I am going to have a stroke.
Before I launch into this story: Kurt's treatment is underway for today, everything is going fine. We got his latest scan results today ~ no change, stable disease. His tumor markers are up a little, but the doctors tell us no reason to worry. The tumors may have gotten a little more active during the August break, but no indication of spread in the scan results. And with regular chemo resuming, we are knocking the tumors back in line!
OK, so the insurance company has denied the SIR-Spheres. Not surprising ~ it is an experimental treatment for esophageal cancer (FDA approved only for colorectal cancer), so they automatically deny and require us to appeal. I think I have mentioned this before, but we have a very helpful case manager at Blue Cross who is handing the appeal. But, that means I am letting someone else advocate for us. Thus: I am going to have a stroke.
I can't do it. I cannot let someone else argue this case. It is the fourth quarter, I see the end zone....PUT THE BALL IN MY HANDS!! Honestly, I am beside myself. I spent an hour on the phone yesterday with the case manager, coaching her on any potential weaknesses and how she should respond. I'm sure she found that super helpful. I keep leaving these extended messages on her voice mail, presenting a new theory of the case that she might want to try.
I admit, I am afflicted with that annoying conviction that if someone disagrees with me, it must be because they just didn't listen to me. So I am convinced that if I could just get in front of the Medical Director at Blue Cross, he would certainly approve the treatment. But to have to sit on the sidelines and let someone else argue -- not even a lawyer!! -- is just more than I can stand.
*SIGH*
So, we should know in 15-20 days if the treatment is approved. Please say a prayer that the Blue Cross Medical Director will have the wisdom to approve the treatment!
October 2, 2009
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5 comments:
omg Jen, I'm going to have a stroke, too, knowing you're NOT the one arguing before the BC med. director! You are Kurt's most important advocate and the only one I want handling this appeal! Thanks for helping your case manager along. I'll not only pray that the treatment will be approved, but that the case manager will really listen to the helpful tips you give her! love you tons!/kim
p.s. couldn't log onto the blog, so I'm anonymous today! thanks for the update!
My suggestion - do both. Let your case manager do her thing and then find out where this guy works. Go sit in his lobby until you get to talk to him. You'll either be arrested or they'll listen. This is certainly a case that warrants a clear explanation of the facts.
We know either way you guys won't stop until you get the answer you want.
Good luck.
BMR.
Jen and Kurt -
We're thinking about you guys, and keeping our fingers and toes crossed for good news from BC since we're not lawyers!
Bestest - Hannah & Bron Robinson
why is this bcbs' decision? i guess it's their decision to pay for it or not, but it shouldn't be. can your oncologist write a letter, or does he/she have a standard letter, surely this has come up before? if all new treatments are denied, then there are no new treatments. kurt should be thanked for advancing research on this therapy. and really, isn't kurt getting great results on a drug trial that's off label already? just what you needed - additional stress. ok, thinking about this gives me an "i hate idiots" headache, but please don't have a stroke.
I totally agree, Jess. Kurt is really providing the data that is needed. But, yes ~ we have letters from all our doctors. They are called Letters of Medical Necessity. Hopefully, they will be enough. If not, I intend to start blast faxing Congress, the media, and anyone else who might care. I am talking unhinged.
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