Update: HMO agrees to pay for ill boy to visit specialist

Update to this post from yesterday...
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=104&topic_id=5274881&mesg_id=5274881


HMO agrees to pay for ill boy to visit specialist
C.W. Nevius

Sunday, November 6, 2005


Little Jack Zembsch, the 4-year-old with an extremely rare bone condition whose parents have been feuding with their HMO, will get his trip East to see a specialist.

Responses to a Saturday column on the little boy's plight were dramatic. E-mails of support poured in as well as offers of cash donations.

Among the calls was one from a Health Net spokesman, saying the medical insurance company would cover the cost of a visit to see Dr. William Mackenzie, the Delaware specialist at the Alfred I. duPont Hospital for Children that Jack's parents, Mark and Kim Zembsch, want to treat their son.

"We will be ready, maybe as soon as Monday, to pay for Jack to see Dr. Mackenzie," said David Olson, senior vice president of communications for Health Net. The HMO had been saying that a doctor at UCSF could perform the delicate surgery Jack needs to prolong his life.

snip...
Olson said the funding would, in fact, "be for consultations. Surgery will be a separate matter."

But he added that funding for an operation would not be a problem if it was determined that it is what Jack requires. "It's in our interest to see that this kid gets what he needs," Olson said.

more...
http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2005/11/06/MNGE0FJU5U1.DTL


Thank you to all of you who wrote letters and held special thoughts for this little guy. Hopefully this is the first step so he can get all the care that he needs.

1. HMO's make money by NOT providing care.
2. HMO Physicians are financially rewarded (through bonuses) by NOT providing care ie. spending less money.
3. HMO's are financially driven, NOT patient-care driven.

And check out this SF Gate article from yesterday:

Somewhere in a corporate office at Health Net Inc. is someone who needs to meet Jack Zembsch. Jack is 4, he loves SpongeBob SquarePants, and he is going to die. One doctor in the country just might be able to save Jack, but the nation's largest HMO won't let Jack see him because the doctor is not within its network.

...(A)fter eight months of appeals, pleas and medical forms, the Zembsch family had gone in a big, pointless circle...They contacted...(a lawyer who)...won the 10th-largest verdict in California history...in a disability insurance case...

The lawsuit will be filed Monday. You want a fight, Health Net? Better suit up. Jack's coming after you.

:woohoo:
rocknation

Keep us updated on progress