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Does anyone else hate insurance companies as much as I do?
Hello. My wife diagnosed in 2021 was put on targeted therapy last year, 2024 to fight her battle against stage 4 pancreatic cancer. The health insurance company approved it in a matter of days. It worked so well that they removed her from all the medications. Fast forward to 2025, the cancer has returned. We went through the oncologist to have the same medication approved through the same insurance company. They denied it three times as "Experimental or investgational use" which it certainly is not. These meds are recognized as treatment options by the NCCN guidelines with a proven track record. Certainly for my wife, as it wiped out the tumors. After repeated documentation, phone calls, and threats of lawsuits, we finally received approval just today. It isn't enough we have to fight the disease, but do we really also have to fight the insurance companies too? grrrrr......Thoughts anyone?
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I about lost my mind dealing with insurance last year when I was trying to get into a clinical trial and understand their appeals process.
The magic word I've have success with in a few cases was "peer-to-peer" phone call, in which an expert (usually your oncologist) speaks with a physician in the approvals department at the insurance company.
You may never get that far if you have United Health Care for insurance, but we can only hope for the best.
Fortunately I have a different insurance company that provides "concierge cancer care" for a very large employer and a top-notch patient advocate / nurse navigator to go along with it. We'll see how it goes as I resume the process of seeking clinical trials again this week.
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2 ReactionsI have signed personal guarantees, beyond the normal financial responsibility paperwork, to get necessary treatment while the insurance process played out. So far, things eventually worked out. I feel rather fortunate.
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2 ReactionsWho is the Insurance company
@ markymarkfl,
Yes. The "Peer to peer" phone call from my oncologist is what finally got the medication approved yesterday. The funny thing is they won't even talk to the patient or their spouse. Only the doctors can correspond to them directly. I'm sure because they would get an earful.
I wish you the best in getting into the clinical trials.
mcharlesfrancis,
Blue Cross Blue Shield Federal.
The Rainmaker is a compelling legal drama that showcases Francis Ford Coppola's return to form after the less successful Jack. Adapted from John Grisham's novel, the film follows Rudy Baylor, a novice attorney portrayed by Matt Damon, as he takes on a powerful insurance company
deny, defend, depose
I have spent more time on the phone with insurance companies than I have being treated.
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