insurance denying radioembolization
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Byron, I would hope your doctor would present your case aggressively to BC/BS’s medical director. Y90 has been used for quite a few years and is not considered especially novel now. If you get much more stalling, I would consider getting some media involvement to plead your case. I can’t believe BC/BS of Utah is that different from other locations.
Percy, thank you for the kind comments about the radio program. It’s unique and has had a growing audience and growing sponsorship. I just hope Kim has the continuing energy to keep it up.
Ed & Percy, the result of the Y90 was for a total of 15 small lesions, 12 became dormant and three stable (no size growth). Percy, the person I’m referring to is Kim, who you heard on the show. If you go to the Let’s Talk Cancer public FB page and Kim’s Krusaders , a public FB group, you can contact Kim if you would like more info. She is very open, especially with cc patients. Send her a FB friend invitation (Kim Cirucci).
Byron,
I searched PubMed for these terms:
cholangiocarcinoma radioembolization
bile duct cancer radioembolization
biliary cancer radioembolizationThis is what I found:
Trans-arterial (90)yttrium radioembolization for patients with unresectable tumors originating from the biliary tree
http://www.ncbi.nlm.nih.gov/pubmed/21677339Transarterial hepatic yttrium-90 radioembolization in patients with unresectable intrahepatic cholangiocarcinoma: factors associated with prolonged survival
http://www.ncbi.nlm.nih.gov/pubmed/2143197018F-FDG PET independently predicts survival in patients with cholangiocellular carcinoma treated with 90Y microspheres
http://www.ncbi.nlm.nih.gov/pubmed/21308371Radioembolization in the Treatment of Unresectable Liver Tumors: Experience Across a Range of Primary Cancers
http://www.ncbi.nlm.nih.gov/pubmed/21127414Radioembolization of liver tumors with yttrium-90 microspheres
http://www.ncbi.nlm.nih.gov/pubmed/20113679Yttrium-90 radiotherapy for unresectable intrahepatic cholangiocarcinoma: a preliminary assessment of this novel treatment option
http://www.ncbi.nlm.nih.gov/pubmed/19876691Treatment of unresectable cholangiocarcinoma using yttrium-90 microspheres: results from a pilot study
http://www.ncbi.nlm.nih.gov/pubmed/18759346Regional infusion-radioembolization
http://www.ncbi.nlm.nih.gov/pubmed/18722928All of these articles were published in “peer reviewed medical literature”.
I can’t access the full text of the articles AND I’m not a doctor. So I can’t tell whether any of these articles prove the efficacy of radioembolization for treating CC.
It would be very prudent to show these articles to your radiation oncologist before forwarding them to your insurance company. You don’t want to give your insurance company MORE ammunition to support their position.
EDIT:
Found two more articles via Goodle Scholar:
Yttrium-90 Radioembolization(SIR-Spheres) for Cholangiocarcinoma: Preliminary Study
http://www.jvir.org/article/S1051-0443%2808%2901410-3/fulltextRadioembolization (Yttrium-90 Microspheres) for Primary and Metastatic Hepatic Malignancies
http://journals.lww.com/journalppo/Abstract/2010/03000/Radioembolization__Yttrium_90_Microspheres__for.12.aspxHi, Jim ,
Same for me here, I research a lot on radioembolization but few actual experience testimony by patients;
BTW, the radio talk show is a great way to give cholangio CA more awareness .
Thanks
God bless.Jim,
If you don’t consider it private information…can you let us know how you friend has done since November with the radioembolization?
EdByron,
I am in the middle of the process right now. I should hear from the insurance company soon. We have been getting support from Sirtex, the maker of the spheres. They seem to have some insights in how to discuss with the insurance companies.
EdHope it gets approved soon. Just keep calling and don’t let up. We went through with the insurance denying my dad’s treatment a month ago. He has now had the “mapping” and should be scheduled for the radioembolization next week. Insurance did not want to approve it, but after the dr appealed they did approve it. He has bc/bs. Doctors from the University of Kentucky are providing his care. I wish I could give you more information. Let me know if you have any other questions.
My policy states 1, that anything “experimental or investigational” is not covered.
It also states, 2, that any health product or service whose effectiveness is unproven based on clinical evidence reported in peer-reviewed medical literature” is considered to be experimental or investigational.They claim that this procedure has no “peer reviewed medical literature” supporting its efficacy for treating cholangiocarcinoma. Now, if I had Hepatocellular Carcinoma, it would be a different story.
I guess my original post was asking if anyone knows if there DOES exist any peer reviewed medical literature about the efficacy of Yttrium-90 microspheres and cholangiocarcinoma.
OK, I’m quite familiar with Y90, as a close friend had it last November, and I can assure you that’s not experimental AND was fully covered w/o any issues by her BC/BS insurance.
I’m quite puzzled at the issurers to saying that. Sounds like they are trying to weasel out of paying by claiming that the procedure is ‘experimental’.
Jim, radioembolization is different from RFA. In this procedure they, through the use of a catheter going in through the femoral artery, inject Yttrium-90 coated microspheres into the hepatic artery where they lodge in the blood vessels of the tumors. The tumors then get a high dose of radiation leaving the healthy liver tissue mostly untouched.
It looks like if it is going to take a while to get approval, we will start with chemoembolization………..the same procedure except that the microspheres are coated with chemo (probably gemzar) instead of Yttrium-90. The chemo get confined mostly to the tumors instead of being introduced systemically throughout your body.
If this is what’s also known as RFA (Radio Frequency Ablation), it’s NOT experimental and has been used for a number of years for cc patients. I think the ‘experimental’ tag happens pretty often with cc, bc there are so relatively few cases per year and bc of that they call a lot of procedures for cc patients ‘experimental’. There are ways of making insurers do things in the “American” way.
Good luck getting the right treatment.
Yeah, the doc is trying, but they are balking. May have to start with chemoembolization first although the Doc would prefer the other first.
Byron…the radiation oncologist should be able to provide the information to the insurance company.
Hugs and love,
MarionByron:
I can’t help you there, but I hope they cover it without too much fuss. Tell them you really really like having CC and can’t WAIT to try another procedure. Maybe sarcasm will work?? :rolleyes:
So far my insurance has covered most, but lately I’ve noticed my onc visits are a lot more than my $50 deductible. I need to find out what’s up myself.Kris
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