If Health Insurance Denied the Payments, don't give up!

I am not sure how many members here will read this thread or how many people in this forum using marijuana for medical purpose. But I am pretty sure the story that I am about to share isn’t that uncommon. If you or someone you know face a similar issue, maybe my story can help resolve issues quickly.

Some of the members here know my husband is sick with terminal cancer. It starts as a noncancerous pituitary tumor in 1999. When our guard was down, his tumor spread to bones. In 2017, he was diagnosed with “metastasis prolactinoma”, stage 4 and given 4-6 months to live. So far, he had 5 brain surgeries, 28 treatment of proton therapy, Gamma knife, 10 sessions of radiation x 3 times, Chemo Therapy and immunotherapy.

His cancer is so rare, they are only about 5 known reported cases in the worldwide and all those documented patients died within 2 years, thus no recorded treatment available. This is bad news for someone who has these types of cancer (rare kind). Because of no known/documented treatment, insurance company pretty much denies every treatment doctor suggest by putting the treatment under the “experimental” category. Also, there is no ‘study group’ available since not many patients have this disease. They wouldn’t spend money to save just a handful of people when they can spend money to study and treat more widely known illness. So, what people like we have to do? Pretty much left the individual to take care of themselves. Like Immunotherapy my husband received, insurance would not authorize the therapy, so we had to pay for it. It’s was approx 13,000.00 per every 3 weeks. Insurance paid for doctor’s visit and administering IV, etc. but not the drug cost. Well, my husband’s case, after 9 months, we had to stop since cancer spread more (determined that immunotherapy didn’t work).

Anyway, here is what I really want to share with the members of this forum.

Last year, he was really sick and hospitalized over a week. After he got discharged from the hospital, his oncologist ordered the pet scan and gene test (blood test - AKA Tempus Lab). Doctor’s office gave us the order for it and we didn’t think about anything other than follow through. This is the beginning of the nightmare! BCBS denied both services (the Pet Scan $8865.00 and Tempus Lab $6140.00) and wouldn’t pay for the bill. The Pet Scan was denied as medically unnecessary.
Tempus Lab test was denied under “experimental”. Are they kidding me? Denied the Pet Scan? Not only that, the Pet Scan was $10,360.00 but the insurance pays the partical payment on some parts of the scan and the rest were denied. It’s like hospital needs to attach the arms but the insurance company only authorize right arm to be attached, but they say the patient does not need the left arm, thus they are going to deny the payment on the left arm to be attached. It’s ridiculous!. After back and forth between the hospital and BCBS, everyone passing the buck, we had to go through the appeal process. first, Internal appeal process got denied and we had to go through the external appeal process. Again, external appeal got denied so no more options left for us but to pay the bill. As a patient, we don’t know if it is medically necessary or procedures that the doctor ordered is experimental or not. Also, before these procedures, the hospital/doctor’s office got precertification for the procedures also. ** Note: Precertification doesn’t mean the guarantee payment by the insurance

Anyway, long story short, my husband and I have too many things to worry about so my daughter volunteer to fight for the bills. She knows medical billing very well (she is in the field) and she knows how to dig and get the right information (what really was the reason that health insurance denied the Pet Scan), etc. And she found out it was the doctor who put the wrong procedure code when the hospital bill for the pet scan. After 11 months of digging, filing appeals, countless phone calls to the billing department and the insurance, even though it was the hospital’s fault, to begin with (putting the wrong code on billing), the balance is ultimately the patient’s responsibility.

My daughter said this is not right and cancer patient shouldn’t have to deal with this nonsense. So, she gathered over 2000+ pages of medical records and wrote a letter and reaches out to The Office of State Attorney General and courtesy copy to BBB, BCBS, Hospital, Oncologist, NBC, CBS.

Yesterday, we received the confirmation from the hospital that they have written off the balance of $15,000.00 and we no longer owe the hospital for these 2 bills that denied by BCBS.
The hospital knew they goofed on this and they don’t want the negative publication. They knew the Office of the Attorney General is involved and news media was notified also. That was the only reason that they wrote the balance off. We were fighting with this over 11 months and the hospital wrote the balance off less than a week after they received the courtesy copy sent to the Office of the Attorney General. Unbelievable!

So, what have I learned from this ordeal and if you are in a similar situation?

  1. The pre-cert must be done before the procedure.
  2. know that insurance confirmed the pre-cert for the procedure doesn’t mean guarantee payment from the insurance company.
  3. Keep eye on a letter from the insurance company. - Read and understand what they are saying. The insurance company sending you (patient) CC but when it comes to money, you (patient) will be paying for the price. - if you get the letter from the insurance, call them and ask what you (patient) need to do. Make sure to ask for the reference number for the conversation and make a note for yourself what the reference number means to you.
  4. If the insurance company denied the payment, you have certain days to appeal. Make sure to send an appeal.
  5. When all failed and if you know you are right, get your local government involved. (The office of the Attorney General) They have a department handles Protecting Consumers Health Care Bureau
  6. CC to Hospitals, Doctor’s office - all involved parties.

His oncologist gave up on treating him in May, so he has not received any treatment past 4 months. I have been searching for a new doctor and because my husband has rare cancer, finding a doctor who specialized for these types of cancer nearby is very hard. The good news is, last week, I found a new oncologist. My husband already exceeds the recorded survival rate and he is still doing well. He is only on RSO currently and still doing OK.

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Rso is a great medicine. My mother-in-law was diagnosed with metastatic liver cancer and was told she had 6 months to a year. I tried and tried to get her to take hash oil capsules I made. She choose to get chemo and passed 1 month later. The chemotherapy made the cancer “super” and practically tripled in a week. I believe they have a cure for everything as long as you have money. Case in point- Magic Johnson

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Awesome job! glad to hear that.

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I think another thing people need to be aware of is hospitals will forgive debt if asked.

I went through some serious health issues, a couple of surgeries and three long hospital stays about three years ago. I stacked up around 150K in debt on my end during the ordeal. I decided to ask to see what I could do and without any other conversation, the hospital reduced my debt by 90% just for asking.

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Perseverance pays good job :clap::clap:

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@TDubWilly check out @HornHead experience.

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I’m not saying this is gonna help you @THCCBD but it is some of the things that are part of my regimen and I’m stage IVB adenocarcinoma (lungs, back, and legs) and I first found out I had a mass in my lung June 18th of this year, a tissue sample of that put me at stage III and a subsequent pet scan found it in my lower back too moving me to stage IVB, considered terminally ill.

This is a type of over the counter chemo

Panacur C Canine Dewormer (fenbendazole), 4 gram

It is known as a microtubule which is a cancer fighting drug

I also take it with these vitamins


I also have a buddy sending me Australian marroon bush tea straight from the outback. Aboriginals have used it against cancer and other ailments for a long time

And if you can afford it, is the burzynski clinic in Houston. 40k - 60k a month and they accept no insurance. The government screwed him and patented all of his products called “antineoplastons” so he gets majorly penalized by the government anytime he treats someone

Finally, I can’t grow allot but I grow what I can and put it towards RSO oil

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@TDubWilly I’m sorry to have read this. You seem like a good guy and this world is severely lacking in that department. I wish you good health my friend

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Damn @TDubWilly god bless you and your trials you go through daily my aunt beat breast cancer but lost to hodgkins lymphoma long story short I’ve seen cancer take the strongest of the strong down to there knees gods speed bro had no idea prayers with ya

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I second that @fano_man God Bless you sir

Best of Luck my Friend

Will

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@TDubWilly. Thank you for sharing that. The more info that is shared the better for all of us. Knowledge is power.

I’m rooting for you. You are a fighter and that’s what counts.

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@TDubWilly. I am only 30 minutes away if it will help.

@TDubWilly, Thank you for sharing your story. I wish you the very best. How are you doing now? Are you on any other treatment guided by oncologist? I know it depends on the types of cancer, but IVB is still considering stage 1 and it has a very good chance of cure. Isn’t it? I believe when anyone dealing with any horrible diseases, educating yourself about the illness that you are facing as much as you can is the key. I believe “the cure” for all and any diseases can be found in nature. But sadly, we don’t know what plant materials cure which diseases.

Have that said, the combination of any prescription drugs, some herbal (natural) and even the foods we used to eat, all can be dangerous when use it in wrong combination.

Fist, my apologies to all for the lengthy post. It seems most all my posting lately is rather lengthy.

When my husband had his 3rd brain surgery, Amitriptyline was prescribed and given to my husband at the hospital. My husband was also on morphine, thyroid med and many other medicines. As my husband got discharged from the hospital, I went out to get the car while transporter brought my husband out to the curve side, I noticed his speech start to slur and one side of his face starting to sag. We haven’t left the hospital driveway yet at the time. I called his discharging doctor from the car and the doctor told me to drive around the parking lot straight to the ER. And by the time I circle to ER, several nurses and the doctors came out waiting for my husband. They start working on him right away. At the time, he had nearly zero pulses (very faint pulse) but blood pressure starting to raise 210+ and He starts to have a seizure. ER was calling “Code Blue”. (He told me later that he was aware of what was happening and he also knew people around him working on him as well (It sounded like his mental status hasn’t altered)). The scare thoughts of this incident, he had to stay at the hospital a few more days before we can come home, but they never found out why he had the incident. What we didn’t know at the time, while you are on Amitriptyline should not take morphine, codeine, or tramadol. thyroid hormones, herbal supplements such St. John’s Wort. I found out when I went to fill the prescription Morphine, a pharmacist told me Amitriptyline should not take with Morphine and explained the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucinations, seizures, extreme changes in blood pressure, etc.

Another example of a deadly combination of the natural material is Aconitum napellus (also known as monkshood or wolfsbane). It is a perennial herb that is widely used as herbal medications. A small dose of wolfsbane processed to be non-toxic and often prescribed to people with poor circulation or cold extremities. However, too much of wolfsbane could literally cook a person from inside, pushing up the blood pressure and body temperature to the point where blood vessels including the ones in the brain to burst. This ingredient was especially lethal when combined with honey, ginseng or crab eggs.

Also, expensive and the latest cancer treatment immunotherapy has it’s own issues if taking with marijuana. Immunotherapy with immune checkpoint inhibitors targeting PD-1 and PD-L1 is now a standard of care for many solid tumors. These agents are highly effective at stimulating anticancer immune responses, resulting in durable responses. But if you are taking cannabis while you are on immunotherapy, cannabis has a negative response to immunotherapy (not all immunotherapy, certain immunotherapy)

So, I believe research and educate yourself before taking any herbs or treatments and mention it to your healthcare provider. Even if you are expecting a negative response from a doctor, at least, it will raise awareness and you have the time to rethink and research.

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This is stage 4B so I’m considered terminally ill

Sorry, just started reading and the alarms for my food when off.

I’ll come back and read everything and answer some more

My immunotherapy, which there are several different kinds, is called monoclonal antibodies. The chemical name is pembroluximab, also known as keytruda.

Luckily my oncologist has told me I can use marijuana with no problems or interactions with my drugs.

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Yes, my husband received Keytruda and he was also taking RSO at the time as well. Unfortunately, Keytruda did not work for him.

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