Lani
07-09-2007, 11:50 PM
Bay Area Man Fights For Insurance To Cover Avastin
To Treat His Breast Cancer
By Carolyn Johnson
A North Bay man with breast cancer is taking on his insurance company for not providing him the same treatment they allow for women with the disease. While he fights for his life, he's also fighting against what he sees as gender discrimination.
Jack Seldner, breast cancer patient: "Physicians don't generally look for breast cancer in men, so they're caught at a later stage."
What Jack Seldner was told was likely a cyst in his chest, turned out to be cancer that had already spread to his lymph nodes, nearly three years later, scans found it had spread even more.
Jack Seldner: "They saw spots in liver lung and probably half a dozen spots on various bones."
His doctor decided to use Avastin -- a drug that stops blood supply to the tumor itself combined with chemotherapy to attack his metastasis breast cancer.
Jack Seldner: "the drug was listed in the oncology compendia index and therefore, at that point the infusion center started providing the drug."
When Jack received the first letter from Blue Cross denying coverage, he and his doctor assumed the decision would be reversed once more information was provided. Only about $2,000 men are diagnosed every year, but Avastin is used in women with advanced breast cancer, and jack was responding well to the treatments.
Jack Seldner: "After the fifth or sixth dose of the Avastin, those spots had pretty much been cleared with the exception of one spot on my spine. so the drug was working."
But despite a letter from his doctor describing the drug as medically necessary, Blue Cross continued to deny Avastin, calling it investigational.
Jack and the infusion center were now responsible for more than $100,000 dollars worth of treatment.
Jack Seldner: "They gave a long a long involved story that there were no studies in men, that the drug isn't approved."
But his own investigation found cancer centers throughout the country were treating women with Avastin and insurance was covering it; even his.
Jack Seldner: "I did some research and found that blue cross of California was actually reimbursing for Avastin being used in women for breast cancer. so all of a sudden, the issue about investigational didn't fly anymore."
Jack appealed his case to the department of managed health care where three independent physicians reviewed his case.
Two found Avastin was likely to be more beneficial for treatment of the patient's medical condition than any available standard therapy" and the health plan's denial should be overturned.
The third doctor disagreed, saying it Avastin was not likely to be more beneficial for treatment of the patient's medical condition" and the denial should be upheld.
Based on the split decision, the center for health dispute resolution ruled that blue cross should cover 6 of jack's 9 treatments.
He is no longer receiving Avastin, but he's not giving up in his efforts to right what he sees as a horrible wrong. Lifesaving treatment denied to him, simply because of his gender. He's concerned about other men facing breast cancer.
Jack Seldner: "I don't want them to have to go through the same thing in fighting for treatment that they should have access to, just as a woman would."
Jack is not giving up. He's hired an attorney and is taking his case to binding arbitration, as required by his health plan. Jack is hopeful the decision by the center for health dispute resolution will help his case. He still owes more than $40,000 dollars for the treatments that were denied. Blue Cross says since the case is in arbitration, it cannot be discussed.
To learn more about male breast cancer and Avastin, visit National Cancer Institute or The American Cancer Society
Copyright 2007, ABC7/KGO-TV/DT.
To Treat His Breast Cancer
By Carolyn Johnson
A North Bay man with breast cancer is taking on his insurance company for not providing him the same treatment they allow for women with the disease. While he fights for his life, he's also fighting against what he sees as gender discrimination.
Jack Seldner, breast cancer patient: "Physicians don't generally look for breast cancer in men, so they're caught at a later stage."
What Jack Seldner was told was likely a cyst in his chest, turned out to be cancer that had already spread to his lymph nodes, nearly three years later, scans found it had spread even more.
Jack Seldner: "They saw spots in liver lung and probably half a dozen spots on various bones."
His doctor decided to use Avastin -- a drug that stops blood supply to the tumor itself combined with chemotherapy to attack his metastasis breast cancer.
Jack Seldner: "the drug was listed in the oncology compendia index and therefore, at that point the infusion center started providing the drug."
When Jack received the first letter from Blue Cross denying coverage, he and his doctor assumed the decision would be reversed once more information was provided. Only about $2,000 men are diagnosed every year, but Avastin is used in women with advanced breast cancer, and jack was responding well to the treatments.
Jack Seldner: "After the fifth or sixth dose of the Avastin, those spots had pretty much been cleared with the exception of one spot on my spine. so the drug was working."
But despite a letter from his doctor describing the drug as medically necessary, Blue Cross continued to deny Avastin, calling it investigational.
Jack and the infusion center were now responsible for more than $100,000 dollars worth of treatment.
Jack Seldner: "They gave a long a long involved story that there were no studies in men, that the drug isn't approved."
But his own investigation found cancer centers throughout the country were treating women with Avastin and insurance was covering it; even his.
Jack Seldner: "I did some research and found that blue cross of California was actually reimbursing for Avastin being used in women for breast cancer. so all of a sudden, the issue about investigational didn't fly anymore."
Jack appealed his case to the department of managed health care where three independent physicians reviewed his case.
Two found Avastin was likely to be more beneficial for treatment of the patient's medical condition than any available standard therapy" and the health plan's denial should be overturned.
The third doctor disagreed, saying it Avastin was not likely to be more beneficial for treatment of the patient's medical condition" and the denial should be upheld.
Based on the split decision, the center for health dispute resolution ruled that blue cross should cover 6 of jack's 9 treatments.
He is no longer receiving Avastin, but he's not giving up in his efforts to right what he sees as a horrible wrong. Lifesaving treatment denied to him, simply because of his gender. He's concerned about other men facing breast cancer.
Jack Seldner: "I don't want them to have to go through the same thing in fighting for treatment that they should have access to, just as a woman would."
Jack is not giving up. He's hired an attorney and is taking his case to binding arbitration, as required by his health plan. Jack is hopeful the decision by the center for health dispute resolution will help his case. He still owes more than $40,000 dollars for the treatments that were denied. Blue Cross says since the case is in arbitration, it cannot be discussed.
To learn more about male breast cancer and Avastin, visit National Cancer Institute or The American Cancer Society
Copyright 2007, ABC7/KGO-TV/DT.