Re: Radiofrequency Ablation is in the cards for Gale918

Patty the librarian chiming in here, there are books with advice on fighting insurance companies, there is an older title that I think is worth reading entitled Making Them Pay, the author is Rhonda Orin. We have to fight fire with fire.

Doing a quick search I found this article about fighting insurance companies, in this case the treatment was CyberKnife but I think it is helpful because the insurance companies eventually paid up after the patients appealed to the state and it sounds like one of the patients had cc, see:

http://cbs5.com/investigates/CyberKnife … 16740.html

Patty

Re: Radiofrequency Ablation is in the cards for Gale918

Thanks so much for the encouragement.  I see the oncologist today.  I want to see what she can do to help.

Re: Radiofrequency Ablation is in the cards for Gale918

I spoke with the hospital yesterday.  I'm going ahead with the surgery without insurance.  I don't want this density to grow to the point nothing can be done.  I'll just give them so much per month.  I will get in touch with my Senator to let her know about this.  I'm waiting for the hospital to get back with me with a date for the surgery.  Chat later.

Re: Radiofrequency Ablation is in the cards for Gale918

You go girl!  Not that I am so smart but I would have made the same decision.
How dare they play god with our lives! You do what ever needs to be done and don't worry about it. You will not be the first nor the last to do this. Excellent decision. Keep us posted.

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Radiofrequency Ablation is in the cards for Gale918

Good Job! Good Attitude! Good Decision! Hoping for all the best for you. Update us when you can.

"One Day At A Time"

All of my comments and suggestions are just my opinions and are not a substitute for professional medical advice.   You should always seek the advice of your physician or other qualified health care providers.

31 (edited by gale918 Thu, 18 Dec 2008 06:08:50)

Re: Radiofrequency Ablation is in the cards for Gale918

I am going through with the RFA.  The hospital will get a monthly check for the rest of my life.  I think I will go through with the external review.  That way if we decided to sue in the future, we can.  I'm waiting for a date for the surgery.  I called the State Insurance Commissioner's office and she said that IF this external review rules in my favor, then the insurance company will reimburse me for the surgery.   Chat later.

Re: Radiofrequency Ablation is in the cards for Gale918

That is so tough Gale, I am so sorry to hear about these experiences! Good for your strength & for your decision!  I have a note out to a hospital insurance specialist I know, that juggles  these issues every day. I'll let you know what I hear back.

As an aside, we did finally secure a team at the Robert Packer-Guthrie in Sayre PA, that has agreed to pursue chemo/brachytherapy radiation & potential surgical removal. 9 out of 10 second-doc opinions said that Dad's intrahepatic cc was unresectable, but the team here is more aggressive & the surgeon has indicated that if they can shrink it just a bit that he'll attempt to remove it. They have asserted the many dangers of radiation.  Dad is expected to start the high-dose radiation (5 days week) for several weeks, next week.  He's just getting over a blood infection, so he's taking things one day at a time. I'll keep you posted.

Good luck to you Gale!

Re: Radiofrequency Ablation is in the cards for Gale918

My RFA is scheduled for January 5th.  I'll be paying for the surgery for the rest of my life.  I am preparing for the External Review with the New Hampshire State Insurance Commissioner.  It's a board of doctors, I was told and I have a 50/50 chance of getting my refusal reversed.

Re: Radiofrequency Ablation is in the cards for Gale918

Tess:  I agree that you need to be soooo pro-active.  It takes ONE doctor to smile and say, Yes, lets try this.  Keep me posted.

Re: Radiofrequency Ablation is in the cards for Gale918

Gale ... you sound to be very pro-active! I talked to the hospital insurance specialist. She indicated that each hospital works differently when it comes to working with insurance providers. A doctor can put together a letter of necessity, arguing for why a patient should receive a certain service, substantiating the necessity for the procedure. This can be performed as an appeal if the patient is initially denied. She also indicated that a patient can contact their congressman, for instances when charges are denied by the insurance company.   A proactive congressman's office, she notes, can research and see if there is a way to work around this either by finding a grant to help, or by offering suggestions on how to proceed.

Good luck to you on the 5th, you are in our thoughts!

Best,
Tess

Re: Radiofrequency Ablation is in the cards for Gale918

Gale,
I am in awe of your determination and spirit. Good luck with the upcoming procedure and appeal.

Kris

Cancer is a word, not a sentence.

36 year old patient with buckets of hope

Re: Radiofrequency Ablation is in the cards for Gale918

Dear Gale:

Here is something to think about: When I had my radiofrequency ablation, I was surprised to discover on the day I was admitted that I was on the surgical schedule for a "liver resection".  When I asked the surgeon about this, he said "don't worry; we are going to do RFA". Interestingly, all my medical records say "resection", and the hospital bill and insurance claim both said "resection". Virtually all insurance companies will pay for a resection. I had no trouble getting my procedure approved and paid for by the insurance company.

I would not want to use this forum to advocate anything shady or illegal, but perhaps you might share this story with your surgeon. It might give him some very creative ideas....

Violarob in Texas

Re: Radiofrequency Ablation is in the cards for Gale918

Violaob:  Hummmmmm, very interesting.

Re: Radiofrequency Ablation is in the cards for Gale918

Hi Violarob & Gale, Interesting is right. I talked to the insurance specialist about this and she indicated that the docs would have to submit a diagnosis code to the insurance company and she recommended googling "diagnosis code" for RFA and resection. I just came into a BC&BS Medical Policy (Mississippi), noting the following:

"6/19/2007: Policy statement updated; RFA as a primary treatment of hepatic metastases from colorectal cancer in the absence of extrahepatic metastatic disease may be considered medically necessary when the tumor cannot be removed by surgical resection, or precluded by underlying condition(s), and when all tumor foci can be treated. Added RFA for hepatic metastases from colorectal cancer that do not meet policy criteria, and from other types of cancer is considered investigational to policy statement."

(source: http://www.bcbsms.com/index.php?q=provi … tion.html)

Perhaps some BCBS regional policies might cover RFA, while others would not? Perhaps secretaries of leading RFA providers would be able to provide insights into how they do it, or perhaps justification for different coding possibilities?

Best,
Tess

Re: Radiofrequency Ablation is in the cards for Gale918

Thanks Tess.