Filing an appeal for denied coverage with your health insurer can be a bureaucratic mess even in simple cases, like coding errors. But for seriously ill patients, particularly those with late stage cancer who want to undergo new and perhaps unorthodox treatments, the hurdles can multiply, sometimes exponentially. As new cancer treatments like immunotherapy and proton beam therapy emerge, patients may face unexpected hurdles to get access to these treatments. That's because insurers, who operate under the premise of paying only for "standard of care," may routinely deny these out-of-the-ordinary treatments, creating miles of red tape in an appeal. For seriously ill patients, the clock is ticking. Plus, they may be too sick to fight for themselves. That may leave it up to family members and other caretakers to understand how the appeals process works. Here's a preliminary roadmap. Going beyond standard treatment Seriously ill patients may have already exhausted standard treatment for … [Read more...] about Seriously ill? Coverage denied? Here’s what you can do
Why insurance companies deny coverage
Ashley Summers said she got an unpleasant surprise in February when she tried to pick up a prescription for her rheumatoid arthritis: Her pharmacy said her insurance had been canceled, even though her premiums were paid. Summers called Blue Shield of California and got her policy reinstated — then she said it happened again in March and this time, the lapse in coverage dragged on for three months. Without insurance to cover her medications and doctor visits, her arthritis and fibromyalgia worsened to the point that she could barely walk, she said. In June, she said, the state granted her permission to switch to another insurer. “This entire mess has been so incredibly stressful,” said Summers, 49, a personal assistant in Los Angeles who had paid $593 a month in premiums. “For Blue Shield just to pull the plug like this is infuriating.” Around the state, consumers with individual Blue Shield policies, like Summers, say they have been subject to sudden, … [Read more...] about A Black Eye For Blue Shield: Consumers Lash Out Over Coverage Lapses
Updated 4:28 AM ET, Wed August 15, 2018 Boston (CNN)Kate Weissman sits at the edge of the patient table. Her oncologist goes over her medical records and says her most recent scans show no recurrence of cervical cancer. "I am remarkably happy," says Dr. Whitfield Growdon, a surgical oncologist who specializes in personalized care at Massachusetts General Hospital. Weissman perks up and claps her hands. "Two years," she says. "We made it two years." "It's amazing," Growdon responds. "It really is." At 33, Weissman is lean, athletic and strong -- a powerful example of cancer survival. Looking at her, it's nearly impossible to comprehend the battle she endured, whether it was her hair falling out or wondering whether she would live. She says she underwent 55 rounds of radiation, 17 rounds of chemotherapy and surgery to remove cancerous lymph nodes. Read More Her battle was twofold: the fight for her life and the fight with her insurance company, UnitedHealthcare. Weissman was … [Read more...] about When insurance wouldn’t pay, parents funded cancer patient’s $95,000 lifesaving treatment
Residents of towns damaged by wildfires may need to prepare for another repercussion: insurers that decide to cancel policies because of increased risks from more frequent fires. Facing mounting losses, some property insurers are reportedly pulling back from selling policies in California and other western states where wildfire risk is elevated. In California alone, damages had mounted to at least $12 billion by early 2018, while the state's Carr fire likely added another $1.5 billion in insured losses. The tinderbox conditions in California were already dangerous in January when Insurance Commissioner Dave Jones warned of the "growing problem" of fire insurance unavailability within the state. Now an additional 17 fires are burning throughout the state, including the Carr fire, which has forced 3,800 people to evacuate and scorched nearly 1,000 homes. California Gov. Jerry Brown has called such conditions "the new normal," with more than two million of the state's … [Read more...] about California’s fires are creating another problem: Fleeing insurers
Story highlights 8 million babies have been born as a result of IVF, but it's mostly seen as elective 12% of American women have difficulty becoming pregnant or carrying a pregnancy to term (CNN)Before I began the process of in-vitro fertilization, I, quite foolishly, thought of it as outsourcing. We can't make a baby ourselves, so now these wonderful doctors are going to try to make one for us. But believing that IVF is like outsourcing is like believing that one of those allegedly simple, do-it-yourself home renovation projects will really only take a couple of hours. Materials have be meticulously sourced, created and combined, and the smallest misstep can send you back to the very beginning of the process. There are regular early morning visits to the doctor's office, where blood is drawn and vaginal ultrasounds are administered -- often by perfect strangers. There are giant boxes of syringes, needles, powders and diluents sent directly to your house, and you -- who has … [Read more...] about 40 years later, why is IVF still not covered by insurance?