Stupid health insurance...

[Mohrfamily]

My husband told me yesterday some distressing news. His nurse at the cancer center called to say that three insurance was going to stop paying for chemo because he had some progression!? They've changed his chemo to include irinotecan now versus waiting to check his numbers. How can they do this. The hits just keep coming.

[stu]

Hi .

I am the wrong person to reply as I don’t understand your insurance system but that sounds very rough . Hope you get some advise and help to get this sorted .
Hold on tight ,
Stu

[Jolene]

My husband told me yesterday some distressing news. His nurse at the cancer center called to say that three insurance was going to stop paying for chemo because he had some progression!? They've changed his chemo to include irinotecan now versus waiting to check his numbers. How can they do this. The hits just keep coming.

This just doesn't sound right. An insurance policy that doesn't pay because there's cancer progression ?

You may want to bring out the original contract of the insurance policy and read the small prints and challenge on their decisions on stop paying. Find out from the insurance company on what basis can they decide to stop paying ?

I had a few dispute with my insurance company along the way too. Always return to the original contract policy to look for basis. They sometimes can get it wrong too as medical paperwork can be so confusing sometimes.

Stay strong.

[Rock_Robster]

I am by no means an expert on the US health insurance system, but I’ve heard that sometimes asking your oncologist to make a “peer-to-peer” call to the insurance company’s medicos can help. If they’ve decided to stop funding that particular chemo regime because they consider it ineffective (i.e. showed progression), but your oncologist still wishes to give it, then he should have a rationale as to why he thinks it’s still potentially beneficial which he could explain to them?

[TinaFish]

Omg. Who is your husband's insurance company??

[Pyro70]

It doesn’t sound right to me either. And typically Nurses don’t know anything about insurance.

[retiredteacher]

Repeating Rock Robster's advice. Please bring your oncologist into the discussion right away and ask him to have a conversation with the insurance company. I tried tangling with my insurance company for over six weeks (going out of network for surgery.) Got nowhere until I brought in my oncologist. I did have a detailed, well documented appeals letter I wrote myself and he carried that forward and obtained an approval. Being able to understand the NCCN flows really helped me navigate and better communicate the direction I was looking for.