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Clinical Trial and Insurance?

npatel22526
Posts: 14
Joined: Sep 2019

My father's liver Mets are progressing  quickly after one liver surgery and  the first-line treatment (FOLOX) and he might be a candidate for a clinical trial  only if the next treatment doesn't work for him (FOLFIRI +  bevacizumab ). The Clinical trial is at MSKCC, when I initially tried to make an appointment with MSKCC when he was first diagnosed they said they don't accept New Jersey MEDICAID so we can't get treatment there.

I spoke to the study coordinator and she said "generally" it's fine but I am just worried if/when the time comes we'll be struggling with insurances rather than focusing on his treatment., because "generally" may or may not apply to us.

So, I am wondering if anyone dealt with such a scenario. I will contact his insurance company too (Horizon NJ Health) but just need advice before I do that because I won't be surprised if the call ends with the note that says "Sorry we don't serve out of network provider or hospital"

 

Thanks in advance.

abita's picture
abita
Posts: 1014
Joined: Dec 2017

Speak to the coordinator again and explain that you need an answer other than "generally", and ask who you can speak to who can answer the question. My guess is that the study coordinator has no idea. I imagine you need to speak to someone in financial services.

np22526
Posts: 6
Joined: Oct 2020

Thanks, Abita for your suggestion. It was indeed the financial services. They said I will need to get "Out of Network" authorization, even for clinical trial. They said it could be either your primary care or oncologist. I will speak to both to see who can help me this.

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