Protests force insurer to back down

MONEY FROM bake sales, church tithing and community fundraisers. That's how the Colombo family, from Placentia in Orange County, Calif., planned to pay the more than $100,000 bill for their 17-year-old son Nick's radiation treatment.

But Nick's brother Ricky and a group of friends and classmates refused to take "no" for an answer--and in the end, insurance giant PacifiCare reversed its decision and agreed to cover the treatment.

Nick has Ewing's Sarcoma in his tailbone and needs an advanced and highly specialized form of radiation therapy called CyberKnife. Nick's doctors begged PacifiCare to approve the treatment, arguing it was his only chance to live. At first, to no avail--PacifiCare refused to pay, saying the treatment wasn't "medically necessary," and the company won a decision from California's Managed Care oversight board.

PacifiCare has a history of denying care. Recently, the corporation, which is owned by United Health Care, the nation's largest insurer, was fined $3.5 million by the state of California for mishandling at least 133,000 claims similar to Nick's--it is facing up to $1.3 billion in penalties for illegally denying care. An investigation by the California Department of Managed Health Care found that PacifiCare wrongly denied claims in 30 percent of its HMO cases in 2006-7.

That could have been the end of the story--one more denial, one more death. Instead, Nick's 19-year-old brother Ricky was determined to fight back.

Ricky had heard how the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) mobilized support for the family of Nataline Sarkisyan, who was at first denied a life-saving liver transplant by CIGNA. The insurance company relented after protests, but it was too late, and Nataline died.

Ricky called the CNA office for help, and the fight to save Nick's life was on. Angry supporters flooded the PacifiCare offices with so many phone calls protesting the denial that the phone system went down at times, and a spokesperson complained about being "overwhelmed" by health care activists.

Ricky wrote about the case online. "My brother Nick Colombo is just 17 years old," read one message, "and he has suffered with a painful bone cancer for four years. Our insurance company, PacifiCare, denied Nick radiation treatment available in Kansas City, which can save his life. He has exhausted all other treatment options, but nothing worked. This is our last effort, and this procedure has worked before with people in Nick's situation. We are now standing up for Nick and telling PacifiCare that what they are doing is wrong."

Nick's story spread around the Internet. Eve Gittlelson, a health policy blogger who writes at the Daily Kos Web site, picked up the story and helped organize further protests. Ricky and the CNA/NNOC organized a demonstration in front of PacifiCare corporate offices in Cypress, Calif. Over 100 of Nick's classmates, friends of the family, and nurses joined the rally, holding picket signs that declared, "We Will Fight For Nick" and "Every Patient Deserves Guaranteed Health Care."

As with CIGNA, the protests and negative publicity forced PacifiCare to reverse its decision and agree to pay for the treatment. As nurse Malinda Markowitz, a member of the CNA/NNOC board of presidents, said in a statement, "PacifiCare had to back down in the face of a mobilized network of patient advocates and health care activists who would not take no for an answer."

This is a victory for the movement for single-payer health care--and a concrete example of the power of protest.

DeAnn McEwen, an RN who is in favor of a single-payer health care system, had this to say after the victory: "The Nataline Sarkysian and Nick Colombo families have insurance. Remember that the next time you think you do. And, remember them the next time you hear a candidate for president tell you about a mandate bill that will enrich the insurance companies. The tragedy of illness and injury shouldn't be compounded by financial ruin for families."