All About Multiple Sclerosis

More MS news articles for November 2002

HMO Refuses To Pay For MS Sufferer's Treatment

Bareis' Medication Costs $1,000 A Month

6:08 p.m. PST November 14, 2002

All over the state, Alzheimer's and multiple sclerosis patients are having to decide whether they can afford medication that keeps them healthy, 10News reported.

Filner said that the No. 1 complaint call to his office is about HMO problems. One of those calls came from Chula Vista resident Breda Bareis (pictured, left), who fears that an HMO denial will cause her to lose her house. The first years of Larry and Breda Bareis' marriage were filled with hiking adventures.
"To get ready for our weekend hikes, I would climb 22 stories and would love to walk to work," Breda Bareis said.

When Breda learned in 1992 that she had MS, she tried to use a cane on their hikes, but the disease still took its toll. And today she cannot walk.

"From my waist down, nothing works. The legs are gone and everything you have from your waist down is gone," she said.

Every night, Larry Bareis helps her inject the drug copaxone, a Food and Drug Administration-approved therapy for MS. Doctors tell Breda that she needs copaxone to slow the progression of the disease.

"I was told my upper body would go the way of my lower body. I was facing 24-hour care and all your independence gone. I cannot face that," Breda said. "That's just taking everything from me."

For two years, Breda paid a $20 insurance co-pay for copaxone. But that all changed this year.

"As of the 1st January, 2002, (my HMO) dropped all of the MS drugs -- dropped them completely. They're gone. They're not available to you. You have to pay for them yourself," Breda said.

The Bareis' are now paying $1,000 a month for copaxone -- a bill that's putting a huge strain on their budget.

"We're not making ends meet," Larry Bareis said. "We're falling short $200 to $300 every month and it's slowly eroding away at our savings."

Breda is on Medicare. Secure Horizons is her supplemental insurance. Because of federal budget cuts, Secure Horizons decided not to cover her MS drug, despite her doctor's recommendations.

"I don't know what I'm facing, and I'm scared -- terrified; terrified of what could happen. I don't want to lose my home," Bred said. Dr. Erik Perkins is Breda's neurologist.

"She's not asking for something that's frivolous, or an experimental drug, or something that's an herbal remedy that's not been tried before. This is the tried-and-true medication," Perkins said.

Dr. Jody Corey-Bloom is the director UCSD medical center. She, too, is frustrated by the HMO's refusal to pay for such an important treatment.

"This is not a third world country. It's particularly saddening, quite frankly, to be dealing with situations where insurance companies are putting cost above patients, and patient's lives. That's not something we used to see in America," Corey-Bloom said.

Meanwhile, Breda's appeals to her HMO to reconsider have failed, despite intervention by Filner.

"The incentive for them is to have everything as cheap as possible, because they're getting the same amount of money no matter what. So, if somebody comes in and says, 'I need this operation, or that pill,' they're going to wait them out -- wait until the patient dies," Filner said. "It is absolutely criminal."

The Bareis' say they will struggle to pay for Breda's medication for as long as they can.

"I want people to know that there's really a silent tragedy going on in this country," Breda said. "Its people are getting older; they're getting pushed out of jobs; they're not being able to get the health care they need and deserve; and they are just kinda quietly crawling over into a corner and dying."

Health Care Townhall Meeting

The 10News Troubleshooter and the Foundation for Taxpayer and Consumer Rights invite the public to a townhall meeting to discuss California's ailing health care system and potential solutions to our common problems. The topic of the townhall will be "Coming to Consensus on Health Care."

The event will be held on Friday, Nov. 15 at the San Diego County Administration Center located at 1600 Pacific Highway in Room 310. All guests are asked to arrive no later then 1:30 pm.

There is a growing commonality of concerns about the escalating costs in the health insurance system and the crisis for uninsured and underinsured Californians. The goal of the townhall is to explore, from different perspectives, common problems with, and common solutions to, the current health care crisis.

The townhall will involve the following health care stakeholders: government officials, nurses, doctors, hospital representatives, patients, consumers, health plans, business owners, and health care advocates.

Townhall Meeting "Coming To Consensus On Health Care"
Friday, Nov. 15, 1:30 p.m.
San Diego County Administration Center
1600 Pacific Highway, Room 310

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