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Don M update


Don M

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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

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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

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I hate hearing this news about the insurance company. If only they would put themselves in these situations- then they would feel the helpless and desperate feeling patients are going thru in the quest to survive!!!

My prayers continue with you that things will move swiftly and successfully in your favor and that you remain stable throughout it all.

Keep us posted.

Hugs,

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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!!!

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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

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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! :roll::wink:

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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

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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.

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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

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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

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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

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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

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