We just received a phone call from our medical group denying our request to seek treatment from the Oncologist at UCLA. We had a phone conversation earlier today from the surgeon, that is with the our medical group, in which he shared that the medical group believes it is not standard treatment to provide chemotherapy in hopes of shrinking the tumor to a point of it becoming resectable. The fact that out medical group is not on the cutting edge is exactly why we are seeking treatment elsewhere. With this forwarning I had already contacted Anthem Blue Cross to find out the procedure for filing a grievance if the denial came. What I didn't know at the time, was that just 15 minutes later I would be using this process. The Medical group feels we should use their oncologist. A few facts to share:
1. Our medical group currently has just ONE oncologist who handles all cancer patients for Santa Clarita and the San Fernando Valley.
2. This Doctor is obviously overworked and limited on resources.
3. This Dr has no area of speciality, and offers only "Standard Treatment" and has personally stated that he feels there has been no chemo. improved in the last 20 Years.
4. He has a history of being a poor communicator with patients and family members.
5. He offered us NO HOPE!!
How could anyone think that this is the person who should be managing George's care...
So, I immediately called Anthem Blue Cross and filed a grievance about the decision. I was blessed by getting a Rep on the phone named Mindy, who was compassionate and took down every detail I shared with her. She wrote up the grievance letter, and has submitted it as an expedited case. I ask that everyone please pray for the people that make this decision. Pray that they want to help us give George a chance at the best treatment we can get him.
The process could take a little as 72 hours or as long as 30 days, however that will depend on the expedited status. They know that we can't wait 30 days, however legally she had to tell us that.
I will also share that I'm also looking into the process of how and when we can change our medical group. I already know that this can't be done immediately, but down the road it might be an option.
Needless to say it has been an emotional day, and I now rest it in God's hands. I can't tell you how grateful we are for all the Prayer Warriors we have.
~Donna
Tons of prayers are being sent that quick decisions will be made and you will soon be getting the treatment from UCLA!!! Only positive thoughts and prayers!!!!
ReplyDeleteWe are very upset that an Insurance company has the authority to make that kind of decision. We are praying that their ruthless and inhuman decision will be overturned in a timely manner.
ReplyDeleteGod bless all of you.
Love,
Uncle Bill and Becky
Praying for you two and your kids. Insurance can be the toughest part of the battle. In God's hands is the best place for that to be right now.
ReplyDeletePraying that the insurance company can put you where you need to be. We have to have hope that they will see your very intelligent reasons for moving. Crossing fingers too...whatever helps!
ReplyDeletePrayers for you all and the ones making the decision.
ReplyDeletePS: I wish I had a swift kick to send to the medical group person who rejected the original claim.
I am praying for your family. I know you are a great advocate for George right now and am so sorry that you must spend both time and energy fighting meaningless battles when your energies really need to be focused on restoring George's health and getting him to the best medical environment. I pray you may quickly resolve this insurace dispute and make the network changes that will give George the best medical attention.
ReplyDeletePraying for all of you. It is so sad that you have to deal with the insurance company at a time when you should be able to focus on George's treatment and your love for your family. You are constantly in our thoughts.
ReplyDeleteGeorge: I am Donna Erckman's brother in law and met you at Rick's house years ago. Donna alerted me to your situation and this blog. I have been a medical malpractice attorney for the last 23 years and represent lots of doctors and hospitals. If there is anything I can do or anyone I can talk to - give me a call at (925) 381-0862. I would be happy to help you any way I can. Also, with your permission, I will add you to my church's prayer line and get our congregation praying for you. I am praying for a speedy resolution to this insurance problem and speedy healing for you. All my best to you and your beautiful family.
ReplyDeleteJohn Dodd