Topic: So upset with BCBS right now

The trial my husband was in didn't work and his cancer has gotten worse, so his oncologists want to do radio embolization, then enter him in another trial in four weeks (he has to wait that long between the last chemo and the new trial).  His main oncologist does not want him to sit idle for weeks, because as he said, the cancer can be aggressive and we don't want to waste that time.  So we met with the interventional radiology oncologists last week and they said we had to get preapproval for the radio embolization, since it is only approved for colorectal cancer (it would be off-lable use).  It is $30,000 per dose (one for each side of the liver).  We found out the next day that it was approved, so we hurriedly set up an appt. on the 25th for the mapping procedure.  Well today, we heard from Georgetown that BCBS has decided to review its decision and may deny it.  They want more documentation to prove it is a necessary treatment.  I cannot believe they would put us through this.  How could they approve it then change their minds?  It may also push the procedure date further out as well, which may also impact his eligibility for the new trial.  We are going through enough already.  I feel it is just cruel that they can do this.  The doctors are putting documentation together to submit to BCBS, but I wonder if there is anything I can do to help as well.

2 (edited by jathy1125 Tue, 16 Oct 2012 14:49:39)

Re: So upset with BCBS right now

I am so sorry to hear about your insurance problems. I have BCBS and have 2.5 million dollars in pay out from them and never had any problems except one. I had a spot on my lung and my doctor decided he wanted a PET scan and it came back denied and they needed more paper work from doctor, long story shore after weeks of waiting and getting no where, I called myself and in about one hour of back and forth phone calls and conference calls it was resolved. It should have never been denied and was more clerical error on both side. I suggest you call BCBS and start crying and taking names, it worked for me. I can honestly say BCBS gave me no grief in the last 4 years except for that one time. I am alive because of God, 2 strangers, Dr. Chapman and great insurance (BCBS)!!
Lots of prayers-Cathy

Re: So upset with BCBS right now

Thank you Cathy.  I am at the point of tears right now.  We will call them and plead our case.  We have been extremely happy with BCBS up until this point.  Hopefully we can get this resolved soon.  Thank you for your quick reply!

Re: So upset with BCBS right now

AH, BLUEBIRD, I am so sorry to hear this. My only suggestion was to do what you are doing as far as getting the ONC to call/write BCBS. I am sending good vibes, juju and prayers that you get this all ok'D. You are so right, you do not need this extra krap to deal with! A ton of love and hugs to you both!

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.