Newbie here, but not to cancer

%&! insurance
Hello,

Welcome to the board & I am so sorry you have experienced this nightmare with your insurance denying coverage for cyberknife.
I am really surprised they denied it, as most people's insurance seems to cover it. What insurance company are you with?
Instead of accepting it, I would definitely appeal it. It is very possible they will just deny it again. I recently (March) had to fight my insurance after they denied my chemo Gemzar (because it is FDA approved for other cancers, but not colorectal). Even though I had used up all the FDA approved chemos for colon cancer and didn't qualify for any clinical trials I could find and I had letters from three oncologists (my own, and two consulting-one of which was the well known Dr. Lenz from USC)- the insurance still denied it. I appealed it & they denied it again. At that point, I contacted the Dept of Managed Care of California (I assume each state has this dept) and filled out all the forms and sent the documentation of why I needed this chemo, included the drs' letters and a very specific letter from myself. I expected I'd get nowhere, but I got a call a week after I sent the letter from my insurance (who was forwarded all my info from the Dept of Managed Care) & they told me they were informing me they had reversed their decision and were going to cover the drug, as well as reimburse me for what I paid out (I actually paid cash for three treatments). So, it can and does happen- the squeaky wheel gets the grease, as the saying goes. Let me know through a PM (private message on this board) if you would like some specific help in how to go about appealing to your insurance and/or appealing to the dept. of managed care for your state.
Don't give up!!!!

Hugs to you,
Lisa

mukamom said:

Hopeful
Thanks to all again for your input and support...I was able to get a hold of patient relations manager at Accuray(cyberknife) who noticed an innacurate statement in BCBS denial letter. They denied coverage for gamma knife...not sterotatic radiation which is what cyberknife is...idiots. Will be talking to her on Monday so I can have some ammunition when I call BCBS..Surgeon and cyberknife of Birmingham are also appealing, and the onc is adding a letter of appeal along with the surgeons. So there is hope..as there are no other treatment options due to the location of the tumor. Onc decided to start chemo again..5FU with levorcorin, campostar, and avastin on Monday. Poor Robert, he was feeling so much better these days. His spirits are back up again and he says he's not going anywhere without a fight.

Have a blessed weekend

Angela

Keep fighting the good fight!
Hi Angela... another Canuck checking in so can't help you with the insurance issues (and don't get me started on how furious they make me every time I hear of another one on this board who have been denied or are having problems with their insurance companies... the same companies that are NOT cheap but insist on their expensive monthly premiums for next to no service). Ok, sorry... just had to get that out

But, you have found the greatest board on the 'net for support and help with your fight. Because this is not an unusual problem with so many, we have lots of very experienced warriors on this board who do not take insurance companies mistakes or denials lying down. Totally understandable that hubby (or any patient) would be deflated, depressed and so let down when hearing the denial. It gives you that feeling that no one cares and your life is not worth the cost of a potential life saving treatment... which the insurance companies are notorious for letting folk know it's all about money and if your treatment costs more money than money they are making ... they will deny. Dirty pigs. I understand the insurance industry is a money-making business so of course they are watching the bottom line, but it makes me so mad that they are making money on the gamble that most people will pay into it and never get seriously ill... but when someone does get seriously ill, well then that affects the bottom line of making money.

Sooooo, one has to get really clever and realize that the insurance world is all one big game to them. They gamble on the majority of people staying healthy but paying the big monthly premiums. For those who get seriously ill, they gamble on the majority of them will accept that they aren't eligible for expensive treatments/surgeries/drugs... take that denial and off they go to their corner and wilt away until they are no longer needing insurance. BUT, there is that small percentage of very ill people who will say, "Enough of this garbage... I pay/my employer pays, and I expect and WILL get proper service for my years of paying into this insurance game". Those are the people the insurance company don't want to annoy and want to keep them happy so they don't go playing the "serious health card", go to the media and higher up and really make waves about the scam these companies are getting away with. It's in the insurance companies best interests to pay the costly treatments/surgeries/drugs than get the bad press. Unfortunately, it takes a lot of anger and energy to go after them and when we are already fighting the battle of our lives, the last thing we need is to take on an industry... hence, good idea to have a patient advocate or good lawyer.

I wish you and your hubby all the best... and I know you will fight for this and get it. Like I say, there are a fair amount of folk on this here board who have gone through the same thing and can give you lots of advice on what to do and how to go about doing it. Being a Canuck, our insurance system is soooo different, but even still, within the country it is different from province to province. It goes without saying I'm shocked at the insurance system in the US, but I am just as shocked at how with our National Healthcare Insurance system here in Canada, it varies from province to province (since every province maintains their own healthcare insurance system. Insurance is insurance, no matter where you are... and if you aren't getting what you need, you need to fight for it with both fists (and a weapon or two)

Please hang out here with us... you will be super surprised at how powerful it is to be with friends who really get it!!

Cheryl