- Example #1: Zoe Keating's (@zoecello) husband
To Read More:
"Read the fine print"- tumbler post that includes photos of the actual bill with denied charges
"As if this isn't hard enough" - tumbler post with initial denial of the claim, along with media's response
"Coverage for the requested service is denied because the service does not meet the criteria for “medical necessity” under your description of benefits."Not medically necessary to hospitalize someone who cannot breathe?
Status: Resolved (for now)
- Example #2: Janet Freeman-Daily (@JFreemanDaily), blogs at Gray Connections
"… in this case the member is already known to have progressive Stage IV Bronchogenic carcinoma even after therapy. Specifically identifying the histopathology of this right upper lobe lesion is not going to affect long-term health outcomes."Anyone who has been following current lung cancer research (heck, anyone who has been following my blog) knows that taking a biopsy and examining the tumor can have an enormous impact on the course of treatment and life of the patient.
Stage IV NSCLC Survivor: 3 years and counting, taking targeted med Xalkori for her ROS1 mutation, currently NED (No Evidence of Disease).
- Example #3: Samantha Mixon (@mixon_samantha), blogs at Keeping my Faith - Living with Stage IV Lung Cancer
“We understand an appeal was requested because your doctor feels this treatment is medically necessary for you. Based on the information we have, the previous coverage decision can’t be changed. The services are considered not medically necessary….”
So the insurance company understands her medical needs better than her oncologist?
Status: Not Resolved
Stage IV NSCLC Survivor: 18 months and counting, taking targeted med Tarceva for her EGFR mutation, currently has no active cancer (thanks to the radiation that BCBS refuses to pay for).
- Example #4: Kim Wieneke (@aquariusvscancr), blogs at Aquarius vs. Cancer
Stage IV NSCLC Survivor: 3 years and counting, currently on a clinical trial of alectinib for her ALK mutation. Her brain mets are shrinking and her lung tumor is stable.
- Example #5: Me!
Stage IV NSCLC Survivor: 1 year and counting, taking Xalkori for ROS1 mutation.
As you can see, insurance company battles are far from rare. Yes, medical treatment is expensive, but as Zoe points out,
"Anthem is owned by WellPoint. Did you know Wellpoint CEO Joseph Swedish earned almost $17 million during his first year on the job? Now you know how they can afford to pay him."$17 million could buy a lot of Xalkori.