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Insurance has denied coverage

Blood Cancers & Disorders | Last Active: Jan 11 8:45pm | Replies (14)

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@snakebite

Hello. No I certainly did not make this up. I didn't say the company name because the last thing I need is to have another issue with them. They are a MAJOR player in the field and I've been with them for around 40 years. To be fair, they have paid out a huge amount of money on my behalf and continue to do so. Before I was illegible for Medicare my share of the cost took my life savings pretty quickly. When Medicare kicked in and took over the primary spot, the two of them together paid most of the cost. Lets face it, when these new Cancer drugs show a cost of $20,000 for a one month supply, or Bone Marrow biopsy cost a $16,000, Blood transfusions, Tens of thousand $ cost of injections every two weeks few people can afford them without having both Medicare and a secondary insurance. I'm actually very thankful to have received as much help as I have. I understand my secondary's actions, even though I don't like it. It says that the drug is for people who's platelet level is at or below 50. Mine bounced around that for a long time and they paid for it. When it jumped up and appeared to be staying up that must have set a flag in their system which triggered the denial response. I'm over the initial shock now, at least for the moment, and will see what happens next. Over the course of my journey with this MF/MDS I've been in tough spots before and managed to survive them. One way or another I'm sure that things will work out. God is good and is on my side!

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Replies to "Hello. No I certainly did not make this up. I didn't say the company name because..."

@snakebite, your medical team may be able to help with contesting the decision made by your insurance company. If the medication is deemed medically necessary, I recommend talking with an oncology social worker. At Mayo Clinic, helping to navigate access to treatment is something our social work teams help patients with. You can read more here:
– How an Oncology Social Worker Can Help https://connect.mayoclinic.org/blog/cancer-education-center/newsfeed-post/how-an-oncology-social-worker-can-help/

Is your oncologist aware of the denial by the insurance company? Do you have an oncology social worker?