Has anyone fought the insurance company?

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cathylee1234
cathylee1234 Member Posts: 1
edited June 2014 in Middle Age 40-60(ish) Years Old With Breast Cancer

I am filing an appeal with Regence in Washington state. They will not pay for brachytherapy treatment out of network in Arizona. Two oncologists in network said I was not a candidate - the size of the tumor was outside the current guidelines. I found the pioneer of the technicque who, after my visit to him in Arizona, said he had no problem doing brachytherpy on me. He wrote a letter but Regence denied. I am trying to find any cases where the insurance company has paid for out of network treatment for brachytherapy. I don't need names, I just need some details to put into my appeal - the point is to let them know I know they have paid for other cases. I will go without any more treatment rather than go through whole breast radiation, but the insurance company does not care about that. The irony of this whole thing is that the company I work for allows me to change insurance plans each year, and in January I can change to a plan that will allow me to go to Arizona. But I just had my second surgery and the radiation optimum window won't get me to January! Thanks for any assistance you can provide ...

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  • dlb823
    dlb823 Member Posts: 9,430
    edited August 2010

    cathylee ~ Not the same procedure, but if you use the search feature @ upper right and look for posts by Dutchy, you will see her story.  She was denied DIEP reconstruction multiple times but continued to appeal all the way to an independent medical review board, and eventually won.  It might be worth reading her posts, which are primarily in a thread that's entitled, UCLA for Diep, Anyone Else?  Hope this helps some, and good luck!    Deanna

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  • Medigal
    Medigal Member Posts: 1,412
    edited August 2010

    cathylee, You said you will be changing insurances in January but the radiation optium window won't get you to January.  I have battled it out for other charges with insurance companies to get them to undo their errors and I can assure you it can take months!  They will keep putting you off that you may be in January before you get them to change their opinions (if they do).  However, I have not read Dutchy's case.  If might be in your best interests to check it out and just see how long it took her to "eventually" win.  She may not have been on your same time limit.  Best of luck to you!

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  • flash
    flash Member Posts: 1,685
    edited September 2010

    Have you tried contacting the insurance commissioner of your state?  The insurance company has to answer to the commissioner and that office may have some info. 

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