Man Refused of Breast Cancer Treatment, May Face $10,000 In Medical Costs

on August 09 2011 9:30 AM

Raymond Johnson, 26, a construction worker who makes $9 an hour, was diagnosed with breast cancer about a month ago, after he checked himself into the emergency room because of a throbbing pain from a lump in his chest.

However, Johnson's job of laying down tile does not make enough to pay for treatment, amounting in $10,000 worth of medical costs.

"We are again urging [Centers for Medicare & Medicaid Services] to reconsider," the South Carolina Department of Health and Human Services said in a statement. "It's a very clear example of how overly rigid federal regulations don't serve the interests of the people we're supposed to be helping."

The uninsured 26-year-old was reportedly stunned when doctors delivered his diagnosis - breast cancer - and shortly after was denied coverage through the state health insurance program, Medicaid, which provides medical treatment for breast cancer patients merely because he’s a man.

Since last month, when Johnson applied for coverage, the state Department of Health and Human Services has been in talks with federal Medicaid officials about the possibility of changing the rules.

Tony Keck, director of the state health department, said in a statement that the federal position is "discriminatory" and urged the Centers for Medicare & Medicaid Services (CMS) to show some flexibility.

"This is a very clear example of how overly rigid federal regulations don't serve the interests of the people we're supposed to be helping," Keck said.

CMS has argued in the past that it would take an act of Congress to allow men to be covered for breast cancer visits. The problem has to do with a discrepancy between two laws, FOX News reports.

"We are working with the [Centers for Disease Control and Prevention] and South Carolina to see what options may exist to address this situation," CMS spokesman Brian Cook said. "We are committed to ensuring that all individuals who should be eligible for this program have coverage."

The federal department's guidelines for the breast and cervical treatment program say women must be diagnosed through "early detection" programs funded by the Centers for Disease Control and Prevention, another federal agency.

In South Carolina, such screening is offered to uninsured women between the ages of 47 and 64 who meet certain income guidelines.

But, not to men.

The Breast and Cervical Cancer Prevention and Treatment Act, a federal law enacted in 2000, uses Medicaid funds to cover treatment for breast cancer or cervical cancer patients who otherwise wouldn't qualify for the state and federally funded health insurance program for the poor and disabled.

Yet, in South Carolina, 16 men with breast cancer diagnoses have applied for coverage through the Medicaid breast and cervical cancer program since 2007 and have been turned down.

Three of them met all the eligibility requirements but were denied because they were men, Jeff Stensland, Health and Human Services spokesman, told the South Carolina paper.

"We want to cover this guy," says Stensland, "but we simply can't."

The American Cancer Society estimates that 2,140 new cases of breast cancer in men are diagnosed annually in the U.S. While roughly 1,180 women are enrolled in the treatment coverage program, according to the department's most recent figures.

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