On 1/23/2008
Carcinoid wrote:
Hello,
I am looking for anyone who has Carcinoid (primary iliium) with mets to the liver who has received SIRT which was covered by Highmark Blue Cross and Blue Shield who is denying this treatment to me as Experimental/Investigative. They will pay for CHemoembolization. I am also looking for anyone who won an appeal citing SIRT as prefered for this specifi situation.
Showing precedent will turn the tides. Thank you one and all for your support. I don't have much time.
Life is mostly bubble and froth; but two things are set in stone. Compassion in another’s trouble; Courage in your own.
I have Carcinoid (primary illeum) and mets to the liver. I have BCBS of KC and when I had chemobolization of the right liver lobe in Nov. 2006 they refused to pay stating that it is investigative. I filed with the Missouri Insurance Board and included all current documentation I could find from the internet that stated this is standard care for Carcinoid Liver mets. I also requested an Independent Board Review from BCBS. In March of 2007 I received a letter from the Independent Board and the State Board stating if BCBS didn't allow this treatment they were denying me palliative treatment for a rare cancer. I subsequently had the left lobe done in May.
My suggestion is to keep fighting, turn it into your State Insurance Board and ask BCBS for an Independent Board Review. There is a very high rate of these claims being overturned but you may have a tougher battle since SIRT isn't as well documented as chemoembolization.
There is a Carcinoid Group on Yahoo that discusses the various medical treatments for Carcinoid and has one of the 'specialist' doctors as a member and he answers questions quite frequently. I know there has been a discussion of SIRT in that group and you would probably benefit from joining that group.