A nurse in St. Dominic's emergency department in Jackson, Miss., received a $42,036 medical bill after his insurer, the hospital, denied payment for cancer treatment he received, according to The Clarion-Ledger.
Here are eight things to know:
1. The nurse, Gus Mohamed, was treated for Non-Hodgkin lymphoma. He received the last of his six doses of chemotherapy in April and is now in remission, according to the report. He ended up with a $42,036 medical bill after his insurer denied payment for one of the treatments.
2. Mr. Mohamed received three treatments — doses of Bendeka — at the St. Dominic infusion center. But he learned in February, days before his fourth treatment, that the hospital ran out of Bendeka, according to the report. The hospital asked him to wait until the medication was back in stock.
3. Mr. Mohamed sought out his oncologist, Guangzhi Qu, MD, who is part of Jackson Oncology Associates, which runs St. Dominic Cancer Center. Dr. Qu had the medication at St. Dominic Cancer Center near the hospital on the St. Dominic's campus, and gave Mr. Mohammed his fourth treatment roughly a week after his original scheduled treatment date, reports The Clarion-Ledger. During the treatment, Mr. Mohamed learned the hospital,which also insures Mr. Mohamed, would not pay for the treatment delivered at the clinic.
4. Mr. Mohamed told The Clarion-Ledger: "They basically wanted me to just get up and go home. There's a business side of the hospital where everybody's a customer and then there's the health care side of a hospital where you're a patient. And the business side of the hospital is the one that's causing the problem."
6. Mr. Mohamed is insured via St. Dominic's self-funded plan for employees, and Aetna determines prior authorizations for the hospital.
St. Dominic's spokesperson Andy North told The Clarion-Ledger: "All employees have access to and agree to follow the policies and procedures governing the plan. Chemotherapy drugs administered at a physician clinic are clearly identified as not covered by the plan."
The hospital declined further comment to the publication about Mr. Mohamed's case, citing patient privacy.
7. The Clarion-Ledger cited an email exchange between Mr. Mohamed and a St. Dominic employee, in which Dr. Qu's office said Aetna approved treatment at the clinic, since the hospital ran out of Bendeka. Since St. Dominic's pharmacy buyer was under the impression that approval had occurred, it told Mr. Mohamed via email it was willing to clear up any confusion and provide Aetna with information showing the hospital did not receive Bendeka until two weeks after his scheduled treatment, and was not able to get Treanda, the alternative medication it tried to substitute, because "when the Bendeka went on back order, many facilities switched to the Treanda, and there was a run on it," according to the report.
8. In the end, the hospital agreed to pay.
Read The Clarion-Ledger's full report here.
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