Man Dies After Insurance Co. Refuses To Cover Treatment

Man Dies After Insurance Co. Refuses To Cover Treatment

Fri Feb 10, 11:32 PM ET

Tracy Pierce, 37, lived a full life. He grew up with family and faith. He went to a Catholic school, got married, had a son, and he even had the car of his dreams. It was the perfect life.


"He's been strong. He has," his wife, Julie Pierce, said.

Two years ago, Tracy Pierce's life changed dramatically when he was diagnosed with kidney cancer.

"I have no treatment. Three months has gone by and I haven't had any treatment," Tracy Pierce told KMBC's Jim Flink in May 2005.

When Flink talked to Tracy Pierce, his cancer was attacking his body. Despite being fully insured, every treatment his doctors sought for him was denied by his insurance provider. First-Health Coventry deemed the treatments were either not a medical necessity or experimental.

"I don't know what else to do but just wait," Tracy Pierce said last May.

As he waited, his doctors appealed again and again, including a 27-page appeal spelling out that Tracy Pierce would die without care. Coventry dismissed each request.

"It's purely economical. You never see an insurance company try to block an inexpensive test," said William Soper.

Soper leads a group of doctors who filed a lawsuit last year against insurance providers. This week, Soper went to Jefferson City to lobby legislators for change.

"And you know, it's not going to get better anytime soon. It's going to get worse," said Myra Christopher, who is the president and chief executive officer of the Center for Practical Bioethics.

Christopher told Flink that change won't happen until there's a change in the entire medical model.

"I just believe strongly that we need to start being honest about what's going on here," Christopher said.

What is going on is that some insurance companies deny even routine treatments because insurance companies treat their patients as costs, not as clients, Christopher said.

"Some of these companies are just unethical the way they treat both subscribers and providers, doctors and hospitals," Soper said.

Two weeks ago, Tracy Pierce talked with Flink again.

"Just holding a lot of anger in," Pierce said.

Cancer ravaged his body, moving from his kidney to his lungs and to his brain.

"Now, we're just to the point where we're trying to make him comfortable," Julie Pierce said.

Even as he was dying, for more than a week, his insurance company denied him oral morphine, which had been prescribed to reduce his pain.

"That's unacceptable because in this day and age, no one should be in pain," Pierce said.

"I just hope we can get something done about it, that's all. We just have to get something done," Tracy Pierce said.

An hour and a half after Tracy Pierce talked to Flink, he took a nap and never woke up. His family calls his case death by denial.

"They just wrote a prescription for him to die," Julie Pierce said.

The family is begging for change.

"The reality is the blame-and-shame game isn't going to get us anywhere. We are all at fault," Christopher said.

Insurance companies, hospitals, doctors, patients and politicians all need to work together, she said.

"We have to have the moral will. We have to have the intelligence. We have to have the political leadership to change this," Christopher said.

For Julie Pierce, it was 15 months of watching her husband die slowly, painfully and helplessly with no chance at lifesaving treatment, Flink reported.

"My mother always told me to get a good job with insurance. For what? It hasn't done anything," Julie Pierce said.

Julie Pierce said that she understands that we will all die. What is expected, she said, is that if you have health insurance, you'll be given every fighting chance. She said that is not happening.

Leukemia Story

Last fall, 12-year-old Nathan Crabtree was an outgoing child getting ready for a new school year. But his father says Nathan often played sick to extend summer vacation by a day or two.

To prove a point, his dad took Nathan to a doctor for test, which showed that Nathan had an aggressive form of leukemia -- one that needed immediate treatment.

Flink reported that a hospital room has become Nathan's classroom. He spent just two days of his sixth-grade year with classmates; mostly, he's been at Children's Mercy Hospital.

"It's not going away, so they were going to send me to Minnesota," Nathan said.

Doctors wrote to Nathan's insurance company, urging it to send him to the nation's foremost research hospital. Nathan's bags were packed, when his father's insurance company, Coventry, refused to pay for that care, calling it "experimental."

"You don't have anyone to fight for you," said Lee Crabtree, Nathan's father.

Lee Crabtree said he's desperate.

"I have to go out and find private grants, because for all intents and purposes, I have to assume I have no medical coverage," Lee Crabtree said.

"I think they expect or depend on people giving up after the first phone call," said Dr. William Soper, the executive director of Mid-America Medical Affiliates.

Soper said his group is so upset with insurance companies that it has filed a lawsuit alleging insurers block patient care.

"We have patients who say, 'I want a complete physical,' and we'll look at their insurance coverage and we have to say, 'Sorry, but your plan doesn't cover a complete physical,'" Soper said.

Flink reported that many people don't realize what isn't covered by health insurance until it is too late.

Lee Crabtree said he has a helpless feeling when he looks at his son and tries to explain why he can't help him live.

"The feeling of this is beyond words. It makes you feel hollow," Lee Crabtree said.

Late Friday, KMBC learned that Nathan's mother found out she could apply for coverage with Blue Cross Blue Shield at her workplace, and so she had applied. What Coventry spent months denying and calling experimental, Blue Cross Blue Shield approved on the first request.

Nathan Crabtree leaves for Minnesota on Sunday morning.