EMT must battle cancer and insurance
5-27-03
By Stacey Creasy
Pilot News
PLYMOUTH � Lenny Retske is learning the hard way neither he or his doctor always have the final say when it comes to healthcare concerns.
Your insurance company often calls the shots and can override any decision you and your doctor make regarding when and where you receive healthcare.
Why do the insurance companies have so much clout? Retske is learning even though he pays the premiums, they pay the bills. If the insurance company refuses to pay, it becomes difficult if not impossible to obtain the health care you desire.
Lenny is an EMT with the Plymouth EMS Department. As a fulltime EMT, Lenny has saved a few lives in his time.
Lenny and Lori Retske�s world was turned upside down Thursday when their worst fear evolved into a reality. The cancerous cells in Lenny�s lungs are malignant.
�The doctor told me I have stage 3 lung cancer,� Lenny said.
Now Lenny, Lori and their doctors will be fighting to save Lenny�s life.
From the first day Lenny and Lori suspected Lenny may have lung cancer, their family physician in Plymouth, officials at the hospital and others have strongly recommended Lenny seek his cancer treatment at the University of Chicago.
�We were told that is by far the best place to go,� Lori added. �Lenny is only 31 so he can take aggressive treatment. We were told they aggressively treat the cancer at the University of Chicago.�
Lenny and Lori believe the University of Chicago is the best place for Lenny to be. His doctor, family and others agree, but there is one pothole on the road to Chicago, a pothole that might as well be the size of the Grand Canyon.
�The health insurance said no,� Lori explained. �They said there are perfectly good doctors here in Indiana and they will not pay for treatment in Chicago.�
Without insurance there is no way Lenny can afford the cost of the treatment at the University of Chicago.
Lori said they have nothing against the doctors in Indiana. From what she has learned Lenny�s cancer is in the advanced stages. The best type of treatment he needs is in Chicago. Lenny�s doctor agrees, but unless the insurance company agrees, the Retskes are on their own.
Managed health care programs have PPO, Preferred Provider Organization. If your doctor or hospital is on a PPO list, the insurance company will provide the full coverage it has agreed to provide. If a doctor, clinic or hospital is not on the list, the company will pay a reduced coverage or no coverage at all even if the doctor recommends the medical service or the patient desires the service or treatment.
�I only want what is best for my husband. He has a family,� Lori stated. �We want the best treatment to help him beat this cancer.�
Lenny is scheduled to have a CAT scan today to show how far the cancer has spread. There are some fears it may have moved into his liver, kidney and lymphnodes. If that is the case, the aggressive treatment could make all the difference.
Despite the outcome of the CAT scan, Lori said the insurance company refuses to budge. The Retskes can appeal, but Lenny would lose valuable time doing that. As an EMT he knows just how valuable time can be.
He is hoping the insurance company realizes the same.
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