In a fit of pique

After going  around and around with the insurance company, I finally wrote them a letter.  Here is the first draft, names have been changed to keep me from being sued by these blood suckers.

To whom it may concern,

I am greatly concerned with the lack of care which has been taken with my case. The finger pointing has got to stop. 

1.       I was first diagnosed with Melanoma in March 2009.  My Surgical Oncologist took the margins March 4^th, 2009.  At that time, the dye did not drain to a lymph node so none was taken.

2.       I was again diagnosed with Melanoma in October of 2012.  My doctor ordered a PET/CT scan which was denied by <insurance company> 11 October 2012, the day before I was scheduled for the PET/CT scan.  The woman on the phone showed little care that I was facing a potentially deadly disease.  She was merely given the odious task of letting me know that <insurance company> felt the PET/CT scan was unwarranted.  She had no answers for me so she forwarded me to the Nursing staff to answer my questions.  The nurse I spoke with was not impressed with my desire to rid myself of the cancerous tumor growing within me.  She said the PET scan was not covered for Melanoma.  I asked at that time for the <insurance company> Standard of Care documentation and was informed by the afore mentioned nurse that she did not have time to forward said document to me as she was only there to take calls and answer questions. 

3.       I repeatedly requested this document over the course of several weeks.  I even enlisted the assistance of my HR director to forward the request for me. 

4.       We appealed this decision and were once again denied, I was told that my Dr. would have to do a Peer to Peer review. 

5.       At this point it had been several weeks and I still had a deadly cancer growing in my right arm.  I did not feel there was time to wait on the <insurance company> appeals process to have it removed.  I elected to get the PET/CT scan so that I could schedule surgery and have the tumor removed.

6.       The PET/CT scan showed that the tumor was confined to my upper right arm so we went ahead and scheduled the surgery. 

7.       My Dr.’s staff applied for and received approval for surgery.  I went to MCV for surgery October 24^th to have the tumor removed and to have a sentinel node biopsy.  The surgery went well.  The tumor ended up being in a lymph node in my upper arm but the sentinel node was clear.

8.       I have since been informed that <insurance company> would indeed not approve the PET/CT scan and have lost the appeals. 

9.       I have had several meetings with the <insurance company> Sales people who represent our company.  I had informed Ms. Insurance Rep in October that I had still not received the <insurance company> Standard of Care.  I informed her of the treatment I had received over the phone with the <insurance company> Nurse.  She informed me that she would indeed look into my case.  A few days later she called me and apologized for the lack of care I had received.  She indicated that she had spoken with the nursing supervisor who said that the nurse I had spoken with did not take my request seriously.  Apparently she thought I was a prank call?  Or maybe she was having a bad day and I drew the short straw?  I neither know nor care.  This treatment is unacceptable.  During this phone call she did inform me where I could find the <insurance company> standard of care on the <insurance company> website.  This took all of 5 minutes.  Why the nurse couldn’t direct me thusly, I have no idea.  Ms. Insurance Rep also indicated that she would further check on my case.  I also received a hard copy of the <insurance company> Standard of Care in the mail November 12^th, 2012. 

10.    I did finally receive my final rejection letter for coverage from <insurance company> November x, 2012.  The National Coalition of Cancer Network Standard of Care was cited in the letter.  However, when I looked up the NCCN Standard of care it still did not match that of the <insurance company> Standard of Care.  Further I looked up the American Cancer Society Standard of Care which was similar to that of the NCCN.  I have spoken to several medical professionals who all agree that the PET/CT was the appropriate diagnostic tool for my case.

11.    The second meeting I had with the <insurance company> sales people included 2 other gentlemen who didn’t say much.  I still feel their excuses are merely that, excuses.  I was informed that my case had been handled poorly by the <insurance company> Staff but that their hands were tied and they could do little but check into things.

12.    I again received a call from Ms. Insurance Rep who indicated that she recommended filing the BOI with the State of VA Insurance Commission.  She also indicated that my Dr. did not forward the clinical data on my case that would have approved the PET/CT scan.  Apparently this information did not come up during Peer to Peer conversation either?  I think not.  For a company such as anthem to blame my Doctor for not forwarding the appropriate information is ludicrous.  My Dr. is a well respected Surgical Oncologyst. 

I also sent copies to my state and federal representatives.  To date I have received 2 replies out of 6 letters.  I am not confident in our legislators to actually give a shit, because they are the ones who gave so much power to the insurance companies in the first place. 

I say we fire them all and start over!