Insurance Refused to Cover Her Vomiting Condition. So She Barfed Outside Their Office.
After repeatedly being denied coverage for treatment that would help alleviate symptoms of the illness that had been causing her to vomit constantly for the last three years—sometimes making it impossible to keep even a cup of water down—Sandy Honig was, in her words, in a “very, very dark place and feeling hopeless.”
“It’s hard to get up in the morning when the first thing you have to do is drink a cup of water, and that makes you sick,” Honig told VICE News.
Honig suffers from gastroparesis, or partial paralysis of the stomach that prevents the stomach from fully emptying. “Anything that I eat or drink makes me really nauseous,” she told VICE News Thursday. “I don’t really eat meals… socially, sometimes that ends up happening, but then I always end up in the bathroom.”
One of the most common treatments for gastroparesis when medication is ineffective is a Botox injection, which helps relax the part of the stomach connecting to the small intestine so the body can more easily digest food. But although Honig’s doctors recommended the treatment after more than a half-dozen medications failed to alleviate her symptoms, Anthem Blue Cross Blue Shield denied her coverage for the injections, saying they weren’t medically necessary.
So Honig decided to give her health insurance company a look at just exactly what she’s been dealing with.
In January, Honig, a comedian and writer who works on The Eric Andre Show and co-created the show Three Busy Debras, went to Anthem’s offices in Los Angeles to file (and film) her appeal in person. The result, which she published on YouTube this week, is a funny but infuriating glimpse into America’s intractable and absurd health insurance bureaucracy.
Honig is unable to get into the offices without an employee badge (“Even if I’m a member of the Anthem family?” she asks), so she spends much of the video barfing in the parking lot and trying (and failing) to talk to employees about her plight. Ultimately, Honig vomits in and on her appeal letter—“relevant documentation”—and attempts in vain to seal the puke-covered envelope (Honig told VICE News she didn’t actually mail that envelope, and that her doctor sent the real appeal).
After Honig visited the offices, she says, police conducted a wellness check at her home. “It was such a lovely surprise to get a visit from two men armed with guns and batons in my own home,” Honig says in the video, which shows two Los Angeles Police Department officers in her living room.
“It’s so nice to know that even if [Anthem] won’t give me the healthcare I need, [they] still care,” Honig said in the video.
Honig shared with VICE News a photo of a note she says was given to her by the cops; it cites a “poss[ible] 5150”—police code that, in California, allows for a person to be placed into an involuntary psychiatric hold for up to 72 hours—and a “welfare check” on Honig with regard to a “letter written to insurance company.”
Anthem did not respond to questions from VICE News Thursday about why it denied Honig coverage, or if it called the police on her, but told NBC News that the company denied her plea to cover the injection because it wants “to ensure Ms. Honig gets the right treatment for her particular condition.”
“Our clinical team has carefully reviewed her case and our medical policies, and the existing medical evidence does not support the treatment she is requesting for her condition,” Anthem told NBC News. “Therefore, it is not a covered benefit under the family’s health plan.”
After she released the video earlier this week, Honig says, a representative from Anthem reached out to her and said the company was “looking into this immediately.” But later, she said, that representative called back and told her that he looked into it and the company doesn’t cover the treatment.
But he did offer to send Honig an email with a link to Anthem’s website, showing what conditions they do deem Botox injections medically necessary for. “I said, ‘I don’t know what I would do with that,’” she told VICE News. “But he emailed it to me anyway.”
A 2015 World Journal of Gastrointestinal Endoscopy review of the (few) studies on the subject found that the Botox injection is “an easy to perform procedure with minimal risk and negligible side effects,” and while there wasn’t conclusive evidence either way on how truly effective it is in treating gastroparesis, “most uncontrolled studies have shown symptomatic improvement.”
“With limited treatment options, we believe that Botox injections can still be considered as treatment option for refractory [gastroparesis] when drug therapy failed,” the authors concluded.
Honig says the procedure can alleviate her symptoms.
After she filmed the video, she says, she was in “such a low place of absolutely no relief” that she went ahead and scheduled her procedure anyway, with the intent of continuing to appeal her case with Anthem.
She’s since had the procedure done twice, as the injections wear off after several months. “I did get it and it worked, and it was amazing,” Honig said. “But it only lasted a few months, so I just got it again last week. I’m anticipating another big bill being sent.”
But a few days ago, she says, she found out via a letter that Anthem did partially cover the procedure. Still, she’s paying nearly $1,000 out of pocket. “Health insurance is fucking made up,” she said.
“I’m in a place right now where if I needed to, I could throw that down, but a lot of people can’t do that multiple times a year,” Honig said. “Especially when I’m already paying [Anthem] a premium. I’m giving them my money, and they’re still charging me. I don’t know what I’m paying for.”
Honig says her problems with Anthem go beyond the Botox injection. She’s supposed to take anti-nausea medication three times a day, but said Anthem only covers 18 pills a month, so she has to use the app GoodRx to find the medicines she needs. “Why is this free app I downloaded giving me my medicine cheaper than the insurance I pay for?” she said.
If Honig’s latest injection is successful, she says, she’ll be a candidate for surgery and a longer-term fix to her condition. “I’m anticipating fighting [Anthem] on that,” Honig said.
“I’m a comedian, so I do have a hard time talking about this stuff in a way that isn’t comedic,” she said. “This is what we’ve come to understand how healthcare works, but it doesn’t have to be that way. We pay money to these companies and then they deny us treatment.”
“Who is this middleman that’s deciding if we’re sick enough to receive care that we’re paying for?”
Want the best of VICE News straight to your inbox? Sign up here.
#DmtDailyNews
via https://www.DMT.NEWS
Paul Blest, Khareem Sudlow
