I recently encountered a denial of treatment. I have been fighting ovarian and breast cancer stage 3c since 2013. My [cancer antigen 125] has proven to be accurate and indicative of active disease. I have been on a maintenance regimen, but my marker started creeping [up]. Also picked up a [pulmonary embolism] 3 months ago which is resolved with anticoagulation. This is the fourth or fifth recurrence. I’ve lost track. [Prior authorization] for chemotherapy treatment was sent to [the] insurance company. Denied. The denial letter sent to me reported the determination was made by a board-certified rheumatologist, not an oncologist. My oncologist, upon hearing of the denial, requested an immediate phone appeal with the physician. The insurance company wanted to know why we didn’t wait until we actually saw a tumor. I guess they would rather have my cancer advance more. Not to mention the possibility of an emergency bowel obstruction from a tumor while on meds that would cause bleeding. No common sense. My first thought of the denial was that my insurance company had decided it was time for me to die. My second thought was it was an automatic denial to save money.
Lorie M.