Dying man's family fighting again over insurance
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http://www.southtownstar.com/news/84764 ... zo.article)
March 18, 2008
BY Clare Walters Correspondent
Cyril Strezo is dying, but maybe not fast enough.
The family of the 58-year-old Frankfort man, whose battle for insurance coverage for chemotherapy drugs spurred state legislation, again is at odds with UniCare.
Jody Polka, one of Strezo's daughters, learned late last week that the insurance company will not pay for hospice benefits if Strezo lives past Wednesday.
"They're trying to dictate what day he's going to die on," she said. "They put him here (in hospice care). We've got comfort, and he's in no pain. This is where he needs to be."
While unable to comment specifically on Strezo's case because of privacy practices, UniCare spokesman Tony Felts said health policies generally have a lifetime maximum benefit for hospice care.
"When we see that any of our members receiving hospice care are approaching their benefit limit, we contact the member's family and his or her caregivers to discuss possible options," he said.
Options could include working to negotiate a reduced rate to extend coverage, helping the family seek alternative funding or maximizing the use of all member benefits available, Felts said.
Strezo's hospice care costs $400 per day, Polka said, and the family plans to pay for the extended care to keep their patriarch comfortable.
"I won't let UniCare deny me what little time I have left with my dad," she said. "I won't let it bother me. I won't let it rob me of time with him."
Duane Krieger, chief executive of the Joliet Area Community Hospice, said the overwhelming majority of patients at his facility are on Medicare, making cases such as Strezo's less common.
But it's not unusual for private insurance to have caps on benefits, he said, requiring the hospice to deal with each case on an individual basis.
"We will work something out," Krieger said about Strezo's situation.
The SouthtownStar first reported on Strezo in December when Polka appealed UniCare's decision to deny coverage for chemotherapy drugs.
Strezo first was diagnosed and treated for esophageal cancer in June. During an October operation, doctors discovered the cancer had spread to Strezo's liver.
A new "best course" of treatment was prescribed by Strezo's oncologist in November. But UniCare denied coverage, viewing the chemotherapy as "experimental or investigative," and the family waited nearly a month before UniCare reversed its decision.
Strezo's case got the attention of the Illinois attorney general's office and state Rep. Mary Flowers (D-Chicago). In January, Flowers sponsored legislation that would expedite the insurance appeals process in cases such as Strezo's when the delay could cause additional harm to the patient. The proposal was OK'd by a House committee last month and soon will go to the full House.
When Strezo finally began treatment, the cancer had spread throughout his body. He remained hospitalized until he recently was moved to the hospice. 03/18/08
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