Seeking help with Insurance Company to get treatment

bandittsgirl · New User Joined: 16 Apr 2007 Posts: 5

I am looking for help from anyone that has had to battle the insurance companies in order to get the treatment they DESERVE.

My Father (age 56) has been diagnosed with prostate cancer that has metastasized to his hip bones. His original PSA was 184. He started hormone therapy in February and with hormone therapy it has dropped to 60 and then 26.6, and hopefully lower; but haven't gotten the latest results yet. His Gleason score is 9 (5+4). His biopsies showed that the prostate had undifferentiated carcinoma (meaning that the cancer was solid all the way through).

He has started seeing Dr's at City of Hope and has signed up for a clinical trial using hormone therapy and Helical Tomo Therapy. The Helical Tomo Therapy is looking like it is going to be his best opportunity to fight this cancer. This type of radiation spirals around the entire tumor and "hits" it from hundreds of different angles as it travels around. The studies are showing that it is really helping people with bone cancer, it is a very precise treatment that does much less damage to surrounding tissues and areas. It is also the only type of radiation therapy that City of Hope uses for people with prostate cancer.

We found out on Friday afternoon that Blue Cross Blue Shield (BCBS) has denied covering the (Helical Tomo Therapy) treatment for him. They said it is just too expensive and the hormone therapy should be enough for him.

He has written a letter to BCBS and so has his Dr. from City of Hope. Where do we start this fight on getting them to change their minds and allow us many more years with our Father.

ANY information on how to go about this would be appreciated. You may also e-mail me at bandittsdaisy@yahoo.com.

THANKS
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bandittsdaisy@yahoo.com

rlee · Site Admin Joined: 15 Jan 2006 Posts: 245

bandittsgirl,
I would talk to the people at City of Hope as I'm sure they've had the same battle. See if they have any pointers regarding this. Good luck and be persistent.
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RLee, MD

Any information provided is NOT intended to provide specific medical advice to users but rather to provide users with information to help them better understand their health condition and related care. All readers are strongly encouraged to consult with a qualified physician for answers to their personal medical questions.

bandittsgirl · New User Joined: 16 Apr 2007 Posts: 5

Thanks, my Father is working with the Dr.s there and they are writing letters and doing what they can to get the insurance companies to understand why he will benefit from this specific type of radiation.

If there is anyone out there that has been denied a certain treatment and then had it approved after fighting it I would be interested in hearing from you, how you did it, what actions you took to get it approved. Thanks!
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bandittsdaisy@yahoo.com

bandittsgirl · New User Joined: 16 Apr 2007 Posts: 5

I just talked to my Mom and she just heard from the Dr.s that they WILL treat the prostate cancer, just not the bone cancer where it has metastasized to the bone, which is really important as it is a very aggressive cancer.
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bandittsdaisy@yahoo.com

rlee · Site Admin Joined: 15 Jan 2006 Posts: 245

Good luck and keep us posted.
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RLee, MD

Any information provided is NOT intended to provide specific medical advice to users but rather to provide users with information to help them better understand their health condition and related care. All readers are strongly encouraged to consult with a qualified physician for answers to their personal medical questions.

Richard Day Gore

Insurance companies are evil, IMO, and they'll let people die to maintain their profits. You can work with them sometimes, though. I've had troubles from time to time with benefits and treatments and medications being denied but my doctor has had good success by getting them on the phone himself and explaining things. It's just a shame he has to! Good luck, these things can and do work out, if we try hard enough to make them.
Regards,
Richard Day Gore
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Richard Day Gore

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