Patient takes stand against Highmark [The Pittsburgh Tribune-Review]

May 19--Soon after doctors diagnosed Mahendra Patel with prostate cancer late last year, his health insurer delivered a bombshell.

Representatives of Highmark's Freedom Blue plan informed Patel that the insurer would not pay for the full radiation treatment plan recommended by his oncologist. Instead of three phases of radiation, Highmark would pay for only two.

Patel, 73, of Upper St. Clair reacted the way most people do when their lives are at stake: "You are telling me you know better than my doctor?" he asked Highmark.

The insurance giant turned down his appeal, and so did an independent panel.

Not that it mattered.

Patel is a successful civil engineer who can afford to pay for the treatment that his insurance won't cover. He told his radiation oncologist, Dr. Robert Werner of UPMC, to go ahead with the three-phase radiation plan.

"I have one life to live, and I can't take money with me," Patel told Werner in a letter.

He wanted to be treated the way his doctor wanted, not the Highmark way.

Patel is a man of principle and, money matters aside, wanted to take a stand against Highmark. He told me about his case on Wednesday, and I immediately called Highmark. By Friday, the health insurer had done a complete turnaround and agreed to pay for Patel's full treatment, spokesman Aaron Billger told me.

Highmark's change of heart, however, won't apply to other prostate cancer patients in the same predicament as Patel. The insurer will review treatment on a case-by-case basis and cover it when medically necessary, Billger said.

Using a highly advanced form of radiation, the treatment is the same that doctors have used for about 12 years, according to Dr. Dwight Heron, director of radiation services for UPMC Cancer Centers. Treatment in three phases gradually reduces the intensity of the radiation. The final phase focuses entirely on the prostate and avoids radiating surrounding areas that can be harmed. The goal is to avoid "severe side-effects" such as bleeding, he said.

Heron said he is puzzled by Highmark's rule, which became effective Jan. 1, not to cover three-phase treatments for everyone. About 12 other UPMC patients have been affected by the change, he said.

"Basically, they're practicing medicine in patients they don't even know," Heron said.

It's a good thing that Highmark's reviewers reversed their decision about Patel's case. The credit should go to the man himself. Patel spoke up, even though he was willing to pay the extra $8,000 for the third phase of his treatment.

If you need proof that it wasn't about the money, consider what Patel did five years ago when his wife was diagnosed with uterine cancer.

He promised God that he would give a $10,000 gift to a charity if she conquered the illness. She survived and the ever-grateful Patel gave $10,000 to the Greater Pittsburgh Community Food Bank. He and his wife were delighted to help those who don't have enough.

Patel finished his last radiation treatment on Thursday. His cancer was caught early, so his prognosis should be good. Let's hope so. He deserves a long, happy life.

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