BY A DRIVER WHO RAN A RED LIGHT.
PAY FOR THE DRUG OR FACE
DEATH FROM CANCER.
MONEY OR YOUR LIFE.
THAT IS THE CHOICE A HOUSTON
MOTHER HAD TO MAKE.
HER INSURANCE COMPANY REFUSED TO
PAY FOR A CANCER DRUG THAT HER
DOCTOR SAID SHE NEEDED.
WELL, THAT WAS BAD ENOUGH.
BUT THEN THAT MOTHER WAS FORCED
TO PAY NEARLY THREE TIMES THE
PRICE FOR THE VERY SAME DRUG
THAT HER INSURANCE COMPANY WOULD
NOT COVER.
AND SHE IS FAR FROM THE ONLY
PERSON BEING TREATED THIS WAY.
CHANNEL 2 INVESTIGATOR
BILL SPENCER IS EXPOSING HOW
INSURANCE COMPANIES AND
HOSPITALS ARE GETTING AWAY WITH
IT, AND HE'S REVEALING THE NEW
PUSH TO PROTECT PATIENTS.
Reporter: HER ENTIRE CAREER,
NURSE ANN MARIE HAS WORKED
TOWARD ONE MISSION, SAVING OTHER
PEOPLE'S LIVES.
IL I'M GOING TO TAKE GREAT
CARE OF.
ANN GOT SOME OF THE WORSE
NEWS ANY WOMAN WILL HEAR.
YOU HAVE STAGE THREE BREAST
CANCER.
I STARTED CRYING.
I JUST CRIED.
Reporter: ALL ANN COULD THINK
ABOUT WAS HER HUSBAND AND TWO
DAUGHTERS AND NOT BEING THERE.
I WAS PRETTY SURE I WAS GONNA
DIE.
SO I DIDN'T THINK I WAS GOING TO
BE AROUND AND SEE THEM ANYMORE.
[BEEPING NOISE]
Reporter: BUT WITH HELP FROM
WORLD RENOWNED DOCTORS AT THE
BAYLOR COLLEGE OF MEDICINE, ANN
MARIE BEAT THAT KILLER CANCER.
BUT THEN THIS PAST SUMMER, IT
CAME BACK.
ANN'S DOCTORS TOLD HER HER BEST
CHANCE FOR SURVIVAL WAS A NEW
EXPENSIVE CANCER DRUG CALLED
PROJECTETA.
THERE'S SOME, YOU KNOW, THIS
IS SOMETHING I HAVE TO DO.
SHE SAID ABSOLUTELY.
AND IF YOU DO IT, I THINK YOU'RE
GOING TO BE -- LIVE TO BE AN OLD
LADY.
$61,000.
THE PROBLEM.
IT'S EXPENSIVE.
IT CAN BE BOUGHT DIRECTLY FOR
ABOUT $5,000.
MEDICARE PAYS ABOUT 4300.
AND INSURANCE COMPANIES CAN PAY
A NEGOTIATED RATE OF ABOUT 4100.
BUT ANN'S INSURANCE COMPANY,
BLUE CROSS BLUE SHIELD OF TEXAS,
REFUSED TO PAY FOR THAT DRUG,
CALLING IT EXPERIMENTAL,
INVESTIGATIONAL.
SAYING THERE IS INSUFFICIENT
EVIDENCE ESTABLISHING THE
SERVICE IS GENERALLY ACCEPTED IN
THE MEDICAL COMMUNITY.
PAY FOR THE DRUG OR FACE
DEATH FROM CANCER.
YOUR MONEY OR YOUR LIFE.
Reporter: EVEN WORSE, NOT
ONLY WOULD ANN HAVE TO PAY FOR
THAT DRUG OUT OF HER OWN POCKET.
THE HOSPITAL TOLD HER SHE'D HAVE
TO PAY ALMOST THREE TIMES MORE
THAN THE INSURANCE COMPANY.
AND DOUBLE WHAT YOU'D PAY AT A
SPECIALTY PHARMACY.
THE INSURANCE COMPANY PAYS
FOR ONE DOSE.
THE 420 MILLION GRAMS AROUND --
412 MILLIGRAMS.
THE SYSTEM ITSELF IS RIGGED
AGAINST PATIENTS.
Reporter: SEAN FRY CALLS IT
RIDICULOUS.
IT IS ABSOLUTELY OUTRAGEOUS
THAT A WOMAN WHO HAS INSURANCE
BENEFITS THROUGH THIS PLAN NOT
BE ALLOWED THE RIGHT TO EXERCISE
THOSE BENEFITS.
I MEAN, THAT'S THE WHOLE PURPOSE
OF WHY WE HAVE INSURANCE.
I THINK IT'S HORRIBLE.
Reporter: NOW, TO PUT AN END
TO DRUG PRICE NIGHTMARE STORIES
LIKE HERS, TEXAS CONGRESSMAN
LLOYD TOGETHER HAS JUST LAUNCHED
THE AFFORDABLE DRUG TASK FORCE,
LOWERING THE COSTS MILLIONS ARE
AMERICANS ARE FORCED TO PAY FOR
LIFE-SAVE, LIFE-IMPROVING DRUGS.
THE FIRST THING WE HAVE TO
DEAL WITH IS WHY IT IS THAT
PARTICULARLY CANCER DRUGS BUT
REALLY ANY, MULTIPLE
SIMILARROSIS -- SCLEROSIS, IS
BEING PRICED SO HIGH.
IT'S MANDATORY WHEN
IT'
S YOUR
MONEY OR
LIFE.
Reporter: AS FOREANN, SHE
PAID -- FOR FOR ANN, SHE PAID
FOR THAT DRUG TO STAY ALIVE.
A TOTAL OF $61,000 FOR FIVE
DOSES.
I WANT IT TO STOP.
I WANT THIS WHOLE THING EXPOSED
BECAUSE IT'S NOT JUST ME.
IT'S EVERYWHERE.
Reporter: AND WE ASKED BLUE
CROSS BLUE SHIELD TO AN
ON-CAMERA INTERVIEW SO WE COULD
ASK QUESTIONS ABOUT ALL THIS, TO
ASK WHY THEY DENIED COVERAGE IN
THIS CASE.
WE ASKED BAYLOR TO EXPLAIN WHY
IT CHARGED ANN SO MUCH MORE THAN
SHE COULD HAVE BOUGHT THE DRUG
FOR ON HER OWN.
BOTH REFUSED.
BLUE CROSS BLUE SHIELD SAID IN A
GENERAL STATEMENT TO US, SUCH
DETERMINATIONS ARE MADE UNDER
THE DIRECTION OF A BLUE CROSS
BLUE SHIELD OF TEXAS MEDICAL
DIRECTOR BASED ON APPLICABLE
MEDICAL POLICY.
BAYLOR WROTE, PRICING FOR DRUGS
AND CLINICAL SERVICES OUTSIDE OF
INSURANCE IS A COMPLICATED
MATRIX.
WE ARE CONFIDENT THAT OUR
PRICING IS AT OR BELOW OTHER
HEALTH CARE INSTITUTIONS.
STAY TUNED, EVERYONE.
WE'RE NOT THROUGH WITH THIS
ISSUE.
UNBELIEVABLE.
IT'S INFURIATING AND OUR
HEART GOES OUT TO ANN MARIE.
IS THERE ANY TAKE AWAY WE CAN
GLEAN SO WE DON'T FIND OURSELVES
IN A SIMILAR SITUATION.
SEAN HAS THREE DIFFERENT
TIPS.
NUMBER ONE, ASK YOUR DOCTOR TO
GO TO BAT FOR YOU.
TO ARGUE FOR YOU WITH THE
INSURANCE COMPANY IF THEY REFUSE
TO PAY.
ALSO, GET A LEATHER OF MEDICAL
NECESSITY.
AND APPEAL THE INSURANCE
COMPANY'S DENIAL ALL THE WAY.
THAT IS WHAT ANN IS DOING.
SHE IS STILL FIGHTING.
SHE HAS NOW BROUGHT HER CASE