1. Provide the title of your story or series and the names of the journalists involved.
"Denials put cancer patient at risk" by Sonya Colberg.
2. List date(s) this work was published or aired.
Oct. 10, 2010.
3. Provide a brief synopsis of the story or stories, including any significant findings.
Brendon Mathis began the fight of his life when doctors discovered the teen had an extremely rare form of Hodgkin's lymphoma. Fortunately, Mathis went into remission after his chemotherapy. But the next battle began when his doctor determined that only Procure Proton Therapy offered him his best chance of staying healthy. The family and doctors began a passionate struggle to try to get the family's insurance company to cover the life-saving treatment. With the clock ticking, Mathis got the treatment though the insurance company continued to delay. To this day, the family isn't sure how much, if any, of the more than $100,000 treatment will be paid by the insurance company. Though the insurance commission figures show that more complaints are lodged against Blue Cross and Blue Shield than any other company, the issue is common in the insurance industry.
4. Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
I used letters from the insurance company to the family regarding denials and appeals, along with Mayo Clinic and other Internet sources about the disease, treatments, differences between proton and photon therapy, etc. I requested documents from the insurance commission on complaints received against insurance companies, the nature of the complaints, any administrative or punitive actions (there were none) and how many dollars worth of premiums Oklahomans paid to these companies. See below for some results.
5. Explain types of human sources used.
Interviewed all family members. Interviewed various doctors, including the doctor from another hospital who ordered the treatment from essentially a competing health care facility. Spent a great deal of time getting comments from the insurance company, though neither the company's medical director nor administrator would speak with me. I also spent several weeks talking to the insurance commission to get information on complaints.
6. Results (if any).
The insurance commission assistant director told me the questions I asked resulted in the commission putting together a database that consumers may access to look at complaints, premiums, etc. of insurance companies doing business in Oklahoma. They said they also plan to develop a way of breaking down those complaints into types, as I requested. Unfortunately, the commission hasn't completed that aspect yet. A more important result is what the Procure medical director said: You've saved lives. He said changes are desperately needed in the way insurance companies, health care providers and families work together. He said a meeting he had with the Blue Cross and Blue Shield administrator and medical director at headquarters two days after the story ran suggests the company was embarrassed about the story and the way the family and doctors were treated. He said the administrator told him to call him directly anytime. He said things will change now that the story has made the rounds across the
7. Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
We're planning a follow-up if something else happens. It might be a good idea to look again at the complaint data from the insurance commission. No requests for corrections or clarifications or accuracy challenges.
8. Advice to other journalists planning a similar story or project.
Be persistent and realize that a story like this may take weeks or more to research and write. Lobby for space for this type of story. I wish this story could have been longer. I got some phone calls, as well as some e-mail from others with similar story ideas. Plus, the story did get lots and lots of comments online. Also, I thought our beautiful photo tied the bow on this package.