HIPEC DENIED!

[blakeswife]

I'm crushed. We just heard back from the insurance company and they've denied HIPEC for Blake. The consider it experimental.

I remember someone else saying they were denied for HIPEC but don't remember who it was - or, if they won on appeal.

Does anybody remember who that was?

Kathy

[joeyooser]

I'm sorry you have to fight the insurance company besides fighting the cancer... I'm sure they'll do what they can to keep from paying for that expensive little procedure.

[Ashlee H.]

That just sucks that they are going to make you jump through hoops. I haven't approached my insurance company with it yet and am wondering if I too will be denied. SkiFletch - what insurance do you have? I know you said you had no problems getting approval. Insurance companies must be approving it 'cause no one could afford it on their own unless they had major money. Keep up the appeals! Praying for a approval soon.

Ashlee

[florencedollar]

Kathy, Check out this thread, viewtopic.php?f=1&t=5149 specifically the 7th or so reply. I read it when I thought my sister might be needing the procedure.

Keep fighting,
S

[SkiFletch]

Definitely keep up the appeals. I have Independant Health, a local HMO here in Buffalo, that will allow out-of-network services in either emergencies, or with prior approval. My oncologist told me my insurance is a particularly good one because when he calls for approval of things like extra CT scans, PET scans, or something bigger like HIPEC, he actually gets to speak to a doctor with real medical knowledge on the subject, and whom is much more likely to be reasoned with than a number crunching pencil pusher that other companies put through on the first-level. He says when he gets those penny pincher types he always knows they'll have to go through a few levels of appeals to finally get through to a doctor who might know what the heck they're talking about.

Anyways, given that Kathy, appeal and go higher, especially because you were denied considering it experimental. That's a crock of BS, if HIPEC were so experimental, how come there are 50+ abstracts here http://www.hipectreatment.com/documents/articles.php on it in the last couple years. And how come there are hundreds of doctors doing the procedure, maybe even in the thousands by now in this country if it's so experimental? If you need me to find more full-text articles or something more than all the abstracts out there Kathy, say the word. I could understand denial if they were worried about overly extensive mets, complications like heart conditions/diabetes/etc, or something real and physical, but to call it experimental is a crock. Find a doctor, or multiple dr's that will go to bat for you saying that HIPEC is necessary to save Blake's life, and go over the heads of the pencil pushers.

[daddys1]

oh gosh... so sorry to hear that, I have heard alot of people having trouble with their insurance companies covering things...good luck to you both.

[barbigirl]

mine was denied initally, but i won on my first appeal because mt tumors were reocurring.

[blakeswife]

Barbigirl, Where did you have your surgery?

Kathy

[Bev G]

Hi Kathy:

I found this on a thread from about a year ago, I think. I hope it might help:

Hi Randy,

I'm sorry you are having to go through this all again. I was wondering if you had mucinous tumors or a more straight forward colon cancer met in the peritoneum?

Have you heard of the insurance warrior? She had to fight for her treatment because she had the very rare appendix cancer. She won and had cytoreductive surgery with HIPEC and it has become her life's work. She can do it for you or her book will show you how.

Here is the link:

http://www.theinsurancewarrior.com/

Hope this helps...

Jennifer

[dianne052506]

Kathy,
I am so sorry you and Blake are having to deal with insurance problems on top of everything else. It's more than unfair.
I'm very lucky, not just with insurance coverage so far, but also because I have developed personal relationships with the two complex case managers I have had. Is Blake with a large insurance company or a large enough plan that he would have a case manager? I know that companies like appeals to be done in writing, but I would start on the phone, asking for a supervisor, or for someone who deals specifically with complex cases. Ask who you should talk to, or who the onc should talk to, in order to speed up the appeal process.

We are with Aetna, so I'll write my case manager tonight and see if HIPEC is considered experimental by them. If they don't have a problem with it, maybe that could also boost your arguments. Perhaps there are others here who could say specifically which insurance carriers have already covered HIPEC for them.

Good luck to you and Blake. If you're fighting cancer, you shouldn't have to fight other battles, too.
Dianne

[barbigirl]

Surgery and treatment at the Cleveland Clinic in Cleveland, Ohio and I have Medical mutual insurance.

[Terry]

Just what you need to deal with more stress, more time wasted that you could spend doing other things

Keep appealing and print out copies of skifletch's articles and anybody elses on here and the names of the insurance companies that have already paid out on it from people on here and send those with your appeal. Did your doctor talk to them about covering this or just you? I'm sure your doctor did but if he didn't, get him involved.

I'm not sure if contacting the insurance commissioner would help or not but you may want to give them a call if you have some free time (yeah right) and ask them if this is considered "experimental" by their standards.

I'm really sorry you have to deal with this. I'm afraid insurance problems are only going to get worse for us:(

[blakeswife]

Thanks everyone for all the ideas. Jenhopesprays & I have also talked via e-mail. This is such a great group!

Terry (cute new pic, btw), The patient advocate at the Oncs office is the one who has dealt with the insurance company so far. She's going to have the Onc talk to them as well. I don't think it's happened yet. I haven't talked to the insurance company yet - and I better not for a couple days. They don't want to hear what I have to say. And, I'm a "more bees with honey" believer so I need to work on my attitude first.

It's alarming. Even though Blake hadn't decided for certain yet - I think this "NO" has really affected him. He sure doesn't feel well and is really mopy (is that a word) today. We may go to San Diego for the consult anyway. Who are they to tell us he can't go for the consult?

It's like the insurance company has said - 'Sorry, sir. Enjoy your remaining time'

Damn insurance.

ttfn

[NMS]

Towards a Virtual Trials strategy with an integrative approach, dealing with peritoneal recurrences.

I have a serious interest in the subject of peritoneal and mesenteric recurrence where this is a potential future, hopefully never, or much distant, to us. Nevertheless, I have addressed a number of possible pathways forward. Should this eventuality rear its head at us, as previous surgical statistics (bottom, the "incomplete cytoreduction" curve, from Harmon and Sugarbaker, 2005) might suggest, I plan to have more Japanese surgical-chemo procedures implemented. Some Japanese papers that I saw, refer to or used simple interperitoneal injection of mitomycin C (MMC), rather than just intravenuos MMC. This is less aggressive than HIPEC but less strenuous too, with much less table time. Perhaps others can see more pre-surgical, simple IP-MMC possibilities.

We would also likely switch to a TS-1 protocol (not available locally here, yet, either) similar to what we do now, directly switching out the current metronomic UFT treatment, locally available, for TS-1.

TS-1 (aka S-1), is shown to successfully replace FOLFOX/FOLFIRI as a low toxicity salvage therapy for colorectal cancer. TS-1 from Japan has similar costs to Xeloda but may functionally replace XELOX, with the extra oxaliplatin.

TS-1 was first extensively documented, approved and recognized in Western textbooks, for peritoneal mets from far more aggressive gastric cancers, as well as being approved in Japan for colon cancer. Also, S-1 showed a surprisingly long-term survival with minimum toxicity in patients with peritoneal metastasis of gastric cancer. I know, "not quite the same," but TS-1 is showing across the board results as well as having firm physiological reasons to exceed previous generation 5FU products without the DPD inhibition.

We, for ourselves, would notably, presumptively, add the non/less-toxic extras like cimetidine, nutrients, and IV C+K3 to the treatment cocktail because it has worked for our single case, with a very high quality of life, and there is no sign of the "ski slope", linked and mentioned above. I cannot emphasize the quality of life with not one "chemo sick day". We will find capable help if and when necessary on any future surgery.

Perhaps there are some doctors that can find merit, appeal to the insurance pocketbook, and see daylight from the published Japanese experience, oupled with a more integrative approach.

--------------------------------------------------------------------------------------------------
Spouse dx'd March with obstructive colon cancer, stage III/IV, possible lung mets <1 cm.
Start cimetidine 1600 mg/d, bid, with modified citrus pectin, after scope+biopsy.
1 month of alt chemo, nutritional fortification before surgery (initially a marginal surgical candidate, anemic, KP score 60-70%).
Highly experienced CRC surgeon laid in multiple metal clips for radiation on non-resectable invaded area. However, pathology showed most invasive material outside colon [peritoneum] necrosed before surgery, obstructed channel opened slightly, 2 lymph nodes remained positive.
April, post op: begin IV vitamin C daily; later stepwise K3 [declined Folfox, Xelox+Av+Erb]
May: cont'd LEF + orthomolecular style nutrition every day; IV vitamin C + K3, every other day
June: begin Metronomic UFT at lowest dose, an oral chemo with tegafur; continue cimetidine, 800mg+high dose nutrients.
July: increase K3, IV vitamin C 3x week . . . . . . . . . . . 4wks pre-op: BG 130s; cholesterol: 260s, TG 200+;
Pre-op CEA: 20+, Sept. 2+; CA19-9 down 40% and stable. 1 mo post-op: BG 100s; TC 200s, TG <100, w/o meds.

[frickletsx3]

Blkeswife,

Sorry to hear about your ins troubles. jenhopesandprays is a good friend of mine. We both have had HIPEC and had it 100% paid for. Someone else rec. the Insurance Warrior, Laurie Todd, I would also rec her and her book. She is easy to find. She visits the website for people with PMP cancer which is 'bellybuttons". If you would like more info about my experience go ahead and PM me. I'm happy to talk