Friday, April 22, 2011

BCBS Does Not Pay For RFA

Yesterday I got a policy statement from BCBS which explained that they do not pay for RFA because it is investigational. This has been their policy since 2007. It is intended, they say, for people too weak for regular surgery, and there is not enough data about the long term (4 to 5 year) benefits. 

FYI, I am not too weak for surgery. My situation is that I have been told that I can't have regular surgery because I have cancer in multiple places.

I got this info because I had asked my nurse caseworker to check into it for me.

I do not even know if RFA would work for me (if my lesions meet the specific criteria) but I was so upset anyway!  I had a total meltdown yesterday morning. Actually, I felt pretty good afterward. So I sent followup email to my caseworker asking for info about cryoablation, too. I wonder if that is investigational, too.

Of course I will keep my appointment with the doctor. Who knows what I will find out. I really want to know if I am a candidate for this. It is not something you can wait a couple of years to do because the tumors have to be small.  If you wait too long, and the tumors grow, then it does not work.


Anonymous said...

How many people and angels do you think it would take to sit on me, to try to keep me still, if I was fighting your battle. It surely would not be a pretty picture. Thanks for being there for me.
I feel pretty small this AM.
Love you

Anonymous said...

I think most insurance companies would be just as happy if you took no for an answer and moved on. You keep on pluggin' -- if you're a good candidate, let the insurance company know it!


Anonymous said...

I got turned down by ins co (may have been BCBS) for a drug once because it was experimental. I appealed and they paid. I also got turned down for a surgery by ins co because they said it would be cosmetic. I appealed and they approved it. Many times that is the first response, hoping you won't push it. But as Meredyth said, if you're a good candidate, you push it!!! Love, CQ

Anonymous said...

I had papillary thyroid cancer 3 years ago and I had BCBS. I had my thyroid removed. BCBS didn't pay for the surgery even though we had the prior approvals because it was billed as total thyroidectomy with carcinoma which is different that what it was originally submitted as, just a total thyroidectomy (they had suspected the cancer from the needle biopsy). I had to fight it for 6 months before they finally paid for it. I agree that they say no sometimes to see if we'll accept that for an answer.
PS, you are loved, and thought of often