If you've had HIPEC, please help

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Kellie
Posts: 37
Joined: Thu Jul 16, 2009 10:13 pm
Location: Orland Park, il

If you've had HIPEC, please help

Postby Kellie » Sat Nov 06, 2010 11:45 am

I have started the appeal process with my insurance company to pay for my HIPEC surgery. I haven’t been officially denied yet, but it is my understanding that BCBS of Illinois will pay for HIPEC for appendix cancer and mesothelioma, but not colon cancer. They consider it “investigational.”

I bought the Insurance Warrior’s book and one of the components of the appeal process is to set precedent. If any of you have had your insurance pay for the procedure, could you please give me your name, surgery date, diagnosis, and name of insurance company that paid for the procedure? Or better yet, if you have won an appeal with your insurance company and are willing to share your appeal, I would be extremely grateful. You can PM me with the information, or if you’re willing to post it, the information my be helpful to someone else going through the process.


Thanks for your help.
Kellie
11/08 colectomy
1/09 Folfox
2/10 VATS
4/10 8 cm mass ovary peri mets
4/10 Folfiri
12/10 cyto/ HIPEC
9/11 recurrent CC, resect,mets in pelvis
10/11 Xeloda,
4/12 pelvic met, folfiri
9/12 2nd HIPEC
5/13 ab met 6/13 cyto
12/13 liver resect,lung mets

SkiFletch
Posts: 6361
Joined: Mon Dec 07, 2009 3:39 pm
Facebook Username: Michael Fletcher
Location: Buffalo, NY

Re: If you've had HIPEC, please help

Postby SkiFletch » Sat Nov 06, 2010 1:12 pm

Sure. Most of my details for diagnosis is in my sig and I've made them public over time, so I'd be happy to list them here

Scope 11/13/09, almost certain dx of CC
12/1/09 Right hemi colectomy, during which peritoneal surface met was discovered
12/28/09 meeting with Oncologist to discuss HIPEC for the first time
1/15/10 meeting with HIPEC surgical oncologist Dr Joseph Skitzki at Roswell Park Cancer Institute do discuss candidacy
Late January I received approval for the surgery from my insurance Independant Health provided it was done at Roswell which is In-Network for them
8/10/10 went under the knife for HIPEC

A couple of thoughts Kellie. When seeking approval for this, if you can try to get your case reviewed by actual doctors, and not pencil pushers, you'll have a much better time. My onc told me part of the reason I was approved so easily for the procedure is that he was able to talk to an MD who reviews cases for the Ins Co and that MD was reasoned with via lots of studies, data, and real proof that does exist showing HIPEC has good benefit. Also, bring up with the Ins that the colon and the appendix are the same organ, so why is it "investigational" for CC but not appendix cancer? That kind of response indicates that whomever wrote that "rule" hasn't read enough research or doesn't know squat about either anatomy or the HIPEC procedure to understand what he/she is actually ruling on. And if you want some help getting research articles showing HIPEC's effectiveness, say the word and I'll bombard you with some this week :)
11/13/09 5cm Stage IV 9/25 lymph nodes w/2cm peritoneal met at 29 YoA
12/15/09 LA right hemi-colectomy
6/16/10 Folfox FINISHED
8/10/10 Prophylactic HIPEC
10/9/10 got Married :D
Still NED and living life to the fullest

"Can any one of you by worrying add a single hour to your life."


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