Don M Posted April 5, 2007 Share Posted April 5, 2007 My cyberknife center contacted my insurance company. I am at the point where I see if the insurance will cover it or not. They said it was "investigational”. That must be a health insurance industry favorite word. They approved every thing except 2 codes, which are the actual treatment and the most expensive part. My center is gathering up documents and a signed statement by my radiation oncologist in hopes of dissuading the insurance people from thinking that cyberknife for lung tumors is investigational. If they don't buy it, then I have to file a formal appeal. In the meantime I am applying for charitable assistance so that I can get the treatment while the insurance process goes on. My insurance is Federal Employees Blue Cross Blue Shield, Basic Plan. I am a little surprised that they won't cover it. The interventional pulmonologist thinks he may be able to get fiducials in my tumor and get a tissue sample too. If he can’t, I may be able to do it later this year when he has SuperDimension Bronchus available. It is more flexible and you would always know where you are in the lung. That may be 6 months from now. In the meantime, if he can’t get the fiducials in, I would go on tarceva and hope to stay stable at least until SuperDimension Bronchus is available. By then, hopefully there will be a good outcome in an insurance appeal. I am retired and won’t mind spending my spare time hounding the insurance company. Don M Quote Link to comment Share on other sites More sharing options...
trish2418 Posted April 5, 2007 Share Posted April 5, 2007 How I hate that you have to fight with the insurance company! For what it's worth, my onc. seems to feel that a letter from an attorney tends to do the trick with insurance companies. Good luck and I have faith that you'll be able to make those bureaucrats see the light. Hang in there Don. Trish Quote Link to comment Share on other sites More sharing options...
Don Wood Posted April 5, 2007 Share Posted April 5, 2007 Thanks for your update, Don. Wishing you the best in your quest for coverage. Don Quote Link to comment Share on other sites More sharing options...
Treebywater Posted April 5, 2007 Share Posted April 5, 2007 Don, Oh that just makes me want to hit something! I just HATE red tape. Don't they GET what a mean beast we're fighting here? Anyway... you give 'em hell and I pray that things will get untangled and worked out ASAP. Quote Link to comment Share on other sites More sharing options...
Shelley (MLC) Posted April 5, 2007 Share Posted April 5, 2007 Don, good luck with the insurance battle! Shelley Quote Link to comment Share on other sites More sharing options...
Ann Posted April 5, 2007 Share Posted April 5, 2007 So very good to hear from you, Don. The more I hear, the more I hate these damned insurance companies. Do they think we only pay our premiums for the times we are healthy? Give me a break!!! Good luck with everything!!! Quote Link to comment Share on other sites More sharing options...
Ry Posted April 5, 2007 Share Posted April 5, 2007 I hope all goes well and you get the insurance company to come through for you. Have you thought of having an attorney send a letter on your behalf? Good luck with it all. Quote Link to comment Share on other sites More sharing options...
Kasey Posted April 5, 2007 Share Posted April 5, 2007 Sorry there are still more hoops to jump through, Don. Same thing happened 2-1/2 years ago when I needed my first PET scan here. No go! Said I could pay myself. It becomes exhausting to keep fighting lc, advocating for the best tx, and then have to work harder yet to get that tx needed. Don, you are just remarkable......in your fight, attitude, and persistence. You are due one BIG break here and SOON! That's my wish and what I pray for. Kasey Quote Link to comment Share on other sites More sharing options...
Connie B Posted April 5, 2007 Share Posted April 5, 2007 Ditto Ditto Ditto And Ditto to what everyone else here has said. It's just NOT RIGHT! Your wonderful attitude will pull you though Don. Hang in there, and as the Cable Man says, "Get er done!" If nothing else let them know you didn't come all this ways just to be pushed around by them! Quote Link to comment Share on other sites More sharing options...
fight Posted April 5, 2007 Share Posted April 5, 2007 Don, I wish you didn't have to spend a second of your time on those darn insurance companies. They make me crazy too. Keep hounding them and have your doctor hound them too. They seems to get results quicker. Take Care, Rachel Quote Link to comment Share on other sites More sharing options...
Suzie Q Posted April 5, 2007 Share Posted April 5, 2007 Go get 'em, Don! Quote Link to comment Share on other sites More sharing options...
rvillella Posted April 5, 2007 Share Posted April 5, 2007 Sorry about the insurance problems Don. Hope they clear up quickly. It's good to see you are still fighting. The attorney thing sounds like a good bet. They hate having to fight in court for things. Ralph Quote Link to comment Share on other sites More sharing options...
Tiny Posted April 6, 2007 Share Posted April 6, 2007 Don, Hound away, buddy, and good luck! Quote Link to comment Share on other sites More sharing options...
kamataca Posted April 6, 2007 Share Posted April 6, 2007 I can see you strapping on the battle gear. Sorry you have to fight this battle, too, but you are one tough cookie. Almost makes me feel sorry for the insurance guys. Almost. Kelly Quote Link to comment Share on other sites More sharing options...
Nick C Posted April 6, 2007 Share Posted April 6, 2007 Geeze Don...I hope they Pony up the dough. Is there a health advocate you can turn to if they give you any initial difficulty? When Mom had her Breast cancer in 1996 they gave her a real problem, she got a nurse advocate (employee of the insureance company...but advocates for the patient) and the nurse advocate got her bi lateral mastechtomy pushed through. I hope they would have the same type of advocate. Quote Link to comment Share on other sites More sharing options...
blaze100 Posted April 6, 2007 Share Posted April 6, 2007 Hi Don, I am sorry to hear the insurance is giving you the run around....I think they hope that most people will "give in" and pay, rather than take the extra effort to hold them to it. Hang in there...they are just testing you. My prayers are with you Don. Barb Quote Link to comment Share on other sites More sharing options...
MEA Posted April 6, 2007 Share Posted April 6, 2007 Don M, I really think insurance companies have a policy of saying "no" and hoping most people won't fight back. My son was born with a bi-lateral cleft palate in 1976 and they did not want to cover some of the 15 surgeries(said it was for cosmetic purposes)he had from 1 month to 15 years. However, if he had been hit in the face with a baseball and required some of the same surgeries, they would cover it. We were always fighting with them. Keeping hounding them. Wishing you the best, Mary Quote Link to comment Share on other sites More sharing options...
dadstimeon Posted April 6, 2007 Share Posted April 6, 2007 Hang in there Don--prayers. Quote Link to comment Share on other sites More sharing options...
melindasue37 Posted April 6, 2007 Share Posted April 6, 2007 Hearing stories like this just make my blood boil! Give em' hell! Praying that you will get it all taken care without too much aggravation so that you can spend your free time doing something a little more enjoyable! Quote Link to comment Share on other sites More sharing options...
Don M Posted April 6, 2007 Author Share Posted April 6, 2007 Thanks for your support everyone. Nick: I do have a nurse advocate with my insurance. I think that you have a good idea in contacting her. I will get some documentation together and give it a shot. Don M Quote Link to comment Share on other sites More sharing options...
Don M Posted April 7, 2007 Author Share Posted April 7, 2007 So, I called my insurance looking to get an email address for the nurse advocate and I found out that the only reason they are calling cyberknife for lung tumors investigational is that according to their information, the FDA has not approved use of cyberknife for soft body tumors. I told the lady it has been approved by the FDA for years. I went to the FDA website and obtained a copy of the latest approval document and faxed it to my insurance company. I hope that this is all it will take to get them to pay. The lady made it sound that way. Don M Quote Link to comment Share on other sites More sharing options...
Andrea Posted April 7, 2007 Share Posted April 7, 2007 Sending strong vibes your way! Quote Link to comment Share on other sites More sharing options...
carolhg Posted April 7, 2007 Share Posted April 7, 2007 No one should have to fight with their insurance company. I am not so happy about nurse advocates either. I was told by a person in the medical field that was one more person that the insurance company hires to put you between your doctor and the treatment that you need. Don I am praying that this all works out for you. Carol Quote Link to comment Share on other sites More sharing options...
Maryanne Posted April 7, 2007 Share Posted April 7, 2007 Grrrrrrrrrr, I hate Insurance companies... they are so frustrating at times. They probably will approve it and it is just wasting valuable time for them to get it straight. I am really pulling for you and hoping with all my heart they get this straightened out real soon. Meanwhile, like you said you have time to argue... I just hope it won't be long. Thinking of you my friend, Maryanne Quote Link to comment Share on other sites More sharing options...
blaze100 Posted April 7, 2007 Share Posted April 7, 2007 Hi Don, Aflac gave me similar run-a-round when I made a claim on my heart problems last year. They kept calling me saying my claim was denied. I kept asking them for hard copy of denial so that I could begin appeal process. They never sent denial on paper. Finally I faxed all the info to them including my policy definitions. When they called again to say claim was denied, I went over the fax page-by-page asking what part of the policy definitions didn't they understand. Then they said they were missing crucial pages - blame it on a fax jam. HA Insurance co's hope we will give up w.o. a fight....well they aren't used to dealing with us LC survivors huh? Good Luck Don. Barb Quote Link to comment Share on other sites More sharing options...
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