I saw a man who had been treated for tonsillar cancer a few years prior. He had recently undergone a biopsy of a lymph node in the left anterior cervical area and had developed an open draining wound on his neck. He had an HMO insurance policy from a major private payer. He was referred to me by his primary care doctor who called with a tremor in his voice saying, “I’ve never seen anything like this before.” I saw the patient 4 days later and the wound on his neck was already much larger and perilously close to the major neck blood vessels. It looked pretty obvious that he had a malignancy. I started urgently calling his ENT doctor. A few days later, the ENT called me back to tell me that he “didn’t do cancer.” But, that wasn’t the worst part. The worst part was that the ENT doctor said he didn’t know any Head and Neck oncologists who took the man’s insurance –and he was right. He couldn’t be seen at MD Anderson.

In desperation, I called the ENT oncologist I had worked with at UT Houston (I’d love to tell you his name because I think he is amazing but I didn’t ask him if I could post it). My friend agreed to see the patient urgently even though he didn’t take the man’s insurance. By then, a week later, the patient’s jugular vein and carotid artery were both exposed, putting him at risk for a “blow out.” My ENT oncologist friend saw the patient only to confirm that he was in a palliative care situation. My point in discussing this is that the poor man THOUGHT he had insurance. He was certainly paying for insurance. He did have a primary care doctor, but there were NO cancer subspecialists in the city of Houston who took his HMO insurance (at least, none that I could find). And why was it MY job to find one of these doctors, anyway? I called his PCP to make certain that there WAS a hospice nursing agency that took his insurance—but really—what are we going to do about insurance that isn’t really insurance? I am seeing this situation more and more often!

Caroline Fife, MD
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