The Irony of Insurance Companies

 

 Finally received the letter from the insurance company as to why my claim was denied.  I am not sure if their opinion changed after a peer-to-peer review.  But I think it may not.  Regardless of that outcome, the fact that this is happening is just ..ummm… messed up.  

I am fortunate that I am being treated at Memorial Sloan Kettering, which is one of the leading cancer hospitals in the U.S. My radiation oncologist has been treating me for 6 years.  He does not administer proton therapy. He said it is the best thing for me due to the location of the tumors and the potential damage which would be caused by other forms of radiation treatment.

Here is an excerpt from https://www.gmlawyers.com/proton-beam-therapy-insurance-denial/ 

"Proton beam therapy has become increasingly popular as a form of cancer treatment, but because it costs more than standard radiation, insurance companies routinely refuse to cover it. Often, insurance companies have policies in place classifying proton beam therapy as experimental or investigational. Based on these policies, insurers issue blanket denials of coverage requests without considering the patient’s request and assessing their individual case. Courts have found this type of conduct to be an example of insurance bad faith and have criticized this insurance tactic in the harshest terms.....

Proton beam therapy differs from standard radiation therapy in that it fires protons at the cancer cells rather than x-rays. The advantage of the proton beam is that it is more precise and can be more selectively targeted only at the cancer cells, leaving nearby healthy tissue largely undisturbed. The proton beam can also be customized to fit the size, shape and depth of the tumor in the body, further increasing its precision."

Knock me over with a feather about what they say there.

Google "proton therapy denial" and you can find many examples.  Including this one - https://www.propublica.org/article/blue-cross-proton-therapy-cancer-lawyer-denial

It is now over three weeks since it was decided it was time to proceed with proton therapy.  As recommended by my radiation oncologist.  And which was thought to be the right course of action by other doctors at MSK.  

Yet I was denied. Though I have been beaten down a ton by what I have been through the last decade, there are others who are older/in worse shape.  Throw this BS at them as they try to keep on living.  Right, because cancer is not enough.

A bit of irony in this all - treatment was denied for September 11 through December.  I have cancer because of 9/11.

Got To Love This

  

Insurance company called an hour before they closed for the weekend.  They left message that I got it 2 minutes before they closed.  They are denying my treatment.  They did not specify what treatment, but since the only one that I am waiting on is for proton therapy,

I am assuming it is for that.  Most of my cancer is stable, but a few tumors in my lungs are close to major structures.  They are located too close to the esophagus and heart to use radiation - there is a good chance it would damage both.

The tumors are growing rather quickly.  Guess the doctor who sits behind the desk there, denying claims, is putting their medical degree to good use.  Instead of doing things like being a real doctor.  

For ten years I have been doing everything I can to stay alive.   In the past the insurance games have not impacted me to this extent - the delays were not quite as critical.  I will now have to wait all weekend

For 10 years I’ve  been doing everything I can to stay alive.   In the past the delays were not quite as critical.  I will now have to wait all weekend to find out what is going on.  Gotta to love this. 

Been Too Long Again

It has been awhile, yet again, since I updated things.  Unfortunately there is not much to add on walking side of things.  I am able to walk, but it is unclear if I will progress further.  

A new brace, which I started wearing about a month ago, is supposed to help trigger the muscles that have atrophied and engage them more.  I am able to walk with it for short distances at a time, and I do feel some pain/stress/activation in my hips and other areas that have been weakened.  But I do not feel that much more sure footed.

I do manage to go 1-1/2 miles a day, with many days going between 2.5 to 4 miles when I am taking photographs.  I am tired and walking slower by the end of those days, but I am moving.  I really wish I could be training more and working on my cardio.  I keep on telling myself I will get on the treadmill and hold the rails tightly.  I cannot use a bike trainer - there is no way I can raise my leg to get over the seat - but I may get one that has the low bar.  I still want to get into a pool, even just to walk.  I am often too tired to do many things, but I think it has been improving some the last 6 weeks.  Occasionally I still have the crashes.  I slept from about 8PM Friday until 10AM today, Sunday, with occasionally getting up for some water or food.  I had gone almost 24 hours without eating.  

I had a CT scan last week and results were overall very good.  The cancer is controlled and not growing.  Except for the few big ones in my lungs.  

It is now time for at least two, possibly more, to have proton therapy.  Proton therapy is more precise and causes less damage than usual radiation treatment.  Due to the proximity of the tumors to my heart, trachea and esophagus, it will be used.  Otherwise there is a good chance I would have damage .  

Proton therapy is coming along quickly, meaning that there should be much more availability and lowering costs in the not so distant future.  It will be a great day when it can be used routinely for tumors in sensitive areas or where surgery is the only option now. If it was used instead of the surgery and radiation on my spine, I probably would be in better shape and my leg may not have been trashed like it was.  It makes me smile to know that the mets in my spine will be easier to treat for others.  What I have seen in the last 10 years has been remarkable.

I am fortunate that based on the particulars of my case and overall health, despite the walking issues, proton therapy is on the table.  

So I will have 10-15 treatments on consecutive days, with weekends off.  The side effects, such as nausea, are also less than radiation. ''

I have not really been looking at my CT scans much since I started immunotherapy, though I had the discs.  I popped one in today after seeing it on the computer when I met with my radiation oncologist last week.   The effect of the immunotherapy was clear.  Where there was once white fuzz of the cancer tumors, there is now black, the remnants of the tumors that.  I have posted a couple of images showing this.  I also have posted a movie to go through my lungs and see the multiple black spots.  It really is awesome.  Unfortunately though, it needs to be 100%, especially when the tumors are in a bad spot.  So far my radiation treatments have been effective in knocking down the cancer.  I knew this was coming down the pike and have been waiting.  I figure the main troublemakers will be put in there place, then back to getting to walk and run.  

#iTRI4aCURE