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I have a kind of complicated question.

rls67
Posts: 127
Joined: Nov 2012

My wife was scheduled to have a treatment this past monday. But because the tumor on her liver grew from 5.1 to 5.8, and a couple smaller ones also grew a little. They rescheduled her for this coming monday to try a different treatment. In the mean time I contacted Roswell cancer institute for a second opinion. 

I called my wifes primary doctor to ask if she should have her treatment or wait until she visited the specialist at Roswell. Because Roswell will only see her in between treatments. So that meant she wouldn't see the specialist for at least three months until her next scan.

Come to find out the insurance company rejected the new treatment suggested by her primary. So I was able to get her an appointment at Roswell for Oct. 14. The treatment she was supposed to get monday will now be on Oct. 18. This will be a span of 5 weeks between treatments. Is that risky? I am hoping The specialist will take a look at her scans and files and suggest something even better. 

So I guess the question is, is 5 weeks between treatment pushing it? Or do you think it would be ok? Sorry about id I rambled. I just wanted all the facts out there so I can get some help. Thank you all in advance.

annalexandria's picture
annalexandria
Posts: 2271
Joined: Oct 2011

I know most people have to be off Avastin for 4-6 weeks prior to surgery, so I do know people take even longer chemo breaks, under certain circumstances.   I guess my worry would be about your insurance company...what if they refuse to pay for whatever Roswell recommends?  What was the chemo that they rejected?  Did they tell you why it was rejected?  I think if it was me I might consider appealing this.  Even if your wife isn't going to take that particular route, it's not good that your insurance is rejecting the doc's recommendations.  My HMO balked at paying for a PET scan (despite the fact that I had come close to dying because my doc was relying on CT scans, which didn't work in my case), and I had to make a number of phone calls, and send emails to anyone I thought had something to do with the process.  I threatened litigation, and they approved my scan (and have approved every scan since...which is a big part of why I'm still around).  

You could ask her doc how to handle the rejection, and how to make sure the next thing doesn't get rejected too.  I'm sure they've dealt with it before. 

Keep us posted~AA

rls67
Posts: 127
Joined: Nov 2012

I already received approval from my insurance co. They said Roswell falls under the umbrella of my insurance plan and I would only be responsible for the copay. I had to get clearence from my insurance before they would even set up an appointment. As far as them rejecting the new treatment, her primary dr. is in charge of contacting the insurance co. for approval. Who knows why they would reject it. It is pretty crazy. 

abrub's picture
abrub
Posts: 1533
Joined: Mar 2010

Get in to the experts at Roswell Park.  (By the way, if you have a United HealthCare plan, you might have the "Cancer REsource Services" rider, which will might even pay for your travel expenses to Roswell.)

I know of too many people who went with the treatments recommended locally, only to be told at one of the major cancer centers that the treatments were off the mark.  Roswell is one of the best.

When I was diagnosed, my local dr (bless him!) would not start treatment until I'd met with experts at Memorial Sloan Kettering.  (Appendix cancer is quite rare, but many "local oncs" just assume it is treated the same as colon cancer, and do so, without recommending further review.)

A couple of weeks should not make a difference, especially since you may find out that something completely different is recommended. 

Good luck at Roswell.  Let us know.

Alice

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