Should Insurers Cover Experimental Treatments?

By Matt Stroud | January 24, 2012

  • January 24, 2012 at 1:24 pm
    Pat Foley says:
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    For a normal English definition of “experimental,” no it should not.

    But we all know..wink…wink..that the definition would be whatever maximizes revenue, subject only to the constraints of public outrage.

    • January 24, 2012 at 9:17 pm
      Sharon says:
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      I like your comment Pat. We live in a predatory healthcare environment where the pharmaceutical companies are allowed to cram down drugs and treatments that are often times toxic and maim and kill. It takes the FDA far too long to get bad drugs off the market, drugs that never should have been approved in the first place. Insurance companies can no longer afford the mass poisoning of the patient population while the pharmaceutical companies, medical device and equipment manufacturers poison with impunity. And no matter what you believe about vaccinations if they are causing illness then the insurers have to pick up the cost for the life time care of the child or adult that was injured, again while pharma walks away with impunity. The vaccination court is a joke.

      Disclosure: I was poisoned by GE and Bayer from gadolinium based contrasting agents and my health insurer is paying dearly while GE and Bayer are walking away with impunity. I do not work in the insurance industry but I am very concerned that they are going to be forced to pick up the negative externalities of pharma’s poisoning. Take drugs and treatments at your own risk.

  • January 24, 2012 at 1:42 pm
    Glen says:
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    If you are willing to submit your body to the treatment, insurance should cover it just like any other treatment!

  • January 24, 2012 at 2:03 pm
    Boca Condo King says:
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    The problem we face in this country is the unwillingness to have an adult conversation about when we say no to health care coverage.

    When asked, “your money or your life” most people will say “life”, but some will say “money”. When asked “other peoples’ money or your life” all will say “life”.

    Health care is a horrible term. When the earthquake struck Haiti, tens of thousands of people suffered crush wounds of their arms and legs. In the USA, most would have had expensive surgeries and treatments resulting in full recoveries and saved limbs. For Haiti, those crush wounds meant amputation to avoid death by infection. Both situations are “Health Care” but one is better and much more expensive than the other.

    As medical care advances, new treatments may be out of reach of many except the most well insured and wealthy. Short term this is hard to see, but in the long term most new treatments become cheaper and widespread.

    If you are trusting your health to a large system looking to control costs, there is a chance that you will not get every treatment that MIGHT help you. The needs of the 1% may be overridden by the desire of the other 99% to spend less.

    As the old saying goes, you can have it fast, you can have it cheap, you can have it good; pick any two.

    • January 24, 2012 at 2:15 pm
      Anejo says:
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      So isn’t the real question, “your money or someone elses life?” It’s a real test of character.

      • January 24, 2012 at 3:04 pm
        Boca Condo King says:
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        Great question and the answer from most will be “it depends…”

        Is it my money to save a little kid with Cancer? Is it my money to save an alcoholic by paying for a new liver? Is it my money to pay for the motorcyclist who did 120 during rush hour on I95? Is it for an illegal immigrant to get dialysis treatment that cannot be had in the home country? Is it to replace a limb lost by an Iraqi veteran? Is it to prolong the life of a ninety year old grandmother? Is it to restore the sight of a young mother?

        Can I save six kids in the third world for the cost of one kid in the US?

        In order for something to be affordable it must have limits. The adult conversation is what needs to happen so we can put in those limits. Every “civilized” country in the world has limits on what its citizens can get under the health plans in that country. We must do the same, or any system we have will collapse (as Medicare and Medicaid already are).

        • January 24, 2012 at 3:38 pm
          Anejo says:
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          Answering makes me feel like I’m sitting on a “Death Panel”. The child with cancer gets help. St. Judes Childrens Hospital does not ever turn down a sick child. If a place like that is not an option, whatever it takes for a child.
          The liver? That’s not experimental. If the alcoholic’s insurance covers transplants it does. If not, I’m not sure.
          The motorcyclist, not a lot of pity for the stupidity. I doubt they’d live through that accident and hope they are an organ donor, if anything left is usable.
          The illegal alien and dialysis, while not a fan of illegal immigration if dialysis is something we’d give away as a part of foreign aid on the otherside of the border, why not here. I’d do it on a humanitarian basis but hope that someday they’d want to head back home for treatment because it was just as good and probably cheaper.
          Lost limb for a veteran, absolutely. No question.
          Prolong the life of my grandmother, of course. Your? I’m not so sure. Kidding.
          Restore the sight for a young mother. Yes. There is progress being made there with transplants and technology.
          6 foreign kids versus one US. If we are talking experimental, it would be a foreign relations nightmare to experiment on kids from other countries. If not experimental, family first and we do what we can for the rest of the world through foreign aid and private donations.
          That’s a starting point. I’m open to discussion.

          • January 24, 2012 at 3:53 pm
            Boca Condo King says:
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            Welcome to the death panel, as the newest member, you will be required to bring cookies to the next meeting. (Must be homemade)
            I was not trying to argue the main point of this article which was “should insurance cover experimental treatments.”
            As others point out, “experimental” is a slippery concept, especially where life and money are in question.
            My only point is that without unlimited resources, hard choices have to be made.

          • January 24, 2012 at 4:01 pm
            Anejo says:
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            Good exchange BCK. The cookies will be peanut butter as long as you have no allergies.

        • January 25, 2012 at 9:14 am
          Sharon says:
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          By far the biggest issue facing the high cost of health care is “Death by Medicine”. It does not have to be either or we just need to stop pharmaceutical companies and medical device and equipment manufacturers from looking at the patient population as their piggy bank. A new diagnostic technology called proteomics could detect disease early and replace scans for diagnosing disease but is being suppressed. Why? These are the questions that keep me awake at night. How many more Vioxxes do we need to wake us up to what the real issues are?

          • January 25, 2012 at 9:27 am
            Boca Condo King says:
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            Vioxx is an excellent example of how human behavour and medicine colldie.

            Vioxx is basically an aspirin substitute (FYI, aspirin would be a prescription drug if discovered today) for people who cannot take aspirin or the other over the counter pain relievers.

            The drug companies did over market it, but many people started to use Vioxx when they found that their drug co pay of $5.00 (remember Vioxx was years ago back when drug co pays were cheaper..) to buy a thirty day supply was cheaper than buying brand name pain relievers like Motrin. Also since Vioxx was prescription only there was a perception that it worked better.
            As a result, this drug which should have been used only by people who could not tolerate the other pain relievers was overused and caused harm.

            Of course, had carriers not allowed the drug on their formularies and insisted that only the proper population use Vioxx they would have been lambasted for limiting people’s medical care.

  • January 24, 2012 at 2:06 pm
    BOBP says:
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    No, your insurance company should not pay the cost of experimental treatments. Nor should the individual. Those sponsoring and/or conducting the experiments should pay all the costs. Afterall, if they are successful those providers will make all the profits.

  • January 24, 2012 at 2:57 pm
    Steve says:
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    In one State is is experimental and in another it is standard procedure.

    • January 25, 2012 at 9:16 am
      Sharon says:
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      Steve, unfortunately I think a lot of it depends on campaign contributions not good science.

  • January 24, 2012 at 3:31 pm
    Jane Dough says:
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    Agree with the first comment (Pat Foley). I have a uterine fibroid, symptoms not severe enough that I would consider a hysterectomy (an over-done procedure, Dr Oz has even stated this), but still causing significant adverse symptoms and affect on my life. There is a non-invasive procedure to destroy the fibroid using ultrsound while in an MRI machine, approved by the FDA seven years ago. The procedure is done at major medical facilities around the world, but not in my city/hospital, which is affiliated with my health plan. My health plan still considers this procedure “experimental” and will not pay for it. The cost is comparable or less than hysterectomy, and much less risky. Why shouldn’t I have the right to choose this procedure, if the plan would pay for a hysterectomy ? They cover one, but not the other.
    I believe it is because their plan/local Dr do not do it, and they don’t want to “pay retail” to another facility – so they call it experimental.

    • January 24, 2012 at 4:12 pm
      southern gal says:
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      I believe there are other options to (hopefully) solve your problem prior to the experimental option you mention. The other options are covered by insurance…..my sister had the same problem.

    • January 24, 2012 at 9:34 pm
      Sharon says:
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      I have to say Jane Dough I wish I had NOT jumped through the hoops my insurance company put me through to get MRIs. I now have a new often-times fatal man-made disease from gadolinium based contrasting agents. These agents are still on the market and they are still making people sick. Depending on if they used a contrasting dye with your MRI you may have dodged a bullet. I’m really happy for you. Look up the images of nephrogenic systemic fibrosis. You only need to get one dose and you do not need to have kidney disease to get it. Gadolinium, a rare earth metal is highly toxic and is nephrotoxic, neurotoxic and a known carginogen.

  • January 24, 2012 at 3:44 pm
    Ins Guy says:
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    @BOBP: yes! We had Drs. at a teaching hospital acutally go out and find “studies in progress” to have my son included. All it took was to submit some blood/tissue samples and a narrative report. Luckily, it was accepted and their research grant covered some of the expenses.

    But, that aside and to offer another idea… Let’s go back to prohibiting drug companies from direct TV Advertising and instead come up with a way to re-invest those monies “experimental” periods that are for a much more broad use than clinical trials. If nothing else those funds could at least offset some costs, if not fund them completely.

    • January 24, 2012 at 5:54 pm
      Anejo says:
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      First, I’m glad your son is getting treatment. That is priority.
      As far as drug companies doing TV ads. They vreate a problem/symptom when ever they discover a drugs effect or side-effect. “Are your eye lashes less than they should be?” Side-effects can dis-color you for good but hey, it’s your lashes. And the disclaimers that some drugs may kill you, but hey, you can dance again. It’s laughable, but so sad that they still make millions off the drugs. TV drug ads are a pet peeve, if you can’t tell… OH, and how they say “Tell you doctor if you have high blood pressure or liver problems or diabetes. Shouldn’t my doctor be telling me if I have those problems?

      • January 25, 2012 at 8:59 pm
        Sharon says:
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        These are excellent points Anejo and Ins Guy.

  • January 24, 2012 at 5:12 pm
    The Other Point of View says:
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    Great discussion.

    • January 31, 2012 at 1:35 pm
      Ins Guy says:
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      Agree OPV. But, I must say to Jane Dough purely without malice or ridicule, be very wary of TV drs, clinicians, etc. 1st, be sure they are acutally a licensed practioner, remember that ad, “Im not a Dr, but I played one on TV, so….”

      Also, research the show’s sponsorship and the hosts paid appearances, endts, etc.

      TV is ENTIRELY about the money. (Even PBS is about the money, although from a different perspective :D ). And the Health Care Industry has TONS OF IT SPEND ON PR AND POLITICAL LOBBY.



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