Topic: SIRT - Y90

Hello,

My father recently had the SIRT - Y90 treatment, and it seems to really be working well.  The vessels that feed the tumors in his liver are shrinking, therefore decreasing the chances of the tumors getting any larger.

I have one question for anyone who has gone through this same treatment:

Was this treatment covered by your insurance company?

Here's the problem.  My dad has Blue Cross.  They initially denied coverage of this treatment stating it was "too new" of a treatment and that there weren't enough successful cases to prove it is worth is basically.

The doctors told my dad to go ahead with the treatment, pay for it, then they would send a letter to the isurance company appealing the denial in order to get my dad reimbursed.  My dad paid close to $100,000 out of his pocket with the expectation of reimbursement.

Yesterday, we received the second denial letter.  This letter now states that we will have to submit an appeal to the Insurance Commission.  It also states that he is only eligible to even be considered to an appeal if he would have died without this treatment.

I am desperately trying to research or locate any cases where Blue Cross, or any other insurance company, has covered this treatment. 

If anyone can help, or direct me to somewhere that can, I would be ever so grateful!!!  It's hard enough to deal with the illness, having to fight the insurace company makes the struggle twice as hard.

Thank you in advance,
Nicole

Re: SIRT - Y90

Nicole,
You may already have this information however, I thought to post it anyway.

Here is the web page for the California Department of Managed Care.  The consumer complaint section will help you describe your specific complaint and give you the direction you need to proceed. 

www.dmhc.ca.gov/dmhc_consumer/default.asp

Good luck and keep up the fight
Marions

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: SIRT - Y90

Thank you so much for this information!  Everything helps at this point!

Thanks again,
Nicole

Re: SIRT - Y90

Please look on the experiences board at the  thread on Yttrium 90. There are two links there regarding insurance.

good luck!