Insurance denies medication to my sister!

[eroomlorac]

Riven, I think deciding whether to take chemo for a terminal cancer is a very personal decision. There are very many different reasons and points of view on what chemo can do for someone and it is not our place to judge. You have your ideas of what you would do but in no way should that be reflected on anyone else. Sometimes all that is left is hope and prayer and HOPE is something that should never be squelched in anyone. Lisa is young, has a child she wants to see graduate from high school if at all possible. She is not 80 years old and has lived a long, fulfilling life. Just like there are different views on raising children, priorities on spending money, religious beliefs, etc. no one should be questioned on what health care decisions they make for themselves. Everyone makes their own decisions for their own personal reasons and should be fully supported in whatever decisions they make. I work in a hospital and often we see family members fight like the dickens to save the life of their extremely ill 87 year old mother or father. Some of my co-workers say "What are they prolonging this person's life for?" Well, let me tell you, my Mother died after a prolonged illness. One of the hardest decisions to make is to decide if you want to keep fighting for your Mother's life or should you just let Mom die. It is very, very difficult to let your Mother die. It's not like, "Oh, well, Mom's gone. It was fun while it lasted." Anyway, I just wanted to point out what therapies people choose to take is extremely personal and really should never be questioned. Everyone, especially terminally ill people, need to be supported 100% every step of the way. It is not our place to judge or question others decisions. I'm not looking for a fight, I just have some very strong feelings about health decisions like this.

 

[alli713]

Laurie, I'm sorry to hear this, I know the struggle you guys are going through as I've been following along and I know you personally.

I think Carol is right and it's not for anyone to question why someone does something. She wrote an excellent post.

I keep your sister in my prayers, and hope that you guys continue to stay strong.

:heart3:

 

[Courtney]

I think a cancer patient is going to suffer no matter what course of action they choose... it's a matter of determining which is better for them, personally. I haven't had personal experience with terminal illness, but my aunt did have (and survive) breast cancer. She opted for chemo because she wanted to live, and she wanted to fight. She wanted to see her daughter get married. In some instances, I guess people choose chemo as a means to prolong their life, even if the illness is terminal. When it comes down to it, everyone wants a little extra time with their loved ones. For some, being ill as a result of the treatment is worth the extended time they get to spend with their family.

I'm sorry, that was a very clumsy response on my part. I wish you and your family the best of luck in this difficult time.

 

[addictedtochins]

My mom died of a brain tumor 6-07. She didn't have insurance, but did receive about $800,000 in free healthcare for surgery, hopitalization, medication, chemo, radiation etc. We signed up for Hospice in what turned out to be the last couple of weeks. I wish we had done it sooner! I am pretty sure it's free for everyone and they take care of all the meds including delivering them to the house. Prayers for you all, Theresa

 

[Leah]

Laurie, I am very upset to hear all of this. I'm going to send you and Lisa TONS of great thoughts.. Just keep faith and know what happens is for a reason.

 

[Riven]

Thanks to people who answered. I know that everyone's life is there own, etc. And given any set of situations anyone may change their opinion on what they would do.

I now understand that she has a daughter in high school who she wants to see graduate, and that the chemo will help prolong her time here, and help her reach that goal.

Insurance can be tricky sometimes, and they tend to have reasons for things ( not that they make any sense ).
Good luck to everyone, your family, your sister, her daughter.

 

[ChilliBean]

My grandad works for them, if you like I can call tomorrow and ask him to fix it and/or ask him what would be the most effective approach for you.

I just started working for BCBS. Your grandad can advise her of who to call possibly, or what actions she should take such as filing an appeal. But he can not "fix it for her." That would be a compliance issue and he could get fired for doing it. He can explain compliance to you.

 

[eroomlorac]

Thanks to people who answered. I know that everyone's life is there own, etc. And given any set of situations anyone may change their opinion on what they would do.

I now understand that she has a daughter in high school who she wants to see graduate, and that the chemo will help prolong her time here, and help her reach that goal.

Insurance can be tricky sometimes, and they tend to have reasons for things ( not that they make any sense ).
Good luck to everyone, your family, your sister, her daughter.

I think if you had developed cancer at this point in your life (and I certainly hope you DO NOT) I think you would have different views. Our point of view changes as we age on certain issues. I would never tell anyone what kind of birth control they should use and I would never tell anyone they made a poor choice in the care of their cancer simply because it isn't a choice I would make. Though I think if I had cancer right now, I, too, would choose the route Lisa is taking, at least for now. And by the way, it's Lisa's son who will be graduating high school in the future.

 

[Laurie]

First of all I want to THANK EVERYONE for feeling my plight in this matter. Thank you for your caring and loving support of not just me but also Lisa.
Here's the UPDATE:
The insurance company has said it is their policy to first have Lisa try a generic of the Nasacort which would be Flonase (I'm not sure on the spellings of each). They require their patients to try generic for 180 days and if it doesn't help then they would allow the non-generic drug. I explained (and I'm sorry you have to hear this Carol because I know how difficult it is for you) that Lisa is TERMINAL and may not have 180 days. They are now putting it up for review and her oncologist is getting involved with the Ear, Nose & Throat doctor. Lisa's entire medical team has always done whatever they can to help her.
I am still writing a letter to the insurance company as well as the drug company because I think it should be known that while a policy is a policy--sometimes they aren't "good" policies.
Even more so they need to understand how difficult it is for the patient to talk about their illness to someone on the phone. Lisa tries very hard to be brave and not break down but when you have to tell a complete stranger living in a foreign land--because Blue Cross Blue Shield outsources that you have terminal cancer it isn't easy. And she breaks down and cries and then doesn't want to talk anymore. She shouldn't have to beg and plead her case--someone should be able to do it for her. Lucky for me I was able to speak with a supervisor today who was supportive and understanding of the situation and didn't not talk to me as I wasn't the insured party. I'm sure this isn't the norm.
We need to find a way to make things better in this country for those who are ill to receive the medical attention they deserve--whether insured or uninsured. No matter what, in my opinion, no one with a terminal illness should be denied anything.
So where we're at is this:
We have samples of the Nasacort--we have staff who will get us samples because they can and they care about my mother and my sister and want to do what they can to help Lisa.
We also have the prescription for the Flonase, the generic form of Nasacort.
We also have Lisa deciding what's better--a stuffy nose, swollen face and plugged ears, or constant coughing from the Nasacort--she may decide not to continue taking the steriod spray.
And we're praying--because it never, EVER hurts to have God in your corner (Elvis and 2 wonderful grandmas, grandpas, & great grandma too!)
Again I appreciate everyone's words of advice, words of comfort and love. You all mean so much more to me than I can ever convey.

 

[alpayton]

I just want to clarify something here....Flonase is NOT a generic form of Nasacort. It's a totally different brand name drug. They do not have the same active ingredients and therefore one could not be the generic of the other. Both do have corticosteroids in them but they're not the same...

Flonase - Fluticasone propionate - made by GlaxoSmithKline
Nasacort - Triamcinolone acetonide - made by Rhone-Poulenc Rorer

Now with that being said....Flonase does come in a generic form and therefore, if the doctor has to switch her to Flonase, then she would get the generic form of the Flonase for her use. Nasacort doesn't come in a generic at this time, that I'm aware of.

 

[Laurie]

Well what the heck Amanda, they said she would have to take the flonase instead of the nasacort--both had steriods. See this is why it's a good thing to ask questions! I guess I'll be back on the phone tomorrow.

 

[alpayton]

Well what the heck Amanda, they said she would have to take the flonase instead of the nasacort--both had steriods. See this is why it's a good thing to ask questions! I guess I'll be back on the phone tomorrow.

Both Flonase AND Nasacort DO have corticosteroids in them....but they're different corticosteroids - and Flonase is NOT a generic form of Nasacort. I just didn't want them to be telling you that information and you assume it's correct, when it's not.

From what I'm gathering, from my past experience dealing with the insurance companies is this...they want her to go to a brand name drug that has a generic available because it'll cost them less $. Nasacort doesn't have a generic, Flonase does. If they can get her on Flonase, they can make her get the generic of Flonase, which would be the fluticasone propionate. Also know that Flonase and Nasacort don't come in the same delivery systems. Not sure if that matters or not.

 

[Riven]

I'm sorry for the confusion, Carol said child, and I guess I was thinking I read daughter.

Each step in life must be planning as we take it, because if you try to think to far ahead, you don't cherish the ones you are taking and will stumble. So it would depend on the situation, but I do have particular views on things, and perhaps my beliefs are part of what makes my choices different.

I am no way saying that Lisa's choice is wrong, I was just wondering why she was making the choices she was. I've seen what chemo does to people, it's a hell I would not want to walk through...

Laurie, I don't know if you've checked but my dad was on nasacort ( they actually told him it would help his heartburn? Who knows, lol ) and he said it was about $40, and the "months worth" last him about 2 months I think he said.

Good luck.

 

[HedgeMom]

Lisa is TERMINAL and may not have 180 days.

If my sister were dying and needed a med that runs from 40 to 120 dollars a month, depending on where you buy it from, I'd pay it out of my pocket before I'd let her suffer.

 

[Tiatrack]

Most doctors should be able to get you a ton of samples. My husband is an allergy nurse and says they have entire cabinets full of samples for patients. His doc won't talk to pharmaceutical reps, but she does allow them to leave samples. Try asking around if Lisa's doc doesn't have the samples you need.

I agree with HM as well. The meds you are talking about aren't that expensive. Get Lisa what she needs NOW, and fight with the insurance company later.

 

[Laurie]

The cost of the meds isn't the issue for us--it's the principle of the idea that insurance would deny medication to a terminally ill patient. But then again honestly the cost of the meds is an issue--if anyone had any idea how many over the counter medications Lisa was taking in addition to the chemo you would be amazed. But it is irrelevant as we do and will pay for whatever she needs. Lucky for us my mom has several doctors and nurses she's worked with through the many years who are will to keep us in samples. I hope to someday see a change in the insurance policy--just as I someday hope to see a cure for cancer.

 

[HedgeMom]

Laurie, if I'm not mistaken, there is a very expensive drug that your sister is getting that is normally cut off after a while (I think you told the story on CnQ). Her insurance company didn't cut her off and you were jubilant.

Seems to me that they are doing a lot and not being total hardcases about her treatment and probably don't deserve to be slammed for a bad thing. It could be the 5000 dollar drug they denied.

 

[Puddles&Chubbs]

Laurie I am so so sorry this is happening to your sister. It's such a shame. It IS a matter of principle and I know you will do everything you can to make that matter known. Prayers to you all.