Ugh! Seriously? Insurance denied my brachytherapy radiation

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CAMommy
CAMommy Member Posts: 437
edited July 2015 in DCIS (Ductal Carcinoma In Situ)

got a call today that my insurance denied my brachytherapy radiation (5 day radiation). I'm so mad. We are moving across country this summer and this works timing wise otherwise I am going to have to do radiation in two different locations.

I am going to have my BS appeal but he's on vacation this week and his office is closed. Ugh.

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  • BrooksideVT
    BrooksideVT Member Posts: 2,211
    edited July 2015

    Perhaps your RO can appeal? Also, as there are difficulties in splitting your treatment between two facilities, do please address with your RO (and maybe MO), and also your insurance company, whether you would be better to simply have all your treatment in the new location.

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  • CAMommy
    CAMommy Member Posts: 437
    edited July 2015

    I think it would be better just to get it done in 1 week here. My RO was on of the Doctors that conducted the clinical trial for Mammosite so I'm sure he can talk to its benefits to the insurance doctor who denied me. This is just crazy. Like dealing with breast cancer isn't stressful enough. :/.

    How long can one wait to start radiation? My surgery is July 28th and we are hoping to move by end of August. Our house is on the market and we are hoping it sells quickly. Houses here see selling very fast but it's summer and everyone is on vacation.


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  • BrooksideVT
    BrooksideVT Member Posts: 2,211
    edited July 2015

    Well, you can't start rads until you've totally healed from your surgery, usually about four to six weeks, but sometimes longer. If your move is firmly planned for the end of August, I guess that would put you in the new location for rads, whether it's for one week or several. The reason I suggest vetting the possibility of splitting treatment between two locations is that this would require an entire new simulation, with completely new calculations, and a resultant delay in resuming treatment. My simulation and plan (treatments not included) cost over $28,000 a couple of years ago. Treatment started eleven days later. Either a rads department or an insurer might well balk at both the cost and the logistics of bilocation.

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  • CAMommy
    CAMommy Member Posts: 437
    edited July 2015

    maybe that extra cost will help my insurance see the light for the mammosite. My mammosite radiation wouldtake place 1 week after the surgery, you don't have the wait time like WBI. My move is not a firm date, depends on when we sell and go through escrow.

    I have feeling the denied it based on my age. 1 of the recommendations is women be over 50 (I'm 46) but three other recommendations say 40 or 45 is fine.


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  • BrooksideVT
    BrooksideVT Member Posts: 2,211
    edited July 2015

    I sure hope your insurance will rethink the mamosite rads. Meanwhile, please do have a real heart-to-heart with your current RO about location logistics, and also clarify with your insurer whether they would pay for two simulations.

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  • april485
    april485 Member Posts: 3,257
    edited July 2015

    Maybe they will pay for another option. I had external beam, partial breast rads in a clinical trial for 5 days, 2x a day at high doses. With DCIS, you are a good candidate for this I suspect. See if they have this option. My insurance did not balk at all and it was more $$ than traditional I believe but since it cut down the time, I jumped at it.

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  • CAMommy
    CAMommy Member Posts: 437
    edited July 2015

    my RO is a past president of the American Brachytherapy society,I'm hoping he will be able to convince the insurance.

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