When insurance companies compound the battle against cancer

Then daddy’s girl snapped out of it and turned into a warrior of sorts. For weeks, I fought the bureaucratic forces of paperwork, voicemail, hold music and call center operators in the Philippines for whom compassion is limited by a corporate script.

An Open Letter to Ms. (Name Withheld), “utilization management team,” Humana,

I won’t use your name. It’s not my intention to harass you or shame you. Only to reach you. Calls and emails have failed. My recent shot in the dark, messaging your personal Facebook account even though we are not friends, went unanswered. All I have left is my pen, mercifully elevated by large rolls of newsprint and the ethereal reaches of the internet. You see, I am desperate. Somewhere on your desk there in Kentucky, I presume — or in your computer inbox — there is a file with my father’s name on it. It holds more than CAT scan results and doctors’ referrals.

It holds the mortality of a kind, hard-working, 69-yearold man in Seguin, Texas — that’s near San Antonio.

It holds the hopes of his three daughters and his grandchildren and his beloved wife, with whom he will celebrate 46 years this month. It holds a quiet man’s increasing anxiety, his sleepless nights locking eyes with my mother at 2 a.m., and his fear that someday soon he won’t be there to hold her hand and get her the roasting pan down from the top shelf.

It holds his best, and perhaps only, chance of beating the seething volcano of cancer cells that began swelling deep in his chest years ago without a tremor of warning. He shook off a stubborn, come-and-go cough, like all former smokers, as collateral damage of a long-fought addiction.

In that folder, dear gatekeeper of insurance benefits, is an authorization code issued by your company — a fast-expiring set of digits that for us was a hard-won key to the kingdom. It came after more than a month of constant calls and emails and interventions from good-hearted doctors. The day Dad got the code earlier this month, we celebrated with a flurry of jubilant texts to friends and family and

the first good night’s sleep in a long while.

The code meant Humana had overturned a previous denial and would let my dad go “out-of-network,” so he could get the highest level of care from a surgeon at MD Anderson who had agreed to take the case, with all its complexities and risks and advancedstage odds. Dad likely will need the entire lung removed, along with bone, and extensive chemo. Mass creeped stealthily

My father, whom many readers of this column know simply as Leroy, the retired truck driver who attended his first opera a few years ago in a plaid, pearl-snap shirt, who let his middle daughter go along on his last haul to the Rio Grande Valley so I could write about it, has sacrificed his entire life for us.

He doesn’t think enough about himself. He still sports a flip-top phone and wears shoes down to the sole. One afternoon in January, as a light drizzle appeared on my windshield while I sat in a Houston parking lot, texting an oncologist, my dad sent a message:

“Reminder,” it read. “Windshield wiper blade.”

In the midst of this existential crisis, he was thinking of the worn-out blade he’d spotted on my car over the holidays.

When it came time to sign up for a Medicare supplement or Advantage plan, he got my mom the more expensive PPO, and he settled for the HMO. His mistake, yes, but he thought it made financial sense. He was never sick. He’s paid for insurance his whole life and never needed it, except for checkups. No high cholesterol, no high blood pressure, no diabetes. Nada. The only thing that could get him was the smoking, which he quit eight years ago, ironically, about the time the tumor started growing.

The mass creeped stealthily. While he drove his last miles of interstate in the 18-wheeler. While he settled into retired life, eating dinner every night with my mom, fishing, bingo and a lifelong dream of farming — he grows spicy Tuscan arugula just for me. Fighting the process

He was afraid to tell me about the mass over the holidays for fear I wouldn’t be able to drive my own kids back to Houston. He told me a day or two after Christmas, late at night, bracing his big, calloused hands on the kitchen counter. He told me the size of it — more than 8 centimeters at that point. And he told me some hopeful lie that it might be bacteria.

I launched into a spiel about the Chronicle’s reporting on Dr. James Allison and the miracle of immunotherapy. I told him not to worry. I got this. Then I got in my car and sobbed as I drove around my hometown, little moments of my father flashing in my mind, and seized by the terror of losing his corny jokes, his encyclopedic knowledge of home repair, his stories, his laugh, his strong arms.

Then daddy’s girl snapped out of it and turned into a warrior of sorts. For weeks, I fought the bureaucratic forces of paperwork, voicemail, hold music and call center operators in the Philippines for whom compassion is limited by a corporate script.

“What if he were your father?” I asked.

“Authorization does not guarantee payment,” he responded.

And now it comes down to you in utilization management. I’m not sure what that phrase actually means, but I imagine you working in a faraway cubicle trying to earn a living like the rest of us, in a job where people gasp all day long for help that you may feel powerless to provide. Code was a promise

To us, that authorization code issued by your company meant somebody at Humana listened, to us and to its own innetwork oncologist in San Antonio, who agreed my dad’s best chance was in Houston.

To us, that code was a promise. I ran to the hospital with it like an excited child, eager to make an appointment with the surgeon and get my dad some answers. Then the managed care office at MD Anderson was told further approval was needed — by Humana, by a subcontracting medical group, it wasn’t clear. Calls and emails went unanswered. Hours turned into days, and then more than a week.

My dad, who needs all his strength to fight the cancer, was withering in a struggle against paperwork and unresponsiveness. Soft torture of silence

Then, with no explanation, MD Anderson’s financial folks said on Friday that they didn’t think Humana would sign the contract needed. They promised to keep trying. But I saw the last ember of hope in my dad’s eyes go out.

I’m writing for him, yes. But also for any patient or family who has felt as helpless as we do right now.

Our health care system is a mess; I get it. Anything outside the emergency room is considered a privilege, not a right. The entire insurance industry, albeit still profiting handsomely, is engulfed in revenue losses and uncertainty. Patients are left reading the fine print, unable to discern the true price of anything from a mammogram to a catheter. We were told we could keep our doctors, but for some, that wasn’t true. Networks are narrowing. So is our faith that anybody besides the medical staff really cares .

So, maybe to cope, people in jobs like yours detach. You stop responding to some of the calls and email. And we, the patients and their families, are left with the soft torture of silence.

This may be the way to keep a job. But is it the way to treat people? As one daughter to another, please for a moment put yourself in my place. Before your next decision, ask:

What if this were your father?