› Forums › General Melanoma Community › Insurance Denial – Need advice – Help
- This topic has 36 replies, 6 voices, and was last updated 10 years, 7 months ago by
killmel.
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- October 8, 2013 at 4:49 pm
Hi all,
I am writing on behalf of a friend. Unfortunately she currently does not have a computer but she contacted me requesting that I try and help her find some information. It is very hard for her to search as she only has access to the internet through her phone.
I will try and obtain more information as you ask questions as I do not know much about melanoma and the exact details of her most recent tests. Here is what I know:
In 2001 she had and was treated for Melanoma. She has been disease free. Recently she noticed inflammed lymph nodes. She had a biopsy and the tests show melanin in her lymph nodes. The doctor submitted a request for a PET scan but her insurance denied it. She wants to fight the insurance but her doctor says it is useless to fight. He wants to follow her every three months until they can find the tumor. I told her to fire the doctor and find another one that will fight for her. Her current doctor says her diagnoses is pending but will be either metastatic malignant melanoma without a primary source since it could have come from her malignant melanoma in 2001 or it could be from another current undetected malignant melanoma.
She is a fighter and won't give up and definately does not want to give this disease a three month head start. I am hoping that someone can give advice on how to fight the insurance company on the PET scan and then also the best doctor to go to in the Southern California area. Any help, adivce or just even supportive words is greatly appreciated. This friend is very dear to me and helped me through some of the toughest times of my life. I want to repay her and I can't imagine life without her here.
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- October 8, 2013 at 6:55 pm
I would think scans are pretty standard at this point. Does she have Kaiser Permanente insurance? Because that alone may change who she can see and why she is being denied. Most doctors will usually go to bat for their patients. Is her current doctor a melanoma specialist or just a general oncologist? Again, that might make a difference. Even without the scan question, typically they might remove all the lymph nodes in the area. And again, before they do that type of surgery, it makes sense to know if it has spread elsewhere (hence the scans). There is no reason to do an invasive surgery if the disease is more widespread and she might need some type of system approach. Scans really are the standard protocol at this point – and that is even at institutions who don't regularly scan if you have no disease. So I think it's well worth the fight, but the doctor (melanoma specialist) and insurance (Kaiser yes/no) can make a difference in the type of fight.
Janner
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- October 8, 2013 at 6:55 pm
I would think scans are pretty standard at this point. Does she have Kaiser Permanente insurance? Because that alone may change who she can see and why she is being denied. Most doctors will usually go to bat for their patients. Is her current doctor a melanoma specialist or just a general oncologist? Again, that might make a difference. Even without the scan question, typically they might remove all the lymph nodes in the area. And again, before they do that type of surgery, it makes sense to know if it has spread elsewhere (hence the scans). There is no reason to do an invasive surgery if the disease is more widespread and she might need some type of system approach. Scans really are the standard protocol at this point – and that is even at institutions who don't regularly scan if you have no disease. So I think it's well worth the fight, but the doctor (melanoma specialist) and insurance (Kaiser yes/no) can make a difference in the type of fight.
Janner
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- October 8, 2013 at 7:51 pm
Hi Jenner,
Thanks for responding. I believe it is just a regular Oncologist she is seeing. She had been going to him as he was really good with her grandmother when she was being treated. Her insurance is United Healthcare PPO (funny you asked because I just asked her the same question earlier this morning). I did some research this morning and found the UC Irvine Health Chao Family Comprehensive Cancer Center in La Jolle, Ca. I told her she needs to give them a call. Looked like they had some good docs that specialize in melanoma and have some trials going for metastatic melanoma. As far as the lymph node removal I have to confirm with her, I was in a kind of shock when I spoke with her last night, but I believe that numerous lymph nodes are affected in various locations. I remember her mentioning her abdomen and her groin at a minimum. Seems like I remember her neck and under arms too. She didn't mention which ones they biopsied. I will have to ask.
I do know she has an appointment with an internists on the 17th. She is hoping that he can piece stuff together and spend a little time with her. She is grasping at anything and hoping that someone will say she doesn't have an expiration date and it isn't a hopeless cause.
She did mention that if her doctor wasn't going to fight the insurance that she was going to take on the battle. She mentioned that she was going to need three documented cases showing that PET scan was the best way to find the tumor in cases where melanin in the lymph nodes was present. That is the next step in my research for her. But I feel she will have a much better advantage if she works with a doctor that is proactive in her care. I can't believe that he wants her to wait three months!! I also found a clinical trial at Washington University School of Medicine in St. Louis, Mo that is doing fPAM imaging study for individuals that have a history of State I-III melanoma (which she had in 2001). She was going to call today on it. I sure hope she qualifies and they take her.
Again, thank you for you input. Every little thing helps!!
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- October 8, 2013 at 7:51 pm
Hi Jenner,
Thanks for responding. I believe it is just a regular Oncologist she is seeing. She had been going to him as he was really good with her grandmother when she was being treated. Her insurance is United Healthcare PPO (funny you asked because I just asked her the same question earlier this morning). I did some research this morning and found the UC Irvine Health Chao Family Comprehensive Cancer Center in La Jolle, Ca. I told her she needs to give them a call. Looked like they had some good docs that specialize in melanoma and have some trials going for metastatic melanoma. As far as the lymph node removal I have to confirm with her, I was in a kind of shock when I spoke with her last night, but I believe that numerous lymph nodes are affected in various locations. I remember her mentioning her abdomen and her groin at a minimum. Seems like I remember her neck and under arms too. She didn't mention which ones they biopsied. I will have to ask.
I do know she has an appointment with an internists on the 17th. She is hoping that he can piece stuff together and spend a little time with her. She is grasping at anything and hoping that someone will say she doesn't have an expiration date and it isn't a hopeless cause.
She did mention that if her doctor wasn't going to fight the insurance that she was going to take on the battle. She mentioned that she was going to need three documented cases showing that PET scan was the best way to find the tumor in cases where melanin in the lymph nodes was present. That is the next step in my research for her. But I feel she will have a much better advantage if she works with a doctor that is proactive in her care. I can't believe that he wants her to wait three months!! I also found a clinical trial at Washington University School of Medicine in St. Louis, Mo that is doing fPAM imaging study for individuals that have a history of State I-III melanoma (which she had in 2001). She was going to call today on it. I sure hope she qualifies and they take her.
Again, thank you for you input. Every little thing helps!!
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- October 8, 2013 at 7:51 pm
Hi Jenner,
Thanks for responding. I believe it is just a regular Oncologist she is seeing. She had been going to him as he was really good with her grandmother when she was being treated. Her insurance is United Healthcare PPO (funny you asked because I just asked her the same question earlier this morning). I did some research this morning and found the UC Irvine Health Chao Family Comprehensive Cancer Center in La Jolle, Ca. I told her she needs to give them a call. Looked like they had some good docs that specialize in melanoma and have some trials going for metastatic melanoma. As far as the lymph node removal I have to confirm with her, I was in a kind of shock when I spoke with her last night, but I believe that numerous lymph nodes are affected in various locations. I remember her mentioning her abdomen and her groin at a minimum. Seems like I remember her neck and under arms too. She didn't mention which ones they biopsied. I will have to ask.
I do know she has an appointment with an internists on the 17th. She is hoping that he can piece stuff together and spend a little time with her. She is grasping at anything and hoping that someone will say she doesn't have an expiration date and it isn't a hopeless cause.
She did mention that if her doctor wasn't going to fight the insurance that she was going to take on the battle. She mentioned that she was going to need three documented cases showing that PET scan was the best way to find the tumor in cases where melanin in the lymph nodes was present. That is the next step in my research for her. But I feel she will have a much better advantage if she works with a doctor that is proactive in her care. I can't believe that he wants her to wait three months!! I also found a clinical trial at Washington University School of Medicine in St. Louis, Mo that is doing fPAM imaging study for individuals that have a history of State I-III melanoma (which she had in 2001). She was going to call today on it. I sure hope she qualifies and they take her.
Again, thank you for you input. Every little thing helps!!
-
- October 8, 2013 at 6:55 pm
I would think scans are pretty standard at this point. Does she have Kaiser Permanente insurance? Because that alone may change who she can see and why she is being denied. Most doctors will usually go to bat for their patients. Is her current doctor a melanoma specialist or just a general oncologist? Again, that might make a difference. Even without the scan question, typically they might remove all the lymph nodes in the area. And again, before they do that type of surgery, it makes sense to know if it has spread elsewhere (hence the scans). There is no reason to do an invasive surgery if the disease is more widespread and she might need some type of system approach. Scans really are the standard protocol at this point – and that is even at institutions who don't regularly scan if you have no disease. So I think it's well worth the fight, but the doctor (melanoma specialist) and insurance (Kaiser yes/no) can make a difference in the type of fight.
Janner
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- October 8, 2013 at 8:45 pm
Hi,
I suggest that your friend see a Melanoma Specialist.
In Southern CA, I HIGHLY recommend Dr. Steven O'Day at the Beverly Hills Cancer Center. Dr. O'Day is a world renowned melanoma specialist who has specializing in research & caring for melnoma specialist for years.
He has been my doctor for over 10 yrs. He is kind and really cares about his patients. He can provide your friend with "state of the art" of treatment.
Her is the link to BH Cancer Center:
http://www.bhcancercenter.com/
Dr. O'day does respond to his emails if you want to email him. His email address is [email protected]
The Beverly Hills Cancer Center
8900 Wilshire Blvd
BH,CA 90211
310-432-8900FYI, I did go to Choa Canter Center too, and I was just treated like a "number" because the Center is huge and like a hospital.
Good Luck to you friend.
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- October 8, 2013 at 8:45 pm
Hi,
I suggest that your friend see a Melanoma Specialist.
In Southern CA, I HIGHLY recommend Dr. Steven O'Day at the Beverly Hills Cancer Center. Dr. O'Day is a world renowned melanoma specialist who has specializing in research & caring for melnoma specialist for years.
He has been my doctor for over 10 yrs. He is kind and really cares about his patients. He can provide your friend with "state of the art" of treatment.
Her is the link to BH Cancer Center:
http://www.bhcancercenter.com/
Dr. O'day does respond to his emails if you want to email him. His email address is [email protected]
The Beverly Hills Cancer Center
8900 Wilshire Blvd
BH,CA 90211
310-432-8900FYI, I did go to Choa Canter Center too, and I was just treated like a "number" because the Center is huge and like a hospital.
Good Luck to you friend.
-
- October 8, 2013 at 8:45 pm
Hi,
I suggest that your friend see a Melanoma Specialist.
In Southern CA, I HIGHLY recommend Dr. Steven O'Day at the Beverly Hills Cancer Center. Dr. O'Day is a world renowned melanoma specialist who has specializing in research & caring for melnoma specialist for years.
He has been my doctor for over 10 yrs. He is kind and really cares about his patients. He can provide your friend with "state of the art" of treatment.
Her is the link to BH Cancer Center:
http://www.bhcancercenter.com/
Dr. O'day does respond to his emails if you want to email him. His email address is [email protected]
The Beverly Hills Cancer Center
8900 Wilshire Blvd
BH,CA 90211
310-432-8900FYI, I did go to Choa Canter Center too, and I was just treated like a "number" because the Center is huge and like a hospital.
Good Luck to you friend.
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- October 8, 2013 at 9:05 pm
THANK YOU!!! I will pass on the info ASAP!!!!
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- October 8, 2013 at 9:05 pm
THANK YOU!!! I will pass on the info ASAP!!!!
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- October 8, 2013 at 9:05 pm
THANK YOU!!! I will pass on the info ASAP!!!!
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- October 9, 2013 at 5:35 pm
Just wanted to let you know I passed on Dr. O'Day's info to my friend. She contacted him via e-mail and has already been received a response and is in contact with his care coordinator Robert. She was instructed to send all her records, imaging, and labs over to them this morning. THANK YOU so much for the information. This has given her hope that someone cares and that she isn't just supposed to accept her fate. You have given her a path to follow. I feel strongly that you have given her the information that will save her life. You have my undying gratitude!
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- October 9, 2013 at 5:35 pm
Just wanted to let you know I passed on Dr. O'Day's info to my friend. She contacted him via e-mail and has already been received a response and is in contact with his care coordinator Robert. She was instructed to send all her records, imaging, and labs over to them this morning. THANK YOU so much for the information. This has given her hope that someone cares and that she isn't just supposed to accept her fate. You have given her a path to follow. I feel strongly that you have given her the information that will save her life. You have my undying gratitude!
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- October 9, 2013 at 5:35 pm
Just wanted to let you know I passed on Dr. O'Day's info to my friend. She contacted him via e-mail and has already been received a response and is in contact with his care coordinator Robert. She was instructed to send all her records, imaging, and labs over to them this morning. THANK YOU so much for the information. This has given her hope that someone cares and that she isn't just supposed to accept her fate. You have given her a path to follow. I feel strongly that you have given her the information that will save her life. You have my undying gratitude!
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- October 11, 2013 at 3:46 pm
I am happy that I could help. I am glad you have hope. Dr. O'day will never give up on your friend. He will do whatever it takes to keep her alive and well. Dr. O'day is a wonderful, caring doctor and a foremeost authority on treating melanoma. Your friend is in good hands.
I have a appointment with Dr. O"day next week. What is your friends first name so that I can mention to Dr. O'Day so that I referred him to her? I do not know but maybe that will help her get an appointment quicker with him.
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- October 11, 2013 at 3:46 pm
I am happy that I could help. I am glad you have hope. Dr. O'day will never give up on your friend. He will do whatever it takes to keep her alive and well. Dr. O'day is a wonderful, caring doctor and a foremeost authority on treating melanoma. Your friend is in good hands.
I have a appointment with Dr. O"day next week. What is your friends first name so that I can mention to Dr. O'Day so that I referred him to her? I do not know but maybe that will help her get an appointment quicker with him.
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- October 11, 2013 at 9:21 pm
She has an appointment November 4th!!. Please private message and I will be happy to give you her name. Since thid forum isn’t private I don’t feel comfortable posting her name. Again thank you so much for the referral!!! -
- October 11, 2013 at 9:21 pm
She has an appointment November 4th!!. Please private message and I will be happy to give you her name. Since thid forum isn’t private I don’t feel comfortable posting her name. Again thank you so much for the referral!!! -
- October 11, 2013 at 9:21 pm
She has an appointment November 4th!!. Please private message and I will be happy to give you her name. Since thid forum isn’t private I don’t feel comfortable posting her name. Again thank you so much for the referral!!! -
- October 11, 2013 at 3:46 pm
I am happy that I could help. I am glad you have hope. Dr. O'day will never give up on your friend. He will do whatever it takes to keep her alive and well. Dr. O'day is a wonderful, caring doctor and a foremeost authority on treating melanoma. Your friend is in good hands.
I have a appointment with Dr. O"day next week. What is your friends first name so that I can mention to Dr. O'Day so that I referred him to her? I do not know but maybe that will help her get an appointment quicker with him.
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- October 9, 2013 at 3:17 am
This is UHC protocol for PET
Pages: 548, 552, 553
I don't know if it will help any, United Healthcare is tough.
Cynthia
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- October 9, 2013 at 3:17 am
This is UHC protocol for PET
Pages: 548, 552, 553
I don't know if it will help any, United Healthcare is tough.
Cynthia
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- October 9, 2013 at 3:17 am
This is UHC protocol for PET
Pages: 548, 552, 553
I don't know if it will help any, United Healthcare is tough.
Cynthia
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- October 11, 2013 at 1:46 am
Time to get an insurance “bad faith” trial lawyer on the team. Getting a letter saying the lawyer is putting a suit on them for you usually runs your case to upper echelons in insurance companies, and they usually give in in life threatening situations.
Look up “insurance bad faith claims” and see the huge damages they incur for this type of conduct. The jury is allowed to assess punitive damages to teach them a lesson. I helped many this way in the 30 years I was an active trial lawyer. -
- October 11, 2013 at 1:46 am
Time to get an insurance “bad faith” trial lawyer on the team. Getting a letter saying the lawyer is putting a suit on them for you usually runs your case to upper echelons in insurance companies, and they usually give in in life threatening situations.
Look up “insurance bad faith claims” and see the huge damages they incur for this type of conduct. The jury is allowed to assess punitive damages to teach them a lesson. I helped many this way in the 30 years I was an active trial lawyer. -
- October 11, 2013 at 1:46 am
Time to get an insurance “bad faith” trial lawyer on the team. Getting a letter saying the lawyer is putting a suit on them for you usually runs your case to upper echelons in insurance companies, and they usually give in in life threatening situations.
Look up “insurance bad faith claims” and see the huge damages they incur for this type of conduct. The jury is allowed to assess punitive damages to teach them a lesson. I helped many this way in the 30 years I was an active trial lawyer. -
- October 11, 2013 at 2:55 pm
Hi!!
I'm so glad that someone mention the Angeles Clinic to you as an option.
I'm not personally a patient of Dr. O'Day, but I see him in the halls when I go see my oncologist, Dr. Hamid, who is WONDERFUL. I've been seeing him for about 4 years now (I think?) and he goes above and beyond, just as everyone there does. I actually got referred there when my Melanoma Specialist I had at City of Hope left to go do research and head up the melanoma board in Seattle. So, they're good. And I'm SO glad you contacted them. :]
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- October 11, 2013 at 2:55 pm
Hi!!
I'm so glad that someone mention the Angeles Clinic to you as an option.
I'm not personally a patient of Dr. O'Day, but I see him in the halls when I go see my oncologist, Dr. Hamid, who is WONDERFUL. I've been seeing him for about 4 years now (I think?) and he goes above and beyond, just as everyone there does. I actually got referred there when my Melanoma Specialist I had at City of Hope left to go do research and head up the melanoma board in Seattle. So, they're good. And I'm SO glad you contacted them. :]
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- October 11, 2013 at 2:55 pm
Hi!!
I'm so glad that someone mention the Angeles Clinic to you as an option.
I'm not personally a patient of Dr. O'Day, but I see him in the halls when I go see my oncologist, Dr. Hamid, who is WONDERFUL. I've been seeing him for about 4 years now (I think?) and he goes above and beyond, just as everyone there does. I actually got referred there when my Melanoma Specialist I had at City of Hope left to go do research and head up the melanoma board in Seattle. So, they're good. And I'm SO glad you contacted them. :]
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