My insurance company, the federal employee Blue Cross Blue Shielf plan aka FEP Blue, denied the drugs for my combination therapy. They’ll pay for doxil without even a preauthorization necessary, but they denied authorization for both of the immunotherapy drugs. We went with Avastin over the cabozatinib hoping they’d approve it, but they didn’t.
So, now we appeal. It took a week for FEP Blue to send me the denial letter for the trametinib, and because it’s an oral drug, I have to be the one to file the appeal, so we couldn’t get started on that process until this week. The Avastin appeal has to be filed by #bestdocever and he didn’t get the denial until this week either. Because it’s not like it’s important to get this information quickly when the patient has terminal cancer.
I’m very grateful to have the team at Avera in my corner right now. Their patient advocate has written tons of these appeal letters, so she’s helping out with the appeal process. She’s also appling to Genentech (maker of Avastin) and Novartis (maker of trametinib) on my behalf to seek support via their patient assistance programs. I’m hopeful we’ll be able to get them to help without me going through the charade of legally divorcing my husband so I fit under their income caps.
Here’s the thing. When I look at the data on this treatment approach, and I see that the 30% of patients who couldn’t get combination therapy are all dead, and that 93% of the patients who got combination therapy are alive? Yeah, I don’t just see numbers. I see people. I see my friends. I see Michelle and Jill and Holley and Carolyn and Sarita and Adrian and Ishuan and Jean and Vickie and Jody and Maria and and and…and I think “What if they lived long enough for combination therapy? Would they be alive right now?”
I’m not gonna lie, I’m pretty depressed right now. I’m putting on a brave face most of the time, but it’s not fatigue keeping me in bed right now. It’s a sense that I’m fighting an uphill battle to stay alive. And I can’t help thinking, if it’s this hard for me, an attorney who knows how to navigate systems and has the ability to demand the best treatments, what hope is there for the broader cancer community to stay alive? What hope is there for my friends who are too sick to fight their insurance companies?
When healthcare decisions are made based on costs and not on saving lives, this is the outcome. We see it happening all over the world, not just here in the US–talk to anyone in the UK about how NICE has made it impossible for them to get access to the cutting edge drugs that are standard of care in the US. But here the disparities between rich and poor, between savvy and unsavvy consumers, feel particularly cruel and despicable. It especially hurts when you realize that the annual cost of my drugs is about the same as one day of pay for an insurance company CEO.
Does all this make you angry? Does it make you want to help? Good. It SHOULD make you angry. It SHOULD make you want to help. Here’s what I need from you. I want you to share this blog post around social media. Post it on the FEP Blue Facebook page. Tweet it at @fepblue on Twitter. And use the hashtag #SaveBeth.
Tell them what you think of their decision to deny me the combination therapy that could keep me alive long enough to see The Boy start middle school. Tell them what you think of their business model that puts profits ahead of patient lives. Tell them that I’m not ready to die. Tell them that I deserve to live. Beg them for my life.
5 thoughts on “Denial”
To make this even more abhorrent… if possible… is the fact that the insurance companies are continuing with record profits year after year.
This so wrong!! When a Doctor orders a prescription, I don’t think an Insurance Company should have any right denying the coverage for that Drug!!
I am so sorry that this battle is such an uphill fight for you!! It’s hard enough to give all your strength and energy to the cancer but to have to fight these corporations for life saving meds… the thought is incomprehensible! I have come to learn over the years it does not matter what it is that you need …either lifesaving or to fix something that is “broken” they don’t care unless they can charge 600% above cost and make you pay you won’t get it! My son requires an Epi pen and without the state ins we would be in a lot of financial trouble at $600+ every prescription… even after my ins kicks in for me my blood thinning meds are $400 a month… I would love for each of those a$$holes to be faced with this potentially life threatening situations so they know what they put people who NEED these medications have to go through!!! What it feels like to fight for your life!!!! And I work in the healthcare field and so many times I saw patients and helped them because they had no idea how to fight the ins co. What happens to those who dont know how?!? My prayers are with you that you can get that medication you need!!!!
ARGHHHHHHHHHHHH U Fing KIdding ME??? DONE!
rebecca timlin-scalera recently posted…Pinktober Wrap Up…The good, the bad, and the very, very sad
I’m gobsmacked. And so, so sorry… xoxo
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