the insurance warrior

lisa42
lisa42 Member Posts: 3,625 Member
edited March 2014 in Colorectal Cancer #1
Many of you read my other thread "starting Gemzar Wed and am paying cash". In it, I talked about how my insurance company (Health Net) has denied the next chemo treatment I need, Gemzar. They say it's not on the standard FDA approved list of chemos for colorectal cancer (it isn't- but I've "used up" all the standard FDA approved drugs and so everything that I take in the future will likely not be on their approved list). I filed an appeal to their denial, and that has now also been denied. Although I'm far from rich, I consider myself very fortunate in that my husband and I do have a savings and so we're going to start me on Gemzar anyhow, and we'll be paying the oncology office cash for it. It is outrageously expensive, so we'll certainly not be able to keep this up for too long. We are going to fight them.
Amy mentioned in a reply to my other thread about how I should check out "The Insurance Warrior". So, I did.
The website is: http://theinsurancewarrior.com

I clicked on and watched her video of her story and what she did to fight, and eventually win, against her insurance company. She gives some good advice. To get the rest of the information, you do have to pay- I think $14.95 for each section, o $24.95 if you get both sections at once.

If there's anyone out there who has had experience using her or any other resources, or has successfully fought against an insurance company, we'd love to hear about it!

Cheers!
Lisa

Comments

  • lcarper2
    lcarper2 Member Posts: 635 Member
    #2
    Lisa
    I had a problem when 1st started on this journey and my insurance had approved me and than said OOPS we made a mistake...I got ahold of the insurance com. and they got it strightened out in 24 hrs. maybe if you did this and provided them with the letters from the doctors they could help you get approved..just a thought
  • msccolon
    msccolon Member Posts: 1,917 Member
    #3
    Patient Advocate Foundation is free
    They are who helped me with my awful insurance woes back in 2005-2006. They were awesome, and again, it's totally free and the people are professionals.
    mary
  • lisa42
    lisa42 Member Posts: 3,625 Member
    #4
    msccolon said:

    Patient Advocate Foundation is free
    They are who helped me with my awful insurance woes back in 2005-2006. They were awesome, and again, it's totally free and the people are professionals.
    mary

    Mary- PAF
    Mary,

    I just got off the phone with the PAF case manager Elaine Martinez. She had me send her via email my Health Net's "plan policy". I realized that I never even got such a thing. I called my former employer, who was supposed to have given it to me, & he sent it to me via email. I've got it saved on my computer now, and sent it on to Elaine. She is going to look it over for me and advise.
  • msccolon
    msccolon Member Posts: 1,917 Member
    #5
    lisa42 said:

    Mary- PAF
    Mary,

    I just got off the phone with the PAF case manager Elaine Martinez. She had me send her via email my Health Net's "plan policy". I realized that I never even got such a thing. I called my former employer, who was supposed to have given it to me, & he sent it to me via email. I've got it saved on my computer now, and sent it on to Elaine. She is going to look it over for me and advise.

    GREAT!
    I'm glad to see you've got PAF working for you! I believe you will find they work very hard and are very good at what they do!
    mary

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