Frustrated with Insurance Companies! Advice?

Hey Jenn,

Ugh!  Don't worry too much.  As you know we have the same team treating us, and I've been reassured throughout that they "know what to say", and obviously carry a lot of weight.  This may be yet another reason we all need to be in the care of specialists.  I failed ipi, and keytruda, before being approved for the combo so it definitely can be done.  I'm in the Blue Shield system as well.  Hopefully the combo will deliver and you can kick this bad-boy to the curb.

Gary

Hey Jenn,

Ugh!  Don't worry too much.  As you know we have the same team treating us, and I've been reassured throughout that they "know what to say", and obviously carry a lot of weight.  This may be yet another reason we all need to be in the care of specialists.  I failed ipi, and keytruda, before being approved for the combo so it definitely can be done.  I'm in the Blue Shield system as well.  Hopefully the combo will deliver and you can kick this bad-boy to the curb.

Gary

Hey Jenn,

Ugh!  Don't worry too much.  As you know we have the same team treating us, and I've been reassured throughout that they "know what to say", and obviously carry a lot of weight.  This may be yet another reason we all need to be in the care of specialists.  I failed ipi, and keytruda, before being approved for the combo so it definitely can be done.  I'm in the Blue Shield system as well.  Hopefully the combo will deliver and you can kick this bad-boy to the curb.

Gary

Hang on in there Jenn.

They are soooooo wrong an appeal is surely in the bag .. but understand the anxiety that delays and admin bullshit  bring.

Really good that Gary has given you the lead that it can and has been approved in this system. Know this might sound daft but I might be tempted to say that if you don't get a higher level review fast you will take the campaign to facebook and social media as a 30 day wait is just not acceptable.

So frustrating for you . Hugs and good wishes

Deb

Hang on in there Jenn.

They are soooooo wrong an appeal is surely in the bag .. but understand the anxiety that delays and admin bullshit  bring.

Really good that Gary has given you the lead that it can and has been approved in this system. Know this might sound daft but I might be tempted to say that if you don't get a higher level review fast you will take the campaign to facebook and social media as a 30 day wait is just not acceptable.

So frustrating for you . Hugs and good wishes

Deb

Hang on in there Jenn.

They are soooooo wrong an appeal is surely in the bag .. but understand the anxiety that delays and admin bullshit  bring.

Really good that Gary has given you the lead that it can and has been approved in this system. Know this might sound daft but I might be tempted to say that if you don't get a higher level review fast you will take the campaign to facebook and social media as a 30 day wait is just not acceptable.

So frustrating for you . Hugs and good wishes

Deb

UGH! Reading things like this really pi$$es me off.  

I am so sorry you are going through this. This "physician advisor" probably has no clue even what melanoma is and is probably reading from a sheet of paper.

I recall seeing a Facebook post on this type of situation a while back: 

1. Call the insurance company and tell them you want to speak with the "HIPAA Compliance/Privacy Officer" (By federal law, they have to have one)
2. Then ask them for the NAMES and CREDENTIALS of every person accessing your record to make that decision of denial. By law you have a right to that information.
3. They will almost always reverse the decision very shortly rather than admit that the committee is made of low paid HS graduates, looking at "criteria words," making the medical decision to deny your care. Even in the rare case it is made by medical personnel, it is unlikely it is made by a board certified doctor in that specialty and they DO NOT WANT YOU TO KNOW THIS!
4. Any refusal [to comply with such a request for documentation] should be reported to the US Office of Civil Rights (OCR.gov) as a HIPAA violation.

I don't know if this holds any water, but it can't hurt to try what it states. 

UGH! Reading things like this really pi$$es me off.  

I am so sorry you are going through this. This "physician advisor" probably has no clue even what melanoma is and is probably reading from a sheet of paper.

I recall seeing a Facebook post on this type of situation a while back: 

1. Call the insurance company and tell them you want to speak with the "HIPAA Compliance/Privacy Officer" (By federal law, they have to have one)
2. Then ask them for the NAMES and CREDENTIALS of every person accessing your record to make that decision of denial. By law you have a right to that information.
3. They will almost always reverse the decision very shortly rather than admit that the committee is made of low paid HS graduates, looking at "criteria words," making the medical decision to deny your care. Even in the rare case it is made by medical personnel, it is unlikely it is made by a board certified doctor in that specialty and they DO NOT WANT YOU TO KNOW THIS!
4. Any refusal [to comply with such a request for documentation] should be reported to the US Office of Civil Rights (OCR.gov) as a HIPAA violation.

I don't know if this holds any water, but it can't hurt to try what it states. 

UGH! Reading things like this really pi$$es me off.  

I am so sorry you are going through this. This "physician advisor" probably has no clue even what melanoma is and is probably reading from a sheet of paper.

I recall seeing a Facebook post on this type of situation a while back: 

1. Call the insurance company and tell them you want to speak with the "HIPAA Compliance/Privacy Officer" (By federal law, they have to have one)
2. Then ask them for the NAMES and CREDENTIALS of every person accessing your record to make that decision of denial. By law you have a right to that information.
3. They will almost always reverse the decision very shortly rather than admit that the committee is made of low paid HS graduates, looking at "criteria words," making the medical decision to deny your care. Even in the rare case it is made by medical personnel, it is unlikely it is made by a board certified doctor in that specialty and they DO NOT WANT YOU TO KNOW THIS!
4. Any refusal [to comply with such a request for documentation] should be reported to the US Office of Civil Rights (OCR.gov) as a HIPAA violation.

I don't know if this holds any water, but it can't hurt to try what it states. 

Your onc office most DEFINITELY has delt with this before. They’ll know how to appeal and get it approved. So now’s the time to put your helmet on and advocate for yourself LOUDLY and with a little pushing and shoving, you’ll get there!!

Hang in there, girl! It’s a very stupid hurdle, but you’ll be past it soon!
Lauren

Your onc office most DEFINITELY has delt with this before. They’ll know how to appeal and get it approved. So now’s the time to put your helmet on and advocate for yourself LOUDLY and with a little pushing and shoving, you’ll get there!!

Hang in there, girl! It’s a very stupid hurdle, but you’ll be past it soon!
Lauren

Your onc office most DEFINITELY has delt with this before. They’ll know how to appeal and get it approved. So now’s the time to put your helmet on and advocate for yourself LOUDLY and with a little pushing and shoving, you’ll get there!!

Hang in there, girl! It’s a very stupid hurdle, but you’ll be past it soon!
Lauren

Sorry for this, we know their position is illogical so i hope your doctor office can fix quickly, am sure will be sorted out

wishing and praying will be sorted out

thanks for all your great posts advice and support

Sorry for this, we know their position is illogical so i hope your doctor office can fix quickly, am sure will be sorted out

wishing and praying will be sorted out

thanks for all your great posts advice and support

Sorry for this, we know their position is illogical so i hope your doctor office can fix quickly, am sure will be sorted out

wishing and praying will be sorted out

thanks for all your great posts advice and support

When I read the reply from Linny it made me think of the scene from the Movie the Incredibles, where Mr. Incredible helps the little old lady beat the Insurance company. If you need a good laugh, look up the movie and see how similiar it is to your situation. Best wishes!!!Ed

When I read the reply from Linny it made me think of the scene from the Movie the Incredibles, where Mr. Incredible helps the little old lady beat the Insurance company. If you need a good laugh, look up the movie and see how similiar it is to your situation. Best wishes!!!Ed

When I read the reply from Linny it made me think of the scene from the Movie the Incredibles, where Mr. Incredible helps the little old lady beat the Insurance company. If you need a good laugh, look up the movie and see how similiar it is to your situation. Best wishes!!!Ed

Sorry, Jenny.  Frustrating doesn't even begin to cover it, does it???  In August, BCBS denied my brain MRI because:  "…your MRI of the brain….was only supported once a year for the first 5 years after your skin disease was found."  WHAT?????  Stage IV melanoma patient here – post brain mets!!!  SKIN disease????  Well, damn!  I lived more than 5 years after the diagnosis of my "skin disease"!!!!  Hang in there.  It sucks.  It is wrong.  But, I'm sure your onc can appeal and get your treatment covered.  It took a couple of appeals for my scan..but it finally was covered by the current inhabitants of Isengard!  Don't know how it will go if I live one more year!  Hmmm…  Keep us posted.  Sorry you are having to deal with this on top of everything else!!  c

Sorry, Jenny.  Frustrating doesn't even begin to cover it, does it???  In August, BCBS denied my brain MRI because:  "…your MRI of the brain….was only supported once a year for the first 5 years after your skin disease was found."  WHAT?????  Stage IV melanoma patient here – post brain mets!!!  SKIN disease????  Well, damn!  I lived more than 5 years after the diagnosis of my "skin disease"!!!!  Hang in there.  It sucks.  It is wrong.  But, I'm sure your onc can appeal and get your treatment covered.  It took a couple of appeals for my scan..but it finally was covered by the current inhabitants of Isengard!  Don't know how it will go if I live one more year!  Hmmm…  Keep us posted.  Sorry you are having to deal with this on top of everything else!!  c

Sorry, Jenny.  Frustrating doesn't even begin to cover it, does it???  In August, BCBS denied my brain MRI because:  "…your MRI of the brain….was only supported once a year for the first 5 years after your skin disease was found."  WHAT?????  Stage IV melanoma patient here – post brain mets!!!  SKIN disease????  Well, damn!  I lived more than 5 years after the diagnosis of my "skin disease"!!!!  Hang in there.  It sucks.  It is wrong.  But, I'm sure your onc can appeal and get your treatment covered.  It took a couple of appeals for my scan..but it finally was covered by the current inhabitants of Isengard!  Don't know how it will go if I live one more year!  Hmmm…  Keep us posted.  Sorry you are having to deal with this on top of everything else!!  c

What a crock of s$&!!! Just the fact that they're putting you through this stress. Did any of these clowns look at the data? Pisses me off that they send that, lot of nerve. Even if you fail ipi then PD-1 you can have a response to combo. What a bunch of asses. Hopefully your onc' office is on it right away.

PS- I'm on my 3rd go around with ipi and that's after I clearly didn't respond to the 3 doses I did in July/August and it got approved for 4 doses for the trial I'm in.

Sorry you have to deal with this, you should be thinking only of whipping this craps a$$ not being aggravated by inept fools "communicating the insurance company script." Praying for great results!!!

Josh

What a crock of s$&!!! Just the fact that they're putting you through this stress. Did any of these clowns look at the data? Pisses me off that they send that, lot of nerve. Even if you fail ipi then PD-1 you can have a response to combo. What a bunch of asses. Hopefully your onc' office is on it right away.

PS- I'm on my 3rd go around with ipi and that's after I clearly didn't respond to the 3 doses I did in July/August and it got approved for 4 doses for the trial I'm in.

Sorry you have to deal with this, you should be thinking only of whipping this craps a$$ not being aggravated by inept fools "communicating the insurance company script." Praying for great results!!!

Josh

What a crock of s$&!!! Just the fact that they're putting you through this stress. Did any of these clowns look at the data? Pisses me off that they send that, lot of nerve. Even if you fail ipi then PD-1 you can have a response to combo. What a bunch of asses. Hopefully your onc' office is on it right away.

PS- I'm on my 3rd go around with ipi and that's after I clearly didn't respond to the 3 doses I did in July/August and it got approved for 4 doses for the trial I'm in.

Sorry you have to deal with this, you should be thinking only of whipping this craps a$$ not being aggravated by inept fools "communicating the insurance company script." Praying for great results!!!

Josh

I feel for you Jenn… This is horrible and I support you in everything you'll do to get your treatment. In a much different fashion, I struggle too here in Canada… But nothing compares to what you are going through.

Hang in there! You are in my prayers!

I feel for you Jenn… This is horrible and I support you in everything you'll do to get your treatment. In a much different fashion, I struggle too here in Canada… But nothing compares to what you are going through.

Hang in there! You are in my prayers!

I feel for you Jenn… This is horrible and I support you in everything you'll do to get your treatment. In a much different fashion, I struggle too here in Canada… But nothing compares to what you are going through.

Hang in there! You are in my prayers!