Insurance won't pay for treatment

John Char
John Char Member Posts: 30
in Esophageal Cancer #1

The insurance denided the chemo pills. We was ready to start the chemo and the day before we got the call insurance wouldn't cover it. Now they have to reschedule everything. They said they are going to put a port in his chest and half to go get chemo every 2 weeks. But now we have to wait again to hear from them to see when he will start.

Comments

  • JKGulliver
    JKGulliver Member Posts: 93
    #2
    The Other Fight

    When my husband was diagnosed with Stage 2 EC, we found out almost immediately that the insurance policy we'd paid for thoughout the past three decades did not cover many, many things that would have helped.  It became apparent, also, that doctors know nothing about what insurance companies will pay.  They only know the treatment side.  Not the cost side.  This is a whole other set of people, within each healthcare system.  Here are some things you can do:

    1.  Check to see if you were denied because of the way the medication was coded.  This happens often.  If it was coding, you can ask your doctor to recode and resubmit.  

    2.  You can appeal the decision.  Sometimes this works, but you have to get a comprehensive perspective of the whole decision making process.  I recommend you find out exactly why the coverage was denied.  Often times, it is one person and there is a very technical reason for the denial.  It helps to enlist the opinion of other doctors who can weigh in on your behalf.

    2.  One way to circumvent this barrier is to join a clinical trial.  Even the most narrow policy will likely pay for treatments.  

    3.  One option you have today that we did not have, is to switch insurance carriers.  They are not allowed to deny you coverage because of a pre-existing medical issue.  Be careful about leaving a gap in coverage, however.  

    4.  From this moment on, you should check with your insurance company prior to starting any treatment.  You have to be specific.  You have to ask about every single thing, no matter how small.  Keep notes.  Remember, the insurance company can later deny you, even if a customer service rep initially says coverage is permitted.  We had this happen to us.  They just said, "Oh, we made a mistake".  

    Best of luck to you.  

  • John Char
    John Char Member Posts: 30
    #3
    JKGulliver said:

    The Other Fight

    When my husband was diagnosed with Stage 2 EC, we found out almost immediately that the insurance policy we'd paid for thoughout the past three decades did not cover many, many things that would have helped.  It became apparent, also, that doctors know nothing about what insurance companies will pay.  They only know the treatment side.  Not the cost side.  This is a whole other set of people, within each healthcare system.  Here are some things you can do:

    1.  Check to see if you were denied because of the way the medication was coded.  This happens often.  If it was coding, you can ask your doctor to recode and resubmit.  

    2.  You can appeal the decision.  Sometimes this works, but you have to get a comprehensive perspective of the whole decision making process.  I recommend you find out exactly why the coverage was denied.  Often times, it is one person and there is a very technical reason for the denial.  It helps to enlist the opinion of other doctors who can weigh in on your behalf.

    2.  One way to circumvent this barrier is to join a clinical trial.  Even the most narrow policy will likely pay for treatments.  

    3.  One option you have today that we did not have, is to switch insurance carriers.  They are not allowed to deny you coverage because of a pre-existing medical issue.  Be careful about leaving a gap in coverage, however.  

    4.  From this moment on, you should check with your insurance company prior to starting any treatment.  You have to be specific.  You have to ask about every single thing, no matter how small.  Keep notes.  Remember, the insurance company can later deny you, even if a customer service rep initially says coverage is permitted.  We had this happen to us.  They just said, "Oh, we made a mistake".  

    Best of luck to you.  

    Insurance won't pay

    Thanks for the information. I will check everything you said. John is not doing so well sense he's been on chemo. Every day seems to be getting worse. I Just don't know what to do to help him. He still mowes and tries to stay busy. Goes to the nursing home. He is such a good person.

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