We know health insurance is a tricky business.
Our political leaders can't begin to agree on how to fix our broken health care system.
In our own community, there is a very small child with an apparently correctable medical condition.
That surgery on baby Patrick Murphy's brain would alleviate the daily seizures that wrack his tiny body is not in dispute. His family and their insurance provider agree he should be treated to stop the epileptic seizures that cause further damage the longer the occur.
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What they can't seem to agree on is where the surgery should be performed. Like most parents, 9-month old Patrick's folks want him to get the best care possible. When you're talking about surgery to remove a portion of a baby's brain, only the best will do, and they sought out a top specialist for the $200,000 surgery.
They found that doctor in Arizona, a man who is the chief of pediatric neurosurgery at Phoenix Children's Hospital. He has performed about 750 epilepsy surgeries on children in the past 10 years. That sounds like just the doctor we'd want operating on our children if they were in Patrick's condition.
Unfortunately, the insurance company doesn't agree. Group Health wants the surgery to be performed in Washington and won't pay if it takes place elsewhere.
Group Health says it has already paid $500,000 for medication to help diminish Patrick's seizures, and it's willing to pay for the surgery as long as it takes place in this state. The company says there are plenty of qualified surgeons, including at Seattle Children's Hospital, which is ranked in the top 10 in the nation for its care of children. That hospital has neurosurgeons who have performed the surgery needed by Patrick hundreds of times. Patrick's parents say that was never mentioned as an option by the insurance company.
Patrick's referring doctor was from Swedish Medical Center, and his parents say they were told not to go to Seattle Children's. It gets a little murky at this point, but suffice to say the parents found the doctor they believe is best qualified to help their child, and that doctor just happens to be in Arizona.
And now they're stuck. Getting the best for their boy is what is needed, so the parents have resigned themselves to coming up with the cash if Group Health will not cooperate. They're holding spaghetti and chili feeds, and their other four children are helping by selling toys and lemonade. The parents are prepared to mortgage their house, if necessary.
We know insurance companies are notoriously hard to deal with. And we know there are capable pediatric neurosurgeons in the state of Washington.
But if it was your kid, what would you want? If you've found the doctor you feel is "the one" to save your child's life, why would you compromise? We admire the Murphys' determination to do the best possible for their son.
Putting off the surgery as they fight with the insurance company isn't in Patrick's best interest, that's for sure. Patrick's arms and legs are limp and he lacks motor skills a kid his age should possess. Group Health could do a lot for the image of insurance companies if it could find a way to get this little boy taken care of. And if that needs to be in Arizona, so be it.
If the surgery is more expensive out of state, the insurer ought to at least be willing to pay the same amount it would give to Seattle Children's Hospital. That way, the company isn't out any additional expense because of the parents' decision.
With a child's life at stake, following insurance company protocol isn't what's most important.