INSURANCE DENIED MY CHEMOTHERAPY...WE NEED TO FIGHT FOR OUR RIGHTS!

2

Comments

  • greyhoundluvr
    greyhoundluvr Member Posts: 402
    #22
    OMG Meena
    I am not shocked by much but I have to say that your story is unbelievable. I have never heard of an insurance company denying chemotherapy but it certainly sounds like they have met a fighter this time. One of my concerns with the group health carriers is that what gets approved or denied can be at their whim and the treatment you can get can vary depending upon who you are signed up with. It just doesn't make sense to me but I am happy to see that you are actively confronting them on this - they should be held accountable!

    Chris
  • rm22111
    rm22111 Member Posts: 54
    #23
    Try this contact
    Try this contact. Patient Advocate Foundation www.patientadvocate.org. 1800-532-5274. My husband picked up their information at the Tour of California Bike race. They have a fair as park of the event and they have a lot of cancer groups their because Lance Armstrong was a part of the race. My husband walked the walk before the event for cancer survivors. He had prostrate cancer. He walked for me because I could not be there. He carried my picture with him and even got on the news. I hope this group can help you. We have not needed their help yet.

    rm22111
  • survivorbc09
    survivorbc09 Member Posts: 4,374 Member
    #24
    meena1 said:

    I called my insurance this
    I called my insurance this morning requesting a denial letter. I advised them that i am contacting the news media and a lawyer. Imagine the headline "Large Insurance denies approved Chemotherapy treatment for one of its employees". I told her that this is an Obama dream, considering all the news about healthcare right now. Well, that was 3 hrs ago and she has not getting back to me. I called and said they are reviewing it. I explained I want the denial letter, they can review it later. still waiting. lover Meena

    I am glad you called them to
    I am glad you called them to request the denial letter. They have to get you one. Let us know what it says if you can.
  • jnl
    jnl Member Posts: 3,869 Member
    #25
    rm22111 said:

    Try this contact
    Try this contact. Patient Advocate Foundation www.patientadvocate.org. 1800-532-5274. My husband picked up their information at the Tour of California Bike race. They have a fair as park of the event and they have a lot of cancer groups their because Lance Armstrong was a part of the race. My husband walked the walk before the event for cancer survivors. He had prostrate cancer. He walked for me because I could not be there. He carried my picture with him and even got on the news. I hope this group can help you. We have not needed their help yet.

    rm22111

    Did they call you back today
    Did they call you back today Meena? Hoping it was good news if they did!

    Hugs, Leeza
  • GregStahl
    GregStahl Member Posts: 188
    #26
    Dont feel like your alone
    My wife works for a hospital and is on their insurance and they are deny treatment coverage. We went to her direct upper management and HR and have received a ton of help. Her insurance company also has treatment advisors that can help get you through this. If not publicity might help you too. I have emailed my local federal congress members AND local reporters.
    With the negative attitude toward insurance companies right now.....a few emails to newpaper, radio, and TV reports might do some good if it needs to come to that.

    We were able to get a bilateral mastectomy going through HR and a VP.

    And FYI. The Obama cuts in medicare payments to doctors and hospitals included a $1.4 billion cut for cancer treatments (chemo and rads specifically), started 01/01/2010!

    Good luck
  • meena1
    meena1 Member Posts: 1,003
    #27
    GregStahl said:

    Dont feel like your alone
    My wife works for a hospital and is on their insurance and they are deny treatment coverage. We went to her direct upper management and HR and have received a ton of help. Her insurance company also has treatment advisors that can help get you through this. If not publicity might help you too. I have emailed my local federal congress members AND local reporters.
    With the negative attitude toward insurance companies right now.....a few emails to newpaper, radio, and TV reports might do some good if it needs to come to that.

    We were able to get a bilateral mastectomy going through HR and a VP.

    And FYI. The Obama cuts in medicare payments to doctors and hospitals included a $1.4 billion cut for cancer treatments (chemo and rads specifically), started 01/01/2010!

    Good luck

    No good news! they did call
    No good news! they did call me back, however, just to tell me that they are sending me a denial. I sent an email to a local tv station and they responded that someone will contact me next week. But you know what, right now i do not have the energy to battle with them. It has been 2 yrs that i have been fighting this and i cannot stand the thought of 2 more years, or a lifetime of this. so at this point, i have given up.
  • Balentine
    Balentine Member Posts: 393
    #28
    meena1 said:

    No good news! they did call
    No good news! they did call me back, however, just to tell me that they are sending me a denial. I sent an email to a local tv station and they responded that someone will contact me next week. But you know what, right now i do not have the energy to battle with them. It has been 2 yrs that i have been fighting this and i cannot stand the thought of 2 more years, or a lifetime of this. so at this point, i have given up.

    Nooooooooo!
    Don't give up Meena! I know that is easy for me to say....I am not dealing with what you are dealing with but you have to hold onto HOPE at all costs. You cannot lose hope. Please continue to fight this until you have exhausted all your resources. There has to be something that can be done and I think the new media is a good place to start. Alot of things have gotten turned around quickly when the media gets involved and exposes the villain. I will continue to pray for you that they will approve your treatments and you can get on with your life. By the way, why are they denying your treatments anyway? Didn't they cover it two years ago when you were first diagnosed?
    Lorrie
  • Ritzy
    Ritzy Member Posts: 4,381 Member
    #29
    meena1 said:

    No good news! they did call
    No good news! they did call me back, however, just to tell me that they are sending me a denial. I sent an email to a local tv station and they responded that someone will contact me next week. But you know what, right now i do not have the energy to battle with them. It has been 2 yrs that i have been fighting this and i cannot stand the thought of 2 more years, or a lifetime of this. so at this point, i have given up.

    Meena please don't!
    Don't give up Meena! Please don't! There has to be something, somewhere, somehow that will help you to get your chemo covered. And, someone wrote on here once that a lot of the time, an insurance company might deny a claim, but, if you resubmit it, they might approve it then. I think they just try to see how far they can get and hope people won't fight them on it. You cannot give up on this! Is there anyone that can help you to fight this? Is there anything that we can do? Please, there is always hope, always a way. We love you Meena and want you to get your treatment.

    Sue :)
  • roseann4
    roseann4 Member Posts: 992 Member
    #30
    I would file a complaint.
    I'm sorry you are in this insurance nightmare, but if I were you I would file a complaint with your state's Dept. of Insurance. It is a bit uncomfortable because you are also an employee but I wouldn't let that stop me. They can't fire you for defending your rights. I would also contact your local news station and see if they will look into it. They have people who do love to spotlight unfair practises. You might be able to shame them into paying.

    Roseann
  • HeartofSoul
    HeartofSoul Member Posts: 729 Member
    #31
    meena1 said:

    No good news! they did call
    No good news! they did call me back, however, just to tell me that they are sending me a denial. I sent an email to a local tv station and they responded that someone will contact me next week. But you know what, right now i do not have the energy to battle with them. It has been 2 yrs that i have been fighting this and i cannot stand the thought of 2 more years, or a lifetime of this. so at this point, i have given up.

    CONACT MEDICAL DIRECTOR of INS Co (thru case manager)
    Meena, do you have a "Case Manager assigned to you? Ask for one thru your Ins Co. Many times they can be your advocate in helping you get either a treatment requested by your DR or help with an approval that is needed. I have used Case Managers for years over the years for getting approval for high risk transplant surgeries, authorizations to go to specific medical centers, and most importantly, help you navigate thru the insurance maze of departments to get you to the person who can make a difference for you.

    The Case Manager often has direct contact with a Medical Director that specializes in say, Cancer. The Medical Director certainly can review your case and understand the importance of you getting Avastin and the other chemo you DR wanted. Because you have late stage cancer and its a reucrrence requiring 2nd line treatment, its even more important you get the best treatment, the Med Director will understand this
  • meena1
    meena1 Member Posts: 1,003
    #32
    roseann4 said:

    I would file a complaint.
    I'm sorry you are in this insurance nightmare, but if I were you I would file a complaint with your state's Dept. of Insurance. It is a bit uncomfortable because you are also an employee but I wouldn't let that stop me. They can't fire you for defending your rights. I would also contact your local news station and see if they will look into it. They have people who do love to spotlight unfair practises. You might be able to shame them into paying.

    Roseann

    My insurance is not
    My insurance is not approving 2 drugs that are approved for metastatic breast cancer, they are Avastin and Abraxene. I believe it is because of the cost. They are approving Taxol and Herceptin. My oncologist believes that i will have a better chance of surviving if he uses Avastin and Abraxene. I do not want to confuse everyone that they are denying Chemo altogether, just the 2 above drugs which are proven to work better than just the taxol.
  • DianeBC
    DianeBC Member Posts: 3,881 Member
    #33
    meena1 said:

    My insurance is not
    My insurance is not approving 2 drugs that are approved for metastatic breast cancer, they are Avastin and Abraxene. I believe it is because of the cost. They are approving Taxol and Herceptin. My oncologist believes that i will have a better chance of surviving if he uses Avastin and Abraxene. I do not want to confuse everyone that they are denying Chemo altogether, just the 2 above drugs which are proven to work better than just the taxol.

    This is still awful.
    This is still awful. Regardless of cost, you should be able to use the best chemo to help you fight this cancer. Did your oncologist say there was a huge difference in the good results between them? I pray that your insurance company will change their mind and give you the best chemo possible.

    Hugs, Diane
  • HeartofSoul
    HeartofSoul Member Posts: 729 Member
    #34
    meena1 said:

    My insurance is not
    My insurance is not approving 2 drugs that are approved for metastatic breast cancer, they are Avastin and Abraxene. I believe it is because of the cost. They are approving Taxol and Herceptin. My oncologist believes that i will have a better chance of surviving if he uses Avastin and Abraxene. I do not want to confuse everyone that they are denying Chemo altogether, just the 2 above drugs which are proven to work better than just the taxol.

    Meena, did you read my post
    Meena, did you read my post on contacting Med Director and and Case Mgr?
  • jnl
    jnl Member Posts: 3,869 Member
    #35
    HeartofSoul said:

    CONACT MEDICAL DIRECTOR of INS Co (thru case manager)
    Meena, do you have a "Case Manager assigned to you? Ask for one thru your Ins Co. Many times they can be your advocate in helping you get either a treatment requested by your DR or help with an approval that is needed. I have used Case Managers for years over the years for getting approval for high risk transplant surgeries, authorizations to go to specific medical centers, and most importantly, help you navigate thru the insurance maze of departments to get you to the person who can make a difference for you.

    The Case Manager often has direct contact with a Medical Director that specializes in say, Cancer. The Medical Director certainly can review your case and understand the importance of you getting Avastin and the other chemo you DR wanted. Because you have late stage cancer and its a reucrrence requiring 2nd line treatment, its even more important you get the best treatment, the Med Director will understand this

    Praying Meena that you can
    Praying Meena that you can get the chemo that will work the best for you! Hang tough! You have to keep trying and keep fighting!

    Leeza
  • meena1
    meena1 Member Posts: 1,003
    #36
    HeartofSoul said:

    Meena, did you read my post
    Meena, did you read my post on contacting Med Director and and Case Mgr?

    Heart, i read the post, i
    Heart, i read the post, i am waiting for the letter to come, they wlll not tell me why they denied it. right now i am too sick and tired to battle...
  • New Flower
    New Flower Member Posts: 4,294 Member
    #37
    meena1 said:

    Heart, i read the post, i
    Heart, i read the post, i am waiting for the letter to come, they wlll not tell me why they denied it. right now i am too sick and tired to battle...

    Meena please
    I am so sorry. I am completely understand.Do not talk on the phone with insurance , it is very stressful, only in writing. I also give my son a "Release form" for talking with my insurance on my behalf.

    The case management will help, for sure. Your oncologist has prescribed two very promising drugs which have shown efficacy. Please ask your doctor to write Letter of Medical necessity. This letter along with lawyer's appeal letter need to be send to insurance. I understand that you are tired and drained by the process, but please do not give up. Look up in yellow pages: there are lawyers who specialized in medical insurance, usually the first consultation is free. It was very helpful. I know it awful that you have to fight two battles, please continue... you will win.
    Hugs,
    New Flower
  • natly15
    natly15 Member Posts: 1,941
    #38
    meena1 said:

    Heart, i read the post, i
    Heart, i read the post, i am waiting for the letter to come, they wlll not tell me why they denied it. right now i am too sick and tired to battle...

    Meena I am furious for you.
    Meena I am furious for you. Insurance companies have no right to determine what is best for our health!! This whole health care thing is absolutely frustrating.

    I can only imagine how worn out you are from fighting the C Beast and the Insurance Beast. Meena please dont give up. Do you have a healthy family member or friend who can help you with their energy so you can fight this?

    I have a lot prayers to say tonite and some of them are for you.
  • Bella Luna
    Bella Luna Member Posts: 1,578 Member
    #39
    What in the World!
    I am sorry to hear your insurance company has denied medical services deemed necessary by your oncologist. I will keep you in prayer.
    BL
  • Akiss4me
    Akiss4me Member Posts: 2,188
    #40
    suggestion....
    I'm so sorry Meena that this Insurance issue has to occur on top of everything else. I would suggest enlisting the help of family or a friend to write a letter for you (you can just talk while they write) and send it to your Senator and Congressman! I have seen them get very involved in these situations and become an advocate for the patient! I am right there with you when you say you don't know if you have the energy....I could not imagine having to muster up anymore energy for one more thing, and all I need to do is get through the day!
    Good luck and please keep us posted.
    Hugs and hope, ♥Pammy
  • meena1
    meena1 Member Posts: 1,003
    #41
    Akiss4me said:

    suggestion....
    I'm so sorry Meena that this Insurance issue has to occur on top of everything else. I would suggest enlisting the help of family or a friend to write a letter for you (you can just talk while they write) and send it to your Senator and Congressman! I have seen them get very involved in these situations and become an advocate for the patient! I am right there with you when you say you don't know if you have the energy....I could not imagine having to muster up anymore energy for one more thing, and all I need to do is get through the day!
    Good luck and please keep us posted.
    Hugs and hope, ♥Pammy

    Thank you for all the great
    Thank you for all the great suggestions...My problem is that i actually am quite shy and quiet. I do not like to cause problems, so i am not a good fighter. I would back down too easily..but i will try

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