Insurance denies Life Saving Transplant

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• July 4, 2006 at 6:30 pm #13835
  SandyB

  Member

  My husband Mike has progressed to AML in a very short time. He has undergone Induction Chemo-therapy and was fortunate enough to gain “Complete Remission” after first round.

  Cigna Insurance placed us on a BMT program and was gracious enough to pay for some HLA testing for his siblings. No one matched.

  They then advised they would authorize a search in the Donor Transplant Bank.

  Now as the search goes on, and the great Dr.’s at the University of Indiana have proposed a Mini SCT, the nice folks at Cigna say they will not pay.

  Has anyone else had this problem?

  Please let me know. Our prayers are still with each of you.

  July 4, 2006 at 6:47 pm #13836
  Engel

  Member

  Sandy,
  My husband went from MDS to AML in a short time and was also lucky to be in complete remission. He just started Vidaza yesterday and again tomorrow, off 21 days and on for 7.BMT for us was out no siplings. Also we were told since my husband is 69 SCT would be out as of now. His hemo doc. seems to think the Vidaza will keep him in remission. Any one have other fews on this. Thanks, Gloria

  July 4, 2006 at 7:13 pm #13837
  geebeebee

  Member

  Sandy, did you get your doctors involved in the push? Also, a second opinion, if possible, might help. When my Mom had hers, she had two identical opinions from two different centers, and her doctor basically steamrolled the insurance company, and refused to take no for an answer.

  Insurance companies like to point out that it is an “experimental” procedure, but I think if you fight hard enough with your doctor at your side, you might make some headway.

  I wish you the best,

  Greg

  July 4, 2006 at 7:26 pm #13838
  PAG2005

  Member

  Hi Sandy,

  There is insurance topic on the Leukemia & Lymphoma discussion board that might help you. Here is the website… Pat
  http://www.leukemia-lymphoma.org/ubb.adp?frame_url=http://ubb-lls.leukemia-lymphoma.org/cgi-bin/ubbcgi/Ultimate.cgi?action=intro&item_id=9388

  July 4, 2006 at 7:44 pm #13839
  patti

  Member

  Sandy,

  I’m sorry to hear about Mike. I’d wondered where you went…

  There is an appeals process with insurance companies that I have found if pushed hard enough will usually give in. If Mike’s doctor is willing to help push you can get this covered. If you contact the insurance company and ask for the appeals department they will send you forms to fill out and start the process from there. A second opinion is very helpful. Just push and keep pushing.

  Sorry you are going through this right now.
  Take care.

  patti

  July 4, 2006 at 8:04 pm #13840
  Terri

  Member

  Sandy try and get a Case Manager assigned to help you through these Things, When BOb was just in the hospital I made sure we had one. I know our Insurance if need be will only pay at a Center of Excellence but where else would I want them to do it. The drs also say Bob would not be a candidate becuase of his age, no siblings and his other medical conditions. He was rushed back on Vidaza this past week, We get his counts tomorrow, its his 7th day and we will see if it helped.

  July 4, 2006 at 8:33 pm #13841
  Rackon

  Member

  Don’t take no for an answer.

  So sorry you have to through this, but don’t accept “no”. The first time you request approval insurance companies often deny SCTs. Don’t give up and talk to the case manager at IU (Indiana University – there is no U of I in the Hoosier state). If you ask, many docs have staff who can help you through the insurance process and get you the extra documentation.

  I just had a friend go through this a year or so ago. Keep pushing, get a second opinion, ask for an appeal. My friend finally got approved but it took extra effort and relentless pushing to get it done.

  July 5, 2006 at 5:12 am #13842
  lindajo

  Member

  Also check in your phone book for the state insurance department. They can help you with the process and tell you what the law is in your state. Good Luck

  July 5, 2006 at 3:27 pm #13843
  frank

  Participant

  From my experience with UnitedHealthcare, they don’t cover the mini_SCT at all, for unrelated SCT they only accept some place, like me the Duke University is the closer one, they don’t accept the search from Johns Hopkins… so you have to ask the insurence for where they covered, and how???

  for me, there are a nurse whom work for unitedhealthcare did tell me all these, and she warned me that Johns hopkins is not covered from my policy, so i stopped…

  Frank

  July 5, 2006 at 4:31 pm #13844
  Dennis

  Member

  In fairness to United Health Care, when I began this process they did say “whatever you need, get”.

  They also did have transplant centers they work with, but the list was so extensive it caused us no difficulty.

  The insurance company has been the least of our problems through my issues as well as my wifes.

  D

  July 11, 2006 at 11:37 am #13845
  SandyB

  Member

  Thank You all so much for your encouragemnt and information. It really is appreciated.

  We are still taking each day, one at a time, and being thankful to have it.

  July 11, 2006 at 11:55 am #13846
  sarah

  Member

  Sandy, keeping you both in my thoughts.

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