I'm so sorry. In addition to the websites already posted, you might want to try to contact someone at the local news stations...one might consider running a story...also maybe the Houston Press. Those might be dead ends but it's definitely worth a try
Thanks everyone for all your prayers and support. The tumor was removed Friday by Dr. Hunt and sent to the Pathology department at MDA. They will not know the type of cancer it is until late next week. However, from the initial biopsy S&W believed it to be sarcoma whereas MDA thought is showed both tendencies of a rare sarcoma and carcinoma mix. They said they would stage it during this time as well. The follow up treatments for these differ drastically. If it is only a form of sarcoma then the lumpsectomy will probably be the only form of treatment. If it is a sarcomatoid-carcinoma then treatment will most likely consist of radiation and chemotherapy. Scott & White wanted to perform the simplest and fastest remedy without regard to the best long term interest of their patient. They wanted to do a full mastectomy with no radiation and no chemo. Their more we learn the more frustrating it gets. Scott & White refused to cover our care "in network" although they don't even have a sarcoma department & we were referred to a general oncologist and a general surgeon. It was only after battling with them after several attempts were we allowed to get a second opinion at MD Anderson. They tried to refer us to another general oncologist in Dallas. Since then they allowed several follow up tests and then Wednesday (two days before the scheduled surgery) while we were at MDA they called to tell us they would not cover the surgery and that our surgery and nuclear test were cancelled. If not for our local state congressman and several other people that had contacts with the Board of Directors at MDA and petitioned them and then having them agree that the "standard of care" was not the same, we never would have been able to have the surgery Friday. Scott & White tried to stonewall us, not by "denying" the treatment, but agreeing to cover it "out of network" - with terms they knew ahead of time were not acceptable to MDA. By doing it this way they blocked our attempt at a 24 hour appeal with the Texas Department of Insurance because they didn't "deny" the coverage. Many client advocates at MDA told us that this is very common tactic used by Scott & White in particular, but that it happens elsewhere as well. This type of treatment infuriates us. Several MDA client advocates told us that most people eventually give up and would have had the surgery at S&W. The whole time we've felt like we were in some type of John Grisham novel. If you have one of these type of insurance plans, please check into it before you get into a similar situation.
I'm glad things are progressing for you. The last thing you want to deal with in a crisis is insurance hassles. Keep us posted.
Glad the tumor was removed and thanks for the advice, my thoughts and prayers are with your wife and family!
Not a health care expert but wouldn't free health care eliminate horror stories like this? Call me crazy but I don't think anyone should die over their health plan and lack of one.
Actually, this is exactly why we don't want "free health care" or government provided health care. We are covered, but if we accepted the initial diagnosis and treatment S&W recommended then my wife would now be a uni-breast. I thought that is why we pay $1000-$1200 a month for our health plan, but now I'm not so sure why???
I found out I had Cancer back in late Aug., St. Luke's found it....was located on my pelvis...the treatment that St. Luke's offered....was 100% different from what M.D. Anderson offered. When I tell you it multi-calls for me just to get my information sent over to M.D.A. but once they received it...process went quickly...I had my surgeries...I can tell you the staff and M.D.A. is great and helped me a great deal and still helping me now, as I go 3 times a week trying to regain my strength so that I can return to work. A test at M.D.A. proved that the type I had was genetic and has helped my whole family, from top to bottom, Grandparents -3rd-4th cousins...being that its a gene that has a 50/50 chance being past at birth. UnitedHealthCare has been great and has not given me any problems with all the care that I have needed. That's why I suggest everyone who knows someone dealing with Cancer to please refer them to M.D.A. I will keep your wife in my prayers
TMD...thoughts and prayers with your wife and family. It's infuriating at how "inhumane" insurance companies can get when a potentially life-threatening situation is occurring. Keep up the good fight...it sounds like you are getting in touch with the right resources to help achieve your desired goals.
2 things: Appeal everything. Then, appeal it again. Most health insurance appeals are denied, most re-appeals are not. Call The American Cancer Society, 24/7 1-800-227-2345, explicitly mention the health insurance issues. Unfortunately Texas is not even a "good state" in the haleth insurance game, but they may be able to help you navigate some of the issues that may lie ahead. oh, and prayers to your wife & you.
I've reviewed the OPs latest post and the video he posted. I am very sorry to hear about her diagnoses of sarcoma of the breast. However, I side with your insurance that they should not pay for your MD Anderson consult/transfer of care. They are willing to pay for the standard of care to be administered in a hospital that is not world-renowned. MD Anderson, Hopkins, Mayo et al are powerhouses for medical research, but not necessarily for treatment. I understand that it is in both your wife's and your family's best interest that she receives the 'best care available', but unfortunately this both costs money and is likely unnecessary. If this is truly an issue, does the option exist for switching to a more premium insurance?
