nickysfight's Cancer Blog

May 9, 2008

Book recommendation: “Fight Your Health Insurer and Win, Secrets of the Insurance Warrior” by Laurie Todd

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Mom had her CT Scan today. She is meeting with Dr. Kane Tuesday to discuss the results and we hope they are good and gives us the green light for the 2nd study we need for approval for the SIR-Spheres (the shunt study).

We are still worried about getting insurance approval for the SIR-Sphere procedure. The doctors mentioned SEVERAL times that we would not be able to get the procedure without insurance approval. The high cost of the procedure is due to the large medical team required, the radioactive nature of the procedure and the radioactive beads themselves which are flown in all the way from Australia on a case by case basis. However, Dr. Durham did say that the SIR-Spheres are becoming the “standard procedure” for metastatic colorectal cancer and is becoming widely accepted for this purpose by most insurance companies. It is ALWAYS approved by Medicare for treatment for metastatic colorectal cancer. It’s use for other types of cancers has not been accepted as readily so we are lucky in that respect. To increase our chances of insurance approval, we are reading “Fight Your Health Insurer and Win, Secrets of the Insurance Warrior” by Laurie Todd. It is a How To book on what to do if you are denied treatment due to a denial of coverage by your health insurer. It covers who you need to contact in such a situation, how to format your letters, what to say, evidence/studies you need to provide etc.

Don’t get me wrong, Aetna has been very, very good to us thus far and we are optimistic that they will approve the SIR-Sheres procedure. And maybe I’ve just seen to many Michael Moore documentaries! Sicko REALLY freaked me out and made me very suspicious of health insurance companies. However, we want to be as prepared as possible…… just in case!