My parents always stressed the importance of having insurance. Since my dad was self-employed he had to take a different approach to securing medical insurance. He was fortunate for many years to be able to get his insurance through an industry association he belonged to. However, after he retired they informed him he was no longer eligible and would have no insurance at the end of the month. It was a stressful time for my parents as the provider they decided to go with would not insure him for one year due to a previous medical issue, but everything worked out eventually.
Fast forward to this past week. A friend of mine was diagnosed with cancer last year. She has insurance. The doctor began with one type of chemo and then decided it was best to go with another chemo drug. The insurance clerk at the doctor’s office told the patient they would call her insurance company and get approval for the chemo. The clerk then called the patient and said it was approved to begin the treatment. She began this second chemo drug last December and has had 15 treatments with it. Fortunately, she has had a good response with this second drug and is currently in a maintenance protocol. Everything is great, right? NO!
Here’s the scary part. She just received an updated benefit statement from her insurance company. She didn’t understand why it showed a significant amount owed for each chemo appointment. She called the insurance company. The rep told her they would not cover the second chemo drug. She had a lengthy call with the rep, but he was firm that the Review Board had made their final decision and it would not be changed. It should be noted this is not a clinical trial. The second drug they selected has been used for some time, with success, on her type of cancer.
She was confused and terrified because now the denied costs tally about $25,000. The doctor’s office was closed when she called them so she was left to worry about this all weekend.
I’ve been trying to help her figure out what to do next, but I have never heard of this happening before. I do not understand how a doctor can get approval and begin treatment for a patient, only to have the insurance company later take it to a Review Board and deny the coverage for treatments that have already been completed.
Please say a prayer for my friend. Stay tuned!
I share this story about a cancer patient because I realize now how easily it could happen to me – a patient with a chronic disease. It’s scary – and how can we possibly protect ourselves.