AboutTina Expertise I can help on all aspects of the condition, treatment, support. I cannot diagnose but only give my personal expertise, and refer you to others who can help. I am in touch with doctors, therapists, and professionals on a regular basis. I can help with disability issues pertaining to lymphedema or cancer.
Experience 13 year cancer survivor, Lymphland Support group owner, Owner of Lymphland.com website, writer for Butterfly Gazette, forums coordinator for ELymphNotes online lymphedema magazine, patient and advocate for 10 years, Yahoo answers advanced level answerer.
Organizations Lymphland Support Group Owner, Lymphland.com website owner, National Lymphedema Network member, American Society of Lymphology member, ELymphNotes forums coordinator and writer, member of many online support groups. Rainbow Bridge Pet Loss Grief Counselor, former bank loan rep, pharmacy ass't
Education/Credentials college graduate, volunteer in pet loss grief counselling.
Expert: Tina Date: 1/23/2008 Subject: rare diseases should hmos pay
Question Hi, I am writing a paper on the health care system of the United States, and to my understanding HMOs do not believe in paying for testing certain diseases because the testing is new and maybe experimental. In your opinion do you believe that they (HMOs) should pay if experimental or not. Also is there any way as a doctor to go around this obstacle if you believe a patient needs a new or experimental testing done,and the patient can not afford it.
Answer Greetings Paul,
I believe that insurance companies should pay for experimental testing because of ethics, they should pay for what the patient prefers for testing methods and also treatments. However, they do not because they base their decisions on cost efficiency, meaning what is true and has been tried that works based on scientific studies and research. Also if they do pay for it and approve the patient to be tested, there is always the chance for a lawsuit from the patient or family if something goes wrong.
There are some cases in which a doctor can go around the obstacle and decision. That would be in the cases where the traditional method was a danger to the patients health and could be backed up with the medical history.
An example would be in myself, I have an allergy to fish, nuts, blue dyes, red dyes, blue and red colorings, and iodine. Some of the dyes used in invasive tests use those basic ingredients such as in a lymphangiography or lymphoscinthy. To test my lymph system, I would need an MRI instead which is more costly than the standard lymphoscinthy or lymphangiography. MRI's have just been approved to be used in looking at the lymphatic system but years ago it would have been experimental. If I had chosen to do this years ago, my doctor would have shown my medical history as a major risk factor in the testing methods and opted to get me approved for the MRI.
It may or may not have happened. The insurance company has the right to deny the coverage for the test. I also have the right to appeal their decision based on medical need which would be shown by my doctor.
But my opinion is that if the experimental test will help the patient get treatment that can improve quality of life or save the patient's life, then it should be covered, however, the insurance company should have the patient sign a waiver of filing any lawsuit if the test injured them in any way.
