HER2 Support Group Forums - View Single Post - Insurance Company Does Not Want to approve TYKERB

Jackie07 · 10-09-2009, 02:12 PM

Sheila,

I hope things are improving. Your situation reminded me the frustration I had to get a special contract from my insurance company almost 20 years ago.

My neurologist told me he would only recommend a certain neurosurgeon in town (affiliated with a hospital not covered by my insurance company) to do my brain surgery (ended up to be a 23-hour operation.)

I called my insurance company about the situation - I cried, I threatened, I pleaded, to no avail (couldn't even pass the operator) I was very fortunate to have a library director back then who had had quite some legal experience and got me a lawyer who had just won the Texas Young Lawyer of the Year award.

I remember the sleepless nights. The neurosurgeon, who happened to be of my same ethnic background and had been introduced to me (but I was already dating my husband)when he first moved to town, checked on me right away the day of my diagnosis (he took my call while he's in the operation room when I had told his secretary that it's an emergency - and we waited 3 hours before he finished that surgery and was able to see me.)

Later, while we were struggling with getting hold of the insurance company, he told us that 'they should pay' (I asked him if we should go the 'fundraising' route) and told us to go to the ER if certain signs appear.

Things will work out, now I believe - just a matter of time and stategy [we did not have to sue for the special contract - my boss was able to talk to the VP of the insurance company and persuaded him to OK our request. And to this day she still thinks that I should have sued my family doctors.] I hope (and believe) your situation will be taken care of soon. (It's a good sign that your oncologist is working on the appeal.)

10-09-2009, 02:12 PM	#31
Jackie07 Senior Member Join Date: Jan 2008 Location: "Love never fails." Posts: 5,808	Re: Insurance Company Does Not Want to approve TYKERB Sheila, I hope things are improving. Your situation reminded me the frustration I had to get a special contract from my insurance company almost 20 years ago. My neurologist told me he would only recommend a certain neurosurgeon in town (affiliated with a hospital not covered by my insurance company) to do my brain surgery (ended up to be a 23-hour operation.) I called my insurance company about the situation - I cried, I threatened, I pleaded, to no avail (couldn't even pass the operator) I was very fortunate to have a library director back then who had had quite some legal experience and got me a lawyer who had just won the Texas Young Lawyer of the Year award. I remember the sleepless nights. The neurosurgeon, who happened to be of my same ethnic background and had been introduced to me (but I was already dating my husband)when he first moved to town, checked on me right away the day of my diagnosis (he took my call while he's in the operation room when I had told his secretary that it's an emergency - and we waited 3 hours before he finished that surgery and was able to see me.) Later, while we were struggling with getting hold of the insurance company, he told us that 'they should pay' (I asked him if we should go the 'fundraising' route) and told us to go to the ER if certain signs appear. Things will work out, now I believe - just a matter of time and stategy [we did not have to sue for the special contract - my boss was able to talk to the VP of the insurance company and persuaded him to OK our request. And to this day she still thinks that I should have sued my family doctors.] I hope (and believe) your situation will be taken care of soon. (It's a good sign that your oncologist is working on the appeal.) __________________ Jackie07 http://www.kevinmd.com/blog/2011/06/doctors-letter-patient-newly-diagnosed-cancer.html http://www.asco.org/ASCOv2/MultiMedi...=114&trackID=2 NICU 4.4 LB Erythema Nodosum 85 Life-long Central Neurocytoma 4x5x6.5 cm 23 hrs 62090 semi-coma 10 d PT OT ST 30 d 3 Infertility tmts 99 > 3 u. fibroids > Pills CN 3 GKRS 52301 IDC 1.2 cm Her2 +++ ER 5% R. Lmptmy SLNB+1 71703 6 FEC 33 R Tamoxifen Recc IIB 2.5 cm Bi-L Mast 61407 2/9 nds PET 6 TCH Cellulitis - Lymphedema - compression sleeve & glove H w x 4 MUGA 51 D, J 49 M Diastasis recti Tamoxifen B. scan Irrtbl bowel 1'09 Colonoscopy 313 BRCA1 V1247I hptc hemangioma Vertigo GI - > yogurt hysterectomy/oophorectomy 011410 Exemestane 25 mg tab 102912 ~ 101016 stopped due to r. hip/l.thigh pain after long walk DEXA 1/13 1-2016 lesions in liver largest 9mm & 1.3 cm onco. says not cancer. 3-11 Appendectomy - visually O.K., a lot of puss. Final path result - not cancer. Start Vitamin D3 and Calcium supplement （600mg x2) 10-10 Stopped Exemestane due to r. hip/l.thigh pain OKed by Onco 11-08-2016 7-23-2018 9 mm groundglass nodule within the right lower lobe with indolent behavior. Due to possible adenocarcinoma, Recommend annual surveilence. 7-10-2019 CT to check lung nodule. 1-10-2020 8mm stable nodule on R Lung, two 6mm new ones on L Lung, a possible lymph node involvement in inter fissule. "I WANT TO BE AN OUTRAGEOUS OLD WOMAN WHO NEVER GETS CALLED AN OLD LADY. I WANT TO GET SHARP EDGED & EARTH COLORED, TILL I FADE AWAY FROM PURE JOY." Irene from Tampa Advocacy is a passion .. not a pastime - Joe Last edited by Jackie07; 10-22-2009 at 10:24 AM..