This document presents an ethical dilemma faced by Alan, a cancer patient undergoing treatment. Alan had been receiving treatment at University Hospital but learned he would need a bone marrow transplant. However, his HMO would only cover the procedure at a facility hours away. This poses the ethical question of whether the HMO and University Hospital should have informed Alan earlier that more complex procedures may not be covered at the original facility. The document analyzes this dilemma and how a healthcare manager should ensure patients are fully informed of coverage limitations to make the best decisions about their care.

1. Running Header: LONG-DISTANCE CANCER TREATMENT – AN ASSESSMENT 1
The Case of the Long-Distance Cancer Treatment
Assessment by Lindsay Allen
HCAD 600-9083
University of Maryland University College
29 October 2015

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Abstract
Managed Care Plans, such as Health Maintenance Organizations (HMO), have
increasingly larger amounts of ethical dilemmas when it comes to their concerns for their
patients’ well-being. In this case study the main point is that Alan, who has had his cancer
treatment at one facility and now needs a bone marrow transplant, will have to go to another
facility a few hours away because his HMO has an agreement with the other facility for that
particular procedure. The case brings to light the ethical dilemma of whether or not the HMO or
University Hospital could have provided Alan and his family information at the beginning of his
treatment letting him know that he might have to go to another facility for any complex
surgeries. Is it ethically right or wrong for the HMO and the facility to disclose this information
to their patient’s?

3. LONG-DISTANCE CANCER TREATMENT – AN ASSESSMENT 3
Relevant Issue Raised by the Case
Alan has been undergoing cancer treatment for non-Hodgkins lymphoma at University
Hospital for the entirety of his battle. After months of chemo therapy and stem-cell harvesting, it
is discovered that he will need a bone marrow transplant. Alan and his family assumed that the
transplant would be conducted at University Hospital, since that is where is team of doctors and
nurses are, but they learn that their HMO will not cover it at that facility and they will have to
travel a couple of hours away to Fair Oaks Hospital in order to receive the transplant. The HMO
tells them it is because they have a contract with Fair Oaks for that particular procedure. Not
only would this move make it harder for family and friends to visit Alan in the hospital, it would
mean that Monica, Alan’s wife, would need to quit her job and the two of them would need to
rent a space to live while he recovers from the surgery. It also means that the several months’
worth of stem cell harvesting would go to waste at University Hospital and the process would
likely have to be restarted by Fair Oaks. While there seem to be a few morally wrong things with
this scenario, there is really only one ethical dilemma that is posed in this case.
Ethical Dilemma Faced
Morally, there are several things wrong with this situation; however, ethically, there is
one thing that stands out: how can the HMO and University Hospital get away with allowing
Alan to undergo so much of his treatment at a facility where more drastic procedures will not be
covered without informing them first?
First of all, it’s necessary to understand why a patient would choose a managed care plan
over a more flexible plan such as a Preferred Provider Organization (PPO) plan. The appeal of a
HMO is that the patient will have a set primary provider, fixed copays and always pay a fixed

4. LONG-DISTANCE CANCER TREATMENT – AN ASSESSMENT 4
amount for their procedures, where a PPO allows the patient to choose where they want to be
seen, who they want to be seen by on case by case basis, and they pay a fluid amount of copays
and coinsurance (Jecker, 1998). Alan and Monica chose a HMO, therefore they chose to have a
set primary care provider with set amounts of copays – which also means that referrals are
needed for any other types of care (“Managed care plans”, 2015). Most people choose the HMO
because it usually costs less up front.
It is also important to know that hospitals know up front which procedures are covered by
the HMO, and which procedures the patient will have to travel in order to receive them. In this
case, University Hospital would have known whether or not more extensive procedures, such as
a bone marrow transplant, would be covered.
There are two sides to this ethical dilemma: a. Do Alan and Monica deserve to know
from the HMO and the hospital if a procedure will not be covered ahead of time; and b. Since
this information was most likely in their contract with their HMO, but they just had to look for it,
is it the HMOs responsibility to inform the patient of such information? From a moral
standpoint, it is not good practice that the HMO or the hospital did not inform Alan and Monica
up front that certain procedures will not be covered at University Hospital. From an ethical
standpoint, the water is murky since the information is likely deeply listed in their contract. It
should still be said that this is an ethical problem, even though it isn’t exactly black or white.
Responding as a Healthcare Manager
According to the ACHE Code of Ethics, the Healthcare Manager has the responsibility to
the patient to inform them of the rights, responsibilities, opportunities, and risks of the
availability of services at specific facilities (“ACHE code of ethics”, 2011). While it is not likely

5. LONG-DISTANCE CANCER TREATMENT – AN ASSESSMENT 5
that a facility can get a HMO to inform their patient’s ahead of time of potential risks involved
with certain types of care, the Healthcare Manager can certainly take on that responsibility to
make sure each patient is responsibly informed about certain procedures not covered by their
facility. In the case of Alan and Monica, with the progression of Alan’s treatment, the
Healthcare Manager of University Hospital should have informed them much more ahead of
time that if he needed a bone marrow transplant, those services couldn’t be provided at their
facility. At least in this case, that would have given them more time to decide what to do before
investing so much time on stem cell harvesting and chemotherapy at University Hospital.
If I were one of the Healthcare Manager’s at this facility, it would be my responsibility
according to the ACHE Code of Ethics to inform the patient up front of potentially uncovered
services. That is the best way that we, as Healthcare Managers, can ensure that our patient’s
receive the highest level of care for their own wellbeing without compromising our positions in
the facility we represent, and without compromising our integrity as ACHE certified Healthcare
Managers.

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References
ACHE code of ethics (2011, November 14). About ACHE. ACHE.org. Retrieved from
http://www.ache.org/ABT_ACHE/code.cfm
Jecker, N. (1998). Managed care. Ethics in Medicine: University of Washington School of
Medicine. Retrieved from http://depts.washington.edu/bioethx/topics/manag.html
Managed care plans (2015, July 17). Health insurance. Nessie: University of Illinois. Retrieved
from https://nessie.uihr.uillinois.edu/cf/benefits/index.cfm?Item_ID=58
Shanks, T. (1996). The case of the long-distance cancer treatment. Markkula Center for Applied
Ethics. Retrieved from http://www.scu.edu/ethics/dialogue/candc/cases/cancer.html