Need help dealing with insurance company?

[Leslie221]

Hi everyone!

I am currently researching info so I can put together a dynamite appeals letter to my insuance company. They (Blue Cross/Blue Shield) won't pay for my Tarceva because I haven't had and failed two rounds of standard chemo. I understand why they won't cover it as first line treatment (I have had only Iressa before Tarceva) - a big expense for them vs.percentage of people who respond successfully and, we all know PROFIT is their first priority!

But I was treated first with Iressa because I was diagnosed with stage iv BAC at the same time as being admitted to the ICU with respiratory failure, was given a 5% chance to survive the respiratory failure and doctor felt regular chemo would kill me at that point. He happened to have a bottle of donated Iressa, so everyone said, "Well, give it a try."

Well, it worked like gangbusters for me - dramatic response within 2 days - so my oncologists decided I should stay on it. Why have more severe chemo if the Iressa worked so well and allowed me to feel great physically?

The insurance company disagreed, however. I have been lucky enough to have to pay for only one month of Iressa out of pocket (still making $100 a month payments on the $1850 dollars owed to Walmart Pharmacy) and have received donations of the med since then. But the anxiety of not knowing from month to month if I would have my Iressa (and now Tarceva) was the worst part of my experience since getting past the initial fear and shock.

Anyway, I found a great group that helps people deal with insurance companies and helps find other funding sources for uninsured people or as well as insured. It's:

www.patientadvocate.org

Hope this info will someone else!

Leslie