Well, after 5+ years of battling, I am just now having to fight my first real battle with insurance. I should be grateful, but I'm not. I'm kind of pissed off. I get why they are fighting us, but this is my LIFE we are talking about.
They denied the Temodar (the brain cancer chemo). They denied the original request, which we expected. They have also denied the appeal. And, now, they aren't allowing my doctor to take it to the next level, which is a peer-to-peer discussion (where he has the chance to talk with an MD working for the insurance company).
In the meantime, Dr. K. has put a request into my insurance company to get me approved for Regorafenib, which is the only other FDA-approved colon cancer chemotherapy that we haven't tried. However, this is a process, too. They put the script in, and it gets denied. Then, they have to send it through for a pre-authorization, and hopefully, they approve it.
Ideally, Dr. K. wants me on the Temodar, but because that process may take a while, the Regorafenib would at least put me on some form of chemotherapy until the Temodar gets approved.
Because the Temodar got denied on the appeal, they (CTCA) are going to fight to get this appealed again. In the meantime, my care manager Vickie mentioned that it might be worth my while to make a few phone calls to my insurance company to move things along, so to speak. Apparently, there have been a few times where, in this kind of situation, a patient conversation with the insurance company can help convince them. So, I'm running to CTCA today to grab a copy of the paperwork that was submitted to the insurance company. I'll look it over this weekend, so I can speak intelligently about this, and on Tuesday, it's so ON!!!
Prayers, mojo, etc. welcome for this process. Of the two, Dr. K. wants me on the Temodar, so if you're the praying, mojo-ing, good vibe-ing kind of person, please put those good energies towards the approval of the Temodar.