New poster Shelana, Insurance question

mom_2_3
mom_2_3 Member Posts: 953 Member
in Colorectal Cancer #1

Shelana posted this question in another thread and re-posting in hopes others may have insight for her.

Amy

 

 

Hi:

I have a friend that is battling colon cancer with mets to liver.  Recently they implanted a port in his groin area for a procedure where they deliver the drugs (chemo/radiation) directly to the liver to kill the cancer cells.  He has had one treatment so far.  Recent scan showed 2 small tumors on other side of the liver.  Oncologist wants to go in throught he port again and deliver chemo meds to the tumors (embolization?). 

Now, after the extensive surgery and costs to implant the port in his groin area, they have rejected the 2nd procedure 3 times!!!  Has anyone else experienced this type of BS from the insurance companies?  Thing is, Medicare has approved it (which will be paying the majority of the costs) but its BCBS where the hold up lies.  I am so frustrated by this and can't even imagine how my friend feels. 

Is there anyone out there experiencing the same from their insurance companies playing God?!  I would love to hear any suggestions on your experiences/success stories when dealing and winning with the insurance companies when trying to help a loved one gain cancer treatment.

Thanks,

Shelana1221

Comments

  • Lovekitties
    Lovekitties Member Posts: 3,364 Member
    #2
    Hi Shelana

    You mention that your friend has both Medicare and BCBS.  I assume that the BCBS is a supplemental insurance.

    It does seem odd that Medicare would cover the procedure but BCBS would not.  I know that my supplemental insurance covers any costs covered by Medicare.

    It may be that the BSBS policy has some sort of limit attached.  I believe I would ask the doctor's office to contact BCBS to try to push it thru or to get a detailed reason by they will not approve.

    In any case, if the doctor accepts Medicare, the max payable by the patient is 20% after deductible satisfied.  Perhaps the doctor woud consider something less in order to get the treatment done.

    Dealing with insurance companies certainly is difficult, because it seems there is always some red tape, fine print, or other hoops to navigate in dealing with cancer treatment.

    Best of luck to your friend.

  • shelana1221
    shelana1221 Member Posts: 2
    #3
    Lovekitties said:

    Hi Shelana

    You mention that your friend has both Medicare and BCBS.  I assume that the BCBS is a supplemental insurance.

    It does seem odd that Medicare would cover the procedure but BCBS would not.  I know that my supplemental insurance covers any costs covered by Medicare.

    It may be that the BSBS policy has some sort of limit attached.  I believe I would ask the doctor's office to contact BCBS to try to push it thru or to get a detailed reason by they will not approve.

    In any case, if the doctor accepts Medicare, the max payable by the patient is 20% after deductible satisfied.  Perhaps the doctor woud consider something less in order to get the treatment done.

    Dealing with insurance companies certainly is difficult, because it seems there is always some red tape, fine print, or other hoops to navigate in dealing with cancer treatment.

    Best of luck to your friend.

    I will mention your reply to

    I will mention your reply to my friend.  Thanks so much for taking the time to read my post.  

  • NewHere
    NewHere Member Posts: 1,427 Member
    #4
    shelana1221 said:

    I will mention your reply to

    I will mention your reply to my friend.  Thanks so much for taking the time to read my post.  

    Make Sure They Document Things

    Note pad or otherwise, days and times they call and speak with people, particularly at the insurance company if they contact them.  Also make sure they follow the papers that come in.  It seems like there is a slew of paperwork, including each denial and time frames for appealing and other rights.

    At this point I am not a big fan of insurance companies - home, auto, health - most of the time.

  • danker
    danker Member Posts: 1,276 Member
    #5
    Insurance

    I have bcbs of Illinois.  They alwaws paid whatever  medicare approved.  Hope you get this ressolved soon.  Good Luck!

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