How To Fight Back

  In Real Life - Carley Christie


      The Christie family was lucky, by the perverse standard of managed-care disputes. They and their physicians understood that they'd gotten preapproval for an emergency procedure by an experienced surgeon to remove a malignant tumor from 9-year-old Carley Christie's kidney. The life-saving surgery went ahead, and five years later a healthy Carley has just finished her freshman-year finals.
       But their HMO, then known as TakeCare, refused to pay the $47,000 for surgery and related medical bills. TakeCare insisted that it had authorized only one doctor to perform the surgery.
       So while Carley was saved, the Woodside, Calif., family faced a bill of nearly $50,000, which they managed to pay before turning to TakeCare's appeal process for compensation. Eventually the case worked its way to an arbitrator, who ordered TakeCare to repay the Christies for the cost of the procedure.
       But they were never compensated for the five-figure legal bills they'd incurred fighting their case, says Carley's father, Harry Christie, a telecommunications sales and marketing consultant who has since become an active advocate for managed care reform.
       Christie had simultaneously pushed the case aggressively with the California Department of Corporations, which regulates managed care plans. He pointed out that the "authorized" surgeon had never removed this type of rare tumor from a child before. TakeCare said the surgeon was well-qualified and had performed the procedure on adults. The department eventually fined TakeCare $500,000 in the case for denying Carley access to appropriate medical care.
       "If it weren't for my determination, the seriousness of the breakdown of the HMO process would never have been revealed," Christie points out indignantly. "I am bewildered as to what can be done. The plans turn a real medical issue into an administrative issue. They take any compassion out of it and say, 'Sorry, we have a process.'


C. Grannan

HMOs Return
HMOs Return