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Billboards and busses in Philadelphia abound with Blue Cross’ current Live Fearless campaign, most featuring healthy-looking young people engaged in vigorous activities - exactly the cohort they love to insure.

“Live in Fear” would be a better tagline for Blue Cross patients with liver metastases, as two of my recent patients discovered. For one, Blue Cross denied both chemoembolization and radioembolization because her primary was anal rather than colorectal, therefore rendering embolotherapy “investigational and experimental”.  What a difference a centimeter makes.  Her med onc participated in the final appeal to a Blue Cross panel to no avail, even though her primary and nodes had responded to chemoradiation, making it likely that her liver mets would respond to Y90 + chemo. Fortunately, the patient was young and web-savvy, and she crowd-sourced $60,000 to pay for her treatment.

Patient #2 was not so fortunate. A 70-year-old craftsman who still worked, he had paid for Blue Cross insurance his whole life with narry a claim until he was stricken down by gastric cancer. He had painful liver metastases requiring increasing doses of narcotics; both the pain and the narcotization limited his ability to work. Embolization has a limited role in prolonging life in metastatic gastric cancer, but it is an excellent technique for pain control for liver metastases, with over 80% of patients experiencing substantial relief in 24 hours. Once again the Blues denied embolization on “investigational and experimental” grounds since his primary was gastric. It was my turn to call in for the appeal panel hearing. I cannot describe how heartbreaking it was to listen to the patient, a proud and stoic man, in tears describing his pain, with the rest of his family sobbing and begging for help. Ironically, his son-in-law works for Nordion, and brought literature to the meeting supporting treatment. The heartless bureaucrats from Blue Cross abandoned him to die in pain.

Live in Fear, indeed.

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