Devil's choice, huh?

Why not just be made comfortable and let your children have your hard earned money and investments?

Thanks for speaking up as I am usually the one with radical viewpoints around here and feel a little out on my own.

**disneysteve** · 10-27-2009, 01:01 PM

Originally posted by Scanner View Post

if the chemo gives me a 50/50 chance of survival past 5 years but there's "uncovered" charges and then I am "indebted" to the Small Taj Mahals the rest of my 50% life. . .I consider myself in my right mind too and I still pose the question -

Is it worth it?

I can't argue with that. You have to look at the stats and odds in each individual case. What if in your scenario, the chemo gives you an 85% chance of survival? Does that change your answer? I don't know but it might.

If you opt for health insurance that doesn't even cover chemo, you are totally giving up the chance to pose that question and make that decision. That's what I would be opposed to. I want all the options available to me. I don't want to close doors before I even get to them.

Of course, I am a doctor and the husband of a childhood cancer survivor, so those facts probably bias my opinion a bit.

**irmanator** · 10-27-2009, 01:48 PM

Like Steve said I would want an insurance that covers chemo. It would be nasty to find a cancer in early treatable stages and not be able to treat it because 5 years ago when you bought the policy you tried to save a couple pennies.

That being said If it was discovered late and prognosis not so good then, well having the option would be good but i would probably just enjoy what was left.

**disneysteve** · 10-27-2009, 02:55 PM

I also want to point out that most people have a very outdated image of chemotherapy as this terrible treatment that makes patients horribly ill. In a great many cases today, chemo has been greatly refined. Side effects are often minimal. Many chemo drugs are given orally today and the patient just takes it every day like any other medicine while they continue to work or go to school or go about their daily lives. Sorry but I can't imagine choosing health insurance that would deny coverage for these agents.

Buy a health ins. plan that excludes chemotherapy?