Please take time to read this, any help or knowledge would be greatly appreciated. Sincerely Melinda Smith Beverly Harmon-Jodka Recently I told you that my son had surgery and the mass of cancer was removed. I used the word cancer free when I thanked so many of you for prayers, support, and positive thoughts. Im sure you knew that I was more optimistic than informed. For this reason I am posting, emailing and phoning to everyone about his current need for radiation. If he had months to wait, he could wait and appeal and appeal for insurance coverage of the proton radiation he needs, but he does not have that time. The doctors wrote a lengthy appeal, but it is not uncommon to be refused and be required to continue appealing. David does not have the luxury of time; he needs the radiation asap. His cancer is too close to the brain to risk traditional radiation. PLEASE TAKE THE TIME TO READ the following posting from my daughter, Meghan, of Davids plea for your help. Until now we have kept Davids cancer off Facebook or anywhere even semi-public to protect his 93 year old grandmother from hearing about his health. She knows now, and there may be someone or some piece of information we need to get insurance coverage for David. HELP is too weak a word. .......................... November 18 ......................... Okay Facebook friends - I got the go ahead from my brother to post his information here in the hopes that many of you will share it to your pages and maybe, just maybe someone will be able to help. Its not a short story - and I know you are all busy, but if you would take 5 minutes to read and share, I would really be forever grateful. My brother, David, was diagnosed with cancer on October 1st - since then he has had surgery and now is preparing for radiation and chemo. He is 43 years old, and has four beautiful children ages 7,5,3 and 2. He and my sister-in-law are the most amazing people, so positive, and strong. Thank you in advance Here is his story- As you know from our last post, we were awaiting insurance approval for the proton radiation, hoping that that would happen quickly so that we could move on to the next steps...unfortunately, thus far that hasnt happened and we have been denied the option for proton radiation therapy... Below is additional information, as well as an appeal for any assistance that anyone may be able to give... As always, thank you for ALL your support, love, energy, thoughts, prayers, etc...keep it coming! xoxo Cigna outsources the majority of the review and approval process for cancer treatments to CareCore National. We have gone through all three stages with CareCore: Initial review, peer to peer phone call between Dr Chan and a CareCore physician and then a final appeal. We were denied during the first step and that denial was upheld through the next two steps. None of my physicians were surprised by the denial as CareCore simply reviews and reiterates Cigna’s existing policies - which made the three step process brutally long and frustrating. The next step is to make an appeal directly with Cigna, which is where we are today. This is really our last hope to gain approval for proton beam treatment. As such, we are writing this to ask if anyone has any connections at Cigna who you think can influence our situation. We are trying to pull out all of the stops on top of the assistance we are getting from MGH & Schroders (Bevs note: Mass General Hospital and Davids firm = David leading new Boston location = London & New York established =his employer). If you have any ideas or know anybody who can help - we would greatly appreciate it. We are in the process of filing all of the paperwork with Cigna and will have a case number tomorrow. My cancer is a rare, aggressive type of cancer. As you all know the tumor was/is located in my sinus which presents many challenges in that it is close to critical parts such as my left eye and the base of my brain. As a result, our radiologist, Dr. Annie Chan and the entire oncology team at MGH, feel it is important that we use Proton beam treatment. The advantage of the proton treatment is not that it is more effective, but more that it is thought to have less of a “spillover” effect and therefore reduces the risk that the tissue/organs around the targeted area will be hit with radiation. Possible effects of radiation on unintended areas likes eyes etc could be loss of sight, brain damage or potentially causing a new cancer down the line. Cigna does have a position paper on proton beam therapy on their website, which states that they do approve the approach for certain types/locations of cancer - just not mine. This is mostly due to the fact that my cancer is rare, and proton beam therapy is relatively new - put those together and it makes it easier to be denied due to lack of supporting research. Plus as you have probably guessed, it’s expensive. Obviously I feel strongly that we go in the direction that our world class doctors believe hold the best chance for a cure and quality of life. It is frustrating to think that there is even a question on coverage for my situation, but we continue to be focused on what we can do. Thank you for all the support that you have sent and continue to send our way - every single bit of it helps. Understanding that contacts within the big insurance machine are unlikely - please just add an additional thought or prayer for us tomorrow and next week as we work through this part of the process, bringing attention to a rare but critical form of cancer. All the best, Dave and Kathleen Like · · Unfollow Post · 4 minutes ago Seen by 1
Posted on: Mon, 18 Nov 2013 19:36:44 +0000
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