We've heard a lot from state and national political leaders recently about the need to reform the U.S. healthcare system, and not least to extend coverage to the 47 million Americans who now lack insurance.
But what about those who are fully insured and still struggle for coverage of necessary treatments?
Monica Blumenfield, a longtime employee of the Long Beach Unified School District, is such a person. She was turned down for coverage of physical therapy for work-related nerve damage and for an MRI scan related to earlier treatment for breast cancer.
Her insurer, Blue Shield, said the decisions were reviewed by the company's medical director. But this wasn't a doctor experienced in either physical therapy or oncology. It was a Northern California osteopathic physician who lists his specialty as pulmonary disorders such as bronchitis and asthma.
"The doctor who reviewed my case wasn't qualified to make these decisions," Blumenfield, 50, told me. "Basically, Blue Shield tried to deceive me."
The government reported this month that the United States spent an average $7,026 per person on healthcare in 2006. That's more than double the amount spent in developed countries with single-payer insurance plans (where life spans are longer and infant mortality lower).
My colleague Lisa Girion has done eye-opening work detailing examples of private insurance companies canceling the policies of patients after they're diagnosed with serious (and costly) ailments.
But for every such horror story, there are thousands more examples of insurers denying coverage for specific treatments and leaving patients holding the bag for their medical expenses.
Blumenfield, a school counselor who ran unsuccessfully for a seat on the Long Beach City Council in 2006, had always enjoyed reasonably good health.
That changed in 2002, when she was diagnosed first with Hodgkin's disease, a cancer of the lymphatic system, and then breast cancer.
Blumenfield underwent radiation treatment for her Hodgkin's and had a mastectomy for the breast cancer, followed by reconstructive surgery.
She said this was when she received her first inkling from Blue Shield that her relationship with the insurer had changed. "I got the reconstruction done," Blumenfield recalled, "but there was a lot of demands for extra documentation."
In early 2006, her doctor diagnosed her as having carpal tunnel syndrome, a nerve disorder of the wrists, arms, shoulders and neck frequently associated with computer use. He prescribed physical therapy.
