Author: Gloria Dunetz
March 3, 2009
My husband and I have been members of Blue Cross/Blue Shield for over 40 years, most of those years healthy. For the most part Government Blue Cross/Care First has paid our medical bills albeit painfully slow. Doctors in some case wait 6-9 months to receive payment.
Of late the insurance companies are pushing back in paying for life saving treatments even with clear evidence of medical necessity. I am now a victim of this arbitrary treatment by my insurance company and will have to go through a protracted process of dispute to justify payment for a years treatment that saved my life.
Last year I was prescribed a chemo cocktail of Abraxane and Avastin. Blue Cross has recentlty denied payment for the Avastin drug which was approved by the FDA for Breast Cancer over a year ago. This drug combo has worked over the last 14 months and responded as prescribed to the science of Molecular Profiling and targeted therapy. The Spark protien was identified as the culprit that had to be dealt with by chemo.
My husband and I are presently in dispute in order to get my Oncologist paid for the treatment. I am bitterly angry about the fact that a medical insurance company dictates which drugs I can have and which drugs I can’t simply by calling the drug experimental (as they have done with Avastin). I think patients have to be more aggressive dealing with their medical insurance companies and with the pharmaceutical companies that charge extraordinary amounts of money for their medicines.
If someone out there has found a way to argue this case with the government please email me. I need help!