Yesterday's Dr. Visit

[Robert A.]

Hello group, It's been a couple of crazy months since my last visit so here's a little update on my wife. In February she had her regular scan which showed some growth in her tumor. She has been on Tabrecta since June of 2020 with great results. When 1st diagnosed in October of 2019 she was given Keytruda & Carbo which also had good results with tumor shrinkage but after 6 moths the same thing happened, shrinking then tumor growth. After the Keytruda was no longer working the Dr. gave her a round of Chemo which hospitalized her for 5 days with gastrointestinal problems. Yesterday we had our 1st office visit with the Dr. in 20 months since all was going well our visits were through tele- conference. The Drs. plan was to start her on Tecentriq which was denied by the insurance and appealed by our Dr. and denied again. The Dr. wants her to continue with the Tabrecta until her next scan and see where we go from there. The reason given by the insurance company for denial was that Tecentriq is a immunotherapy like Keytruda which my wife has taken and it didn't work. I asked about surgery or radiation therapy but the Dr. said because of location of the tumor that was not an option. Feeling bummed but still hopeful. Robert.

[Rower Michelle]

Robert-

Its good to hear from you.  I’m sorry you’re going through this and want to share that an insurance company should not have the final say in a treatment plan.  Most of the time these decisions are made by either clerks or physicians who are not board certified in thoracic oncology. 
 

I would urge you to contact your US Senator immediately (assuming we’re talking Medicare Advantage).  The politicians in my opinion aren’t useful for much these days but they all have contempt for insurance denials.  Also contact your local news stations and see if you can file a help request.  
 

I’ve been down this road before and now once again.  Senator Moran’s office is making people jump around trying to explain their irrational cost saving “medical necessity” criteria.  
 

We all have to fight back….  Will keep you in my prayers. 

[Robert A.]

1 hour ago, Rower Michelle said:

Robert-

Its good to hear from you.  I’m sorry you’re going through this and want to share that an insurance company should not have the final say in a treatment plan.  Most of the time these decisions are made by either clerks or physicians who are not board certified in thoracic oncology. 
 

I would urge you to contact your US Senator immediately (assuming we’re talking Medicare Advantage).  The politicians in my opinion aren’t useful for much these days but they all have contempt for insurance denials.  Also contact your local news stations and see if you can file a help request.  
 

I’ve been down this road before and now once again.  Senator Moran’s office is making people jump around trying to explain their irrational cost saving “medical necessity” criteria.  
 

We all have to fight back….  Will keep you in my prayers. 

We're a few years from Medicare, and the Dr. met with the Drs. that work for the insurance in a peer to peer conference.

[Rower Michelle]

Okay- then the next step is to file an on line complaint with the State Department of Insurance.  They have jurisdiction over the insurance companies.  It’s usually a short on line form that takes about 10-15 minutes to fill out.  It’s worth your time… not all insurance doctors are “peers”.