I am looking for help from anyone that has had to battle the insurance companies in order to get the treatment they DESERVE.My Father (56) has been diagnosed with prostate cancer that has metastasized to his hip bones. His original PSA was 184. He started hormone therapy in February and with hormone therapy it has dropped to 60 and then 26.6, and hopefully lower; but haven%26#039;t gotten the latest results yet. His Gleason score is 9 (5+4). His biopsies showed that the prostate had undifferentiated carcinoma (meaning that the cancer was solid all the way through).He has started seeing Dr%26#039;s at City of Hope and has signed up for a clinical trial using hormone therapy and Helical Tomo Therapy. The Helical Tomo Therapy is looking like it is going to be his best opportunity to fight this cancer. This type of radiation spirals around the entire tumor and %26quot;hits%26quot; it from hundreds of different angles as it travels around. Blue Cross Blue Shield has denied the treatment, how do we fight this???|||My son has a very rare abdmoninal sarcoma that does not follow any known protocol. Because of this he is frequently denied benefits including a treatment we feel may have saved his life. What we did, and what you need to do is file for an appeal. Continuously.

Even though my son was a stage IV with no known %26#039;cure%26#039; available, the insurance company would deny the benefit based on being %26#039;medically unnecessary%26#039;. At first we were just too horrified not to react emotionally, but we soon learned that if we talked calmly to enough people that eventually they would approve the benefit based on %26#039;compassionate need%26#039;. We did need to go through two appeals for one denial. One thing you need to do is ask specifically for an expert in your fathers type of cancer to review the treatment plan. We asked that our insurance company provide us with the reviewers name and credentials too. Once we had someone review the case who understood what we were up against his benefits were paid.

Another option is to contact your states insurance bureau to register a complaint. And, you should also put a call into your local and state representatives (the last thing they want is bad publicity).

Turn to a lawyer only as a last resort. It is best to just try and reason with the insurance people first. You might also check to see if your father can have a %26#039;case worker%26#039; help you manage his insurance (the company provides a case worker who can help guide you through some of the process - although they can%26#039;t determine benefits).

Don%26#039;t give up. Keep after the insurance company, especially if you feel they should cover this expense. Get your fathers medical team to back you on this, have them write or talk to your Dads insurance provider.

It%26#039;s a lot of work sometimes and we%26#039;re still at it. It helps to keep a notebook and write everything down too, any correspondence, who you talk to, and the dates. I keep a huge notebook and keep all insurance and billings in plastic sleeves arranged by date. Works really well.

Good luck. I know what its like, just keep cool and go after what you deserve.|||why should they deny treatment when your Dad is being a volunteer on a new drug=If anything they should be compensating your Dad for being a so called quinea pig for them=sometimes I think the government sucks|||that is terrible. i thought when hospitals were testing a drug that they gave it for free. i think you can contest the insurance co decision. but i doubt if you would win.|||If he is having experimental treatment No Insurance will cover it even Medicare Go to his Doctor %26amp; see if there are grants covering expenses If it is a clinical trial It should be free anyway.|||It can be hard to find insurance companies that will keep cancer patients and help them. I%26#039;m not trying to scare you. I would call a lawyer referral service in your area ( the intial consultation is usally free) and %26quot;feel them out%26quot; regarding the best approach. FYI: Although your father is just 56, you may want to investigate, at some point, getting him on Medicare Medical Disability. One of the lawyers who advertises frequently in my area of Texas is Ronald D. Honig. He handles Social Security %26amp; SSI Disability cases. Per the ad on pg. 190 0f the January 2007 AT%26amp;T Yellow Pages: %26quot;Over 30 years experience. 12 years as a Social Security Staff attorney. Free Intial Consultation. Retirement, Widows, and Childrens claims. 1.800.359.0019 or 214.368.0777. 9400 N. Central Expressway # 905 Dallas, Texas 75231. Not certified by the Texas Board of Legal Specialization.%26quot;|||I went through this myself for different medical treatment and it was Blue Shield. They ALWAYS deny everything hoping you will not fight it. Put together an appeal letter stating the reasons why it is so necessary and give a good argument against their reasons for denying. Get Drs to write letters to attach to appeal. Also attach any studies that have been done to prove that the therapy works. I did this and it was approved very quickly after they got my appeal. This is on a med that costs $1200 a month for life.|||Agree with everything above, but I suggest you also bring the problem back to City of Hope and your doctors. It%26#039;s in the hospital%26#039;s interest to help you through the appeal process, and most have administrative specialists that can help you.|||try a hompathic doctor, some one that know how to cure cancer by raising body ph level and killing the cancer with out killing the patient, caner cannot live in a high oxygen, high hydrogen attmostphere, so simple and yet doctors are killing people with chemo