INSURANCE/DRUG CO TRUMPH AGAIN!

DJG1
DJG1 Member Posts: 121
edited March 2014 in Head and Neck Cancer #1
I posted about a month ago, that I was stage 3 tonsil with right lymph node. The alternative doctor i seen called about proton thearpy. To make a long story short, the Ok facility approved me for the trearpy after about a week. However, after about 4 days the insurance co said NOT. Even though it FDA approved, they said no go. So as usual the insurance co wins again. On a side note, one reason why the proton thearpy can be beneficial with less side effects, is that they would only radiate one side and not both. Just curious why RO insist on always radiating both side of neck/face, even it the cancer is only on one side. Maybe this is why there are so many issues with the treatment. Or is it because the stupid insurance co allow the doctor to cook patients as much as they want to get the almight dollar. afterall the more they cook you, the more drugs you need to get throught it all. So who is winning that battle? Sorry to be so negative. I wish each patient the very best. Is it time that the patients demand more answers and better treatment?????

Comments

  • Skiffin16
    Skiffin16 Member Posts: 8,305 Member
    #2
    Frustration Understood
    I can feel your frustration....

    Just to give you a little clarity (as I understand it). I had similar diagnosis, SCC right tonsil STGIII HPV+, also a lyhmpnode.

    Nine rounds of chemo (Cisplaten, Taxotere and 5FU) in three weeks cycles. That followed with concurrent Carboplaten (weekly), and 35 daily IMRT rads....

    The radiation does hit both sides, but a lesser concentration on the opposite, this is mainly as a catch all and possible preventative. The feeling I believe to treat any potential or existing cells that might be present on the opposite or in transition to that side.

    I don't think anyone wants more than needed although that line isn't real clear, other than 35 does seems to be the magic number.

    I wouldn't give up fighting with the insurance company. Find out what alternatives you have higher up the chain, and involve your medical professionals.

    Best,
    John
  • Kimba1505
    Kimba1505 Member Posts: 557
    #3
    Skiffin16 said:

    Frustration Understood
    I can feel your frustration....

    Just to give you a little clarity (as I understand it). I had similar diagnosis, SCC right tonsil STGIII HPV+, also a lyhmpnode.

    Nine rounds of chemo (Cisplaten, Taxotere and 5FU) in three weeks cycles. That followed with concurrent Carboplaten (weekly), and 35 daily IMRT rads....

    The radiation does hit both sides, but a lesser concentration on the opposite, this is mainly as a catch all and possible preventative. The feeling I believe to treat any potential or existing cells that might be present on the opposite or in transition to that side.

    I don't think anyone wants more than needed although that line isn't real clear, other than 35 does seems to be the magic number.

    I wouldn't give up fighting with the insurance company. Find out what alternatives you have higher up the chain, and involve your medical professionals.

    Best,
    John

    Proton Radiation
    I find it very frustrating when insurance companies (business people) make decision against what the medical professionals are recommending. I have never understood that...how can someone sitting at a desk across the country know what treatment is best when there is doctor who has seen and touched you right there stating their opinion based on umteen years of education, training, and experience. ?????
    As for proton radiation. Where my partner is being treated there is proton radiation and it is a big buzz there. When I asked if Mark would be getting the super-duper proton radiation, his radiation oncologist said it was not the best choice for head and neck. This was a while back so I cannot recall details, as I am sure he provided them, but Mark is getting IMRT to both sides for a primary that was found to be in his left tonsil.
    Kim
  • Hal61
    Hal61 Member Posts: 655
    #4
    both sides
    Treating both sides. My understanding is like John's. I had base of tongue primary with spread to two lymph nodes on the left side, and my IMRT sessions targeted both sides and lymph glands. PET scans can not see so fine as to recognize a single cancer cell. I don't know how many it takes to register activity on the sugar "uptake" scale they use to grade cancer activity, but less radiation is directed to what PET scans consider to be "unaffected" glands. It's good precaution. Sorry with your problems with having the proton therapy. I know that some, but not many here, have had the treatment. Regardless, the drug companies rule, and reigning them in is one of the prime actions that needs to be taken when thinking of improving our healthcare system.

    best of luck with whatever treatment you have,

    Hal
  • Unknown
    Unknown
    #5
    Hal61 said:

    both sides
    Treating both sides. My understanding is like John's. I had base of tongue primary with spread to two lymph nodes on the left side, and my IMRT sessions targeted both sides and lymph glands. PET scans can not see so fine as to recognize a single cancer cell. I don't know how many it takes to register activity on the sugar "uptake" scale they use to grade cancer activity, but less radiation is directed to what PET scans consider to be "unaffected" glands. It's good precaution. Sorry with your problems with having the proton therapy. I know that some, but not many here, have had the treatment. Regardless, the drug companies rule, and reigning them in is one of the prime actions that needs to be taken when thinking of improving our healthcare system.

    best of luck with whatever treatment you have,

    Hal

    This comment has been removed by the Moderator

Discussion Boards