How To Learn More About Your Health Care Rights Jan 16, 2006

mirrored from: http://cbs2.com/consumer/local_story_016195509.html

Jan 16, 2006 4:53 pm US/Pacific
How To Learn More About Your Health Care Rights

Randy Paige Reporting

(CBS) LOS ANGELES A cancer patient in the fight of his life suddenly has to fight his HMO at the same time. They cancelled his membership just when he needed it most. So we got involved to help him and what happened next could be a lesson for everyone.

Scott Bracy is the father of a three-month-old baby girl, and he’s fighting for his life. Just two weeks ago, he thought he had lost the battle.

"I got a letter saying my insurance has been cancelled and don’t show up, don’t show up for your chemotherapy," Bracy said.

In August Scott was diagnosed with malignant melanoma. Doctors at Kaiser Permanente medical center in Riverside told him with aggressive chemotherapy treatment he would have a twelve percent chance of survival.

Then, just a few days before his fourth scheduled treatment, Scott received this letter from Kaiser, which says, “your membership in Kaiser foundation health plan has been revoked due to the intentional misrepresentation of your health history." An allegation that Scott vehemently denies.

"I was completely deflated, I cried and I cried; that was the most horrible thing I think I've ever heard, was you're not to show up, don’t even show up," Bracy said.

The question as to whether or not Kaiser has acted properly in this case is a legal question which will take months to answer and its not the most important question, the important question is how can Scott Bracy get the treatment he so desperately needs, that is, how can he wind through this labyrinth of bureaucracy we call our medical system and get the help he needs before its too late? I've stepped in to help them answer this question and in the process I can show you the things you need to know if you ever find yourself in a similar situation.

Kaiser told us that Scott is eligible for Medical, so we started at the county USC Medical Center because it accepts Medical patients and the top cancer doctors from USC practice there. County USC agreed to see Scott right away, then we learned the high dose chemotherapy Scott needed is not offered there, we would need to try UCLA.

We asked Kaiser if their doctor would speak directly to the top UCLA oncologist about Scott's case. Within hours UCLA's doctor was in the loop and prepared to see Scott. Then the next snag, UCLA won’t make the appointment until Scott's medical funding is approved and that could take weeks.

With UCLA waiting in the wings its unclear how long it will take for the medical funding to come through and in the meantime Scott Bracy desperately needs his chemotherapy treatment. That’s when the phone rings at his home, its Kaiser, they want to bring him back, they want to give him that chemotherapy treatment before its too late.

"I feel really good today, I have a whole different outlook on everything," Bracy said.

Now, Scott prepares to leave for the hospital, on his birthday. He tells us that this feels like a birthday present, "I'm looking forward to getting checked in because I know it’s the only thing that’s going to save me."

Bracy told us that he wishes for a new beginning, "to see my daughter go to first grade and see her go to high school and raise my daughter I want to raise this child and I think I'm going to be able to do that."

Scott Bracy says he has found new hope as he returns to Kaiser hospital for his fourth chemotherapy treatment. "Now I'm going to beat this thing," he said, "I'm going to fight harder than I did before because I feel I'm getting a second chance here."

So what can you learn from Scott's case? First, you can’t go it alone, you need to find a friend or family member to take charge and help you work through the system. As we saw in Scott's case, there are setbacks every step of the way, each setback can be emotionally devastating when your life is on the line, a friend or family member can push through those setbacks and keep the ball rolling. You don’t need a television reporter, just a committed friend who can lend a hand. There are also professionals and volunteers who can help.