nicole
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nicoleSpectator
Thank you all so much for the helpful information. We have sent in our appeal to the Board of Insurance and we are waiting to hear if they will approve an Independent Medical Review. Thanks again! Every little bit of information is helpful and greatly appreciated!
Nicole
nicoleSpectatorG,
That is so crazy! My dad also received the SIRT – Y90 treatment at UCSD (Dr. Rose) where he has been a patient since his diagnoses in 2005. What a small world!
Since we have already received the second denial letter, we are now forced to file a formal appeal. In an effort to show that Blue Cross has paid for this treatment in the very recent past, would you mind if my parents used your case as a reference in their fight? Here is my direct email address so that you may contact me there in order to maintain privacy.
You have no idea how excited my parents were when I told them that I found someone with Blue Cross who not only had the treatment and had it covered, but also had the treatment at the same facility.
You have been extremely helpful, and anything that you can provide is appreciated more than you know.
Thank you again,
NicolenicoleSpectatorHello Glightfoot,
Thank you so much for your reply. If you don’t mind me asking, what state are you in? Also, was there anything special that you did to get Blue Cross to cover the treatment? Any information that you can give me is so greatly appreciated!
Thank you,
NicolenicoleSpectatorBill,
You have been more help than you know! I am so grateful to have met you on here.
Thank you so much, and I wish the best for you and your wife!
Nicole
nicoleSpectatorThank you so much for this information! Everything helps at this point!
Thanks again,
NicolenicoleSpectatorHello,
My father recently had the SIRT – Y90 treatment, and it seems to really be working well. The vessels that feed the tumors in his liver are shrinking, therefore decreasing the chances of the tumors getting any larger.
Here’s the problem. My dad has Blue Cross. They initially denied coverage of this treatment stating it was “too new” of a treatment and that there weren’t enough successful cases to prove it is worth is basically.
The doctors told my dad to go ahead with the treatment, pay for it, then they would send a letter to the isurance company appealing the denial in order to get my dad reimbursed. My dad paid close to $100,000 out of his pocket with the expectation of reimbursement.
Yesterday, we received the second denial letter. This letter now states that we will have to submit an appeal to the Insurance Commission. It also states that he is only eligible to even be considered to an appeal if he would have died without this treatment.
I am desperately trying to research or locate any cases where Blue Cross, or any other insurance company, has covered this treatment.
I feel for you, as I know the struggle you are going through. You just have to keep fighting the fight. I know I will. I’m not going to stop until I get the answer that I’m looking for. It’s hard enough for my parents to deal with the pain and heartache that this disease brings…it’s just not right for insurance companies to make the struggle twice as hard.
Do not give up!
Nicole
nicoleSpectatorSara,
Thank you so much for posting this article! This information is a huge help to me, seeing as how we are fighting Blue Cross right now.
Thanks again!
Nicole
nicoleSpectatorBill,
Thank you so much for your reply. It is so comforting to hear of the success your wife has had so far with this treatment.
You said that your insurance company covered the treatment with no problems, do you mind me asking what insurance you have?
My dad had the treatment, but had to pay close to $100,000 out of his pocket, in hopes that his second request for coverage would be approved since the doctor sent a letter.
We have just received the second denial and now have to go to appeal the Insurance Commission. I am trying to research cases where Blue Cross (which is what my dad has), or any other insurance companies have covered this treatment in order to help assist in the appeal. The appeal paperwork we received states that we are only eligible for appeal if my father would have died if not for this treatment. I’m sure the doctor’s will attest to that, but I want to cover all my basis just to be safe.
Thank you again for everything!
Nicole
nicoleSpectatorHi Katia,
Here is a little bit of info that I was able to find on SIRT Y90:
Yttrium-90 (Y-90) radioembolization, also known as selective internal radiation therapy (SIRT), is a regional hepatic therapy used in the treatment of unresectable colorectal cancer (CRC) liver metastases. In SIRT, Y-90 impregnated microspheres are injected into the VASCULAR SUPPLY of hepatic tumor, leading to selective irradiation and necrosis of tumor TISSUE,” scientists in the United States report.
“While several studies demonstrate improved local control and survival with SIRT, the specific indications for this therapy have yet to be defined. Typically, SIRT is given in combination with chemotherapy as multimodal treatment for unresectable hepatic CRC. However, it has also found increasing use as a salvage therapy in chemo-refractory patients. -
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