Insurance Battle

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rdrylie
rdrylie Member Posts: 3 *
edited August 2022 in Lymphoma (Hodgkin and Non-Hodgkin) #1

I am in the middle of CAR-T cell therapy for Stage 4 Non-Hodgkins Diffuse Large B Cell Lymphoma. The people at my cancer center got insurance approval from BCBS of Texas to have an EKG, PET Scan Bloodwork and my T cells collected & sent out to KITE to be engineered. The cells are done now & waiting to be sent back to be infused in me.

Today I got a call from my Oncologist's Nurse/coordinator at the (University of Alabama at Birmingham) and they are telling me that BC/BS of Texas has now, out of the blue, said they don't want to approve the remainder of the treatment ..ie. putting the engineered cells back in me and the therapy's follow-up.

It seems to me that this is absolutely no different than a surgeon getting insurance approval to do a quadruple bypass on someone. He has the operation room set up, nurses, anesthesia, ICU and the entire surgery planned out, start to finish. So now he begins the operation, opening up the chest, removing a vein from the leg of the patient and then, out of the blue, a hospital insurance administrator walks in the room and declares that the insurance company has said he cant go any further... Now the surgeon, though he definitely knows that this man could die if he doesn't complete the operation, has no choice but to stop and walk out of the operating room to explain to the family that BCBS of Texas has said that they don't want to approve having the remaining life saving portion of the operation done.

In my case, when BCBS of Texas approved all the CAR-T precursor steps involved in getting the cells collected and engineered, they acted as if they didn't know that there was more to the CAR-T cell therapy than collecting and engineering. There's also that LIFE SAVING PORTION of the therapy they are denying that must be completed or I could die.

I am completely confused and at a complete loss as to the the senseless lack of reasoning behind denying the remainder of my therapy. They approved chemotherapy, which failed, they approved the EKG, the PET Scan, The education on side effects, the setting of all the appointments start to finish as well as the collection and engineering of my cells. Now, out of the blue, they tell my team of doctors and patient coordinators to just stop right in the middle of everything and deny me and the the doctors the ability to complete the Life Saving Portion of the therapy and, I guess, just let me die. This is completely unethical and unconscionable if not in some way illegal...

Sorry for ranting but my anxiety. anger and depression just increased 100 fold today.

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  • ShadyGuy
    ShadyGuy Member Posts: 903 Member
    edited August 2022 #2
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    Have you spoken to BC/BS directly?

  • rdrylie
    rdrylie Member Posts: 3 *
    #3
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    https://csn.cancer.org/discussion/comment/1699418#Comment_1699418

    Yes and so has my wife and patient coordinator

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,812 Member
    #4
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    I seldom recommend this (virtually never, actually), but I would get a medical malpractice attorney. By funding the front end of your procedure but then refusing the second portion, they in essence set you up.

    max

  • rdrylie
    rdrylie Member Posts: 3 *
    #5
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    https://csn.cancer.org/discussion/comment/1699429#Comment_1699429

    Thanks Max. I too had Hodgkins back in 05. Went to Cleveland clinic and received ABVD and 17 years has gone by without a problem until this Non-Hodgkins appeared in October of last year. I just wanted to wish you all the best and thank you for your input. I agree with you completely.

  • po18guy
    po18guy Member Posts: 1,466 Member
    #6
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    Sorry to hear this. Just a letter or sometimes even a phone call from a prominent (i.e. successful) attorney's office might just tip the scales in your balance. At the same time, hospitals should have an aggressive team to deal with insurance hassles. However, they may just be running a bluff. A very cold and cruel bluff, but we humans are capable of some pretty vile stuff.

    I'm with Max. Get some attorneys on it.

  • ShadyGuy
    ShadyGuy Member Posts: 903 Member
    edited August 2022 #7
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    I see you have DLBCL? Did BC/BS state any medical reason for denying the treatments? Have they recommended any alternative treatments? It could be something your doctor put in the request. CAR-T is not for everyone and can in fact be fatal in and of itself. Success rate can be very small for some patients. If I were in your position I would try to get something in writing then see an attorney. Get copies of all key documents. Good luck! Hang in there. Is there a shelf life on your T-cells? You don’t need this when you are sick.

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