I've Run Out of Words for OUTRAGE

Yesterday, a 36-year-old woman who has metastatic breast cancer e-mailed me and asked for my help. 

Her story is all too common, which is why the head on this post is "I've run out of words for OUTRAGE." However, even if I've run out of ways to express my outrage, I haven't run out of the outrage itself, thank goodness.

Here's her story: Megan Jones is her name. She is 36, as I said, and lives in Pasedena, California. She has metastatic breast cancer, which has spread to the liver, bones, pleural cavity, and brain. Her cancer is HER2neu-positive like mine.

She has been on Herceptin, plus Taxotere and carboplatin. And a recent PET scan showed that this regimen has reduced the lesions in her liver, and stabilized the ones in her bone and body. However, the brain mets are growing. 

So her doctor wants her to go on Tykerb (another of my drugs) and also have stereotactic radiation to her brain.   But her health insurance plan is REFUSING to pay for either the Tykerb or the stereotactic radiation to the brain. The insurance plan is California Blue Shield, and they should be ashamed of themselves. 

Megan writes, "... my insurance co. has denied Tykerb (since I'm on Herceptin and not Xeloda) and they've denied stereotactic brain radiation--the kind that can be done again and again and pinpoints the lesions--but they've approved whole brain radiation (which I could only receive once, and has higher risk for cognitive impairment)."

So now we have health insurance plans--NOT DOCTORS--deciding what treatment patients with metastatic cancer should receive? 

Megan asked for my help, and I suggested that she challenge her health insurance company's decision. She should ask her doctor to write a letter explaining the medical need for Tykerb and the medical need for the radiation treatment he or she is recommending. 

I suggested she ask her doctor to fax the letter, to speed things up, and that she get a copy and keep a file of all correspondence. Plus notes on any phone conversations. 

An aside here, when you are dealing with a health insurance plan, get EVERYTHING in writing. Something said on the phone can always be denied later. 

Then, I said, if that doesn't work, I think she should make the biggest stink she is capable of. And I plan to help her do that. 

I mean, here is a woman who is 36, who has a life expectancy, I would guess, of 40 or 50 years, and her insurance company wants her to get a cheaper treatment than what her doctor thinks is best? 

That sound you hear is me, breaking plates to get rid of my anger!

@ Jeanne Sather 2009. 

Comments

[Lorilei]

I am shaking my head... How dare these A-hole jerk pencil pushers decide over and above a MD, what is medically sound????? I can only hope that when the day comes, and it will, that the pencil pusher idiot gets the same sort of compassion for themselves or their loved one in the hospital system!!!

[Lisa Saunders]

How about if you had a Co. that you worked for,10 years after you were told you had Hep C that denied you coverage,then tried to fix their mistake without you knowing it. And if thats not bad enough, now out of work can not get work in this state,because that Co. does not want to be held responsible for the Docs malpratice, I dont know what is happening with my own health,and may loose my home. I'am widow with 14 year old who has lived her own nightmare,about loosing Mom.God Help us all..