My dad has lung cancer that has also moved to the brain. Gave him a year to live back in November. Started radiation and chemo with both the lung and brain tumor significantly reduced in size. Doc says you may be one of the few who beat this thing. Let's do 30 days of daily radiation and I'll see you back in 3 months for an mri and as long as the tumor has not increased in size no more treatment necessary. Insurance said no radiation. Doc personally appeals and calls and insurance has denied 3x. This seems illegal and I wonder if the insurance company's ceo would be denied.
Insurance denies cancer treatment
- Thread starter H. Lecter
- Start date
I do not know whether or not your Dad has a bad faith claim based on your post; but, I'd certainly recommend contacting an attorney familiar with these type issues as soon as possible. I'd suggest you contact Hans Poppe at The Poppe Law Firm. I believe he handles a decent amount of bad faith cases, and I think his office is in Louisville. 502-895-3400.
For obvious reasons I would not delay in seeking counsel.
For obvious reasons I would not delay in seeking counsel.
Insurance companies are the devil. To have a for profit corporation handling how much to pay for your health probably isn't the best setup, but hopefully all works out well for your dad.
Things like THIS is what obama should have fixed! If a dr says you NEED it, the insurance should have to pay!
While you are waiting on getting an attorney, it might be beneficial if you have the insurance company confirm in writing exactly why they are denying the treatment. Make them cite to the specific policy provision.
I would also request in writing (email, fax, whatever) a complete copy of his health plan language. I personally would make sure to tell them that you are asking for the actual plan language, and not the summary plan description.
I would also request in writing (email, fax, whatever) a complete copy of his health plan language. I personally would make sure to tell them that you are asking for the actual plan language, and not the summary plan description.
Thanks a bunch for the kind replies. My dad is 65 and we live in Louisville. Pretty sure my dad filed the appeals and doc spoke on his behalf. Everything that has been recommended I will make sure happens.
Sorry to hear that, Lecter. I agree with Chase that you should get the plan language and any documents re: your dad's claim in writing right away. I would also log everything at this point. Best of luck with the appellate process.
I've worked for an insurer, and have seen both sides of this. What does the policy say? Often people don't know or care about that, the thing is they have expenses and they expect the insurer to pay them. Which is kind of like me and you signing a contract for you to build me a $200,000 house, and then later I get really upset because you refuse to build a $500,000 house. On the other hand, sometimes the people making the denial decisions are hide-bound and stubborn. You get the sense they are used to people lying and cheating, and so they think they have to act that way to compete in the game. Almost like a cop who decides if he's going to catch the criminals, he'd be a fool to play by the rules.
The advice the OP has been given in this thread is good. Good luck to you. Horrible disease....have seen it first hand.
The advice the OP has been given in this thread is good. Good luck to you. Horrible disease....have seen it first hand.
First I sincerely hope HL's dad gets every treatment option he needs and is entitled to.
The problem with going after insurance companies legally is that they have staff attorneys on fixed salary whereas you are paying by the hour. They can basically "out-lawyer" you becasue they can afford to invest hundreds of hours whereas most regular folks can't. You might win and recover attorney fees but it's a gamble.
The problem with going after insurance companies legally is that they have staff attorneys on fixed salary whereas you are paying by the hour. They can basically "out-lawyer" you becasue they can afford to invest hundreds of hours whereas most regular folks can't. You might win and recover attorney fees but it's a gamble.
When an insurance company denies a treatment, they usually give a reason why (even if it's a vague reason). What did they tell you?
Also, what type of lung cancer is it and what type of chemo is your father on?
It's not unheard of - and it might even be standard practice - to do a limited run of radiation at first, to shrink the tumor(s), and then to continue on with chemo only (ideally to kill any remaining cancer cells that survived/escaped the radiation treatments).
Also, what type of lung cancer is it and what type of chemo is your father on?
It's not unheard of - and it might even be standard practice - to do a limited run of radiation at first, to shrink the tumor(s), and then to continue on with chemo only (ideally to kill any remaining cancer cells that survived/escaped the radiation treatments).
If OP's Dad has a legit bad faith case, his attorney is highly likely to take the case on a contingency fee basis, so he'd really have nothing to lose and everything to gain.
That's the way the system got into trouble years ago. Once doctors saw they could order a high priced treatment because you have a cold, insurance companies put together a team of doctors to determine if high priced treatment is necessary.
It's amazing to me that Americans put up with the the BS politicians and the approach to health care. Putting Insurance Companies, Drug Companies, and politicians in charge of your health care is beyond stupid. Some things in life have to be profitless and healthcare is the only one that affects everyone's. Why does health care cost so much less in other countries than in USA? Because these countries do not allow their governments to be run by lobbyists as is the norm in USA.
I am lucky. My wife is Taiwanese and we live here in Taiwan. My wife is a teacher and like everyone in Taiwan has government healthcare via health insurance. It costs $100 dollars a month for a family of 4. When you go to the doctor you pay them 100 Taiwan dollars which is 3 Bucks. That also includes dental. After your examination and you need any type drugs, you get it for free at the hospital. Now if you have a condition that require a special Doctor it's the same situation. The only difference is now your cost may be up to 500 Taiwan dollars which is less than $20 dollars.
This is not social medicine but an attempt of a country to provide good healthcare at reasonable prices. Doctors here are just as good as the ones in USA and like my doctor graduated from Southern Cal. So why is it cheaper? Easy answer. Doctors offices here are not full of big screen tvs, leather couches, and look like the medical palaces found in USA. Doctors here are dedicated to healthcare not how much they can make.
Profit has to be taken out of the equation and that means the drug companies and insurance companies and the government regulations. You can buy most drugs here other than narcotics over the counter at very low cost. I can buy my blood pressure medicine here that was prescribed to me in the states. I bought a years supply for what a month costs in USA. Every wonder why you prescription is good for only 3 months? It forces you to go back to the doctor so you have to pay for the visit.
Wake up.
I am lucky. My wife is Taiwanese and we live here in Taiwan. My wife is a teacher and like everyone in Taiwan has government healthcare via health insurance. It costs $100 dollars a month for a family of 4. When you go to the doctor you pay them 100 Taiwan dollars which is 3 Bucks. That also includes dental. After your examination and you need any type drugs, you get it for free at the hospital. Now if you have a condition that require a special Doctor it's the same situation. The only difference is now your cost may be up to 500 Taiwan dollars which is less than $20 dollars.
This is not social medicine but an attempt of a country to provide good healthcare at reasonable prices. Doctors here are just as good as the ones in USA and like my doctor graduated from Southern Cal. So why is it cheaper? Easy answer. Doctors offices here are not full of big screen tvs, leather couches, and look like the medical palaces found in USA. Doctors here are dedicated to healthcare not how much they can make.
Profit has to be taken out of the equation and that means the drug companies and insurance companies and the government regulations. You can buy most drugs here other than narcotics over the counter at very low cost. I can buy my blood pressure medicine here that was prescribed to me in the states. I bought a years supply for what a month costs in USA. Every wonder why you prescription is good for only 3 months? It forces you to go back to the doctor so you have to pay for the visit.
Wake up.
It is small cell. They gave the reason that the type of radiation the doc requested is usually administered in conjunction with chemo. The doc said chemo is no longer needed and 30 days of this specific radiation will be the most beneficial. You are correct because initial treatment was radiation first followed by chemo.
They are going to do a 3D radiation while continuing to appeal. Can't imagine how he feels thinking you have a year then being told things are looking good, lets aggressively do this and then told no!
Has your father gotten a second opinion on his treatment plan? I would strongly recommend that. Insurance should cover it. If the second opinion agrees with the first, then you know to fight the insurance. If the second opinion differs, then it gets even more complicated.
What medical group and/or hospital is he going to? I don't want you to name the specific doctor, but who is he seeing?
http://www.cancer.org/cancer/lungca.../small-cell-lung-cancer-treating-chemotherapy
"For people with extensive stage SCLC, chemo alone is usually the main treatment (although sometimes radiation therapy is given as well)."
"For people with extensive stage SCLC, chemo alone is usually the main treatment (although sometimes radiation therapy is given as well)."
So he had radiation on the lung but not for the brain tumor?
Generally if the chemo helps with the lung tumor it will also help with the tumor in the brain (assuming of course they're the same type of cancer).
But if there hasn't been any radiation done on the brain, it would seem to make sense to do that and to keep doing the chemo.
Without knowing all the details, I can't really say. But I do strongly recommend anybody in that situation (complex cancer) get a second opinion no matter what, even if there weren't issues with the insurance.