Today my doctor learned why insurance denied my admittance into the trial. My company is self-insured and uses the insurance company to administer the insurance. They wrote a clause into the insurance that specifically states that the insured are not allowed to participate in medical trials. Why? Because trials can cause more harm than good, and insurance companies don’t want to be on the hook for what might come after.
That being said – my trial arm is the SAME drug I will start NO MATTER WHAT. And, to add to that, I will be monitored more closely and the pharmaceutical company pays for the drug – really, a win-win for the insurance company.
Today I also learned why I love my doctor so much. His immediate response was to appeal the insurance company, show the cost benefit analysis for why I should be allowed into the trial, why it’s a benefit for the insurance company, etc. I’m SO thankful to have such wonderful advocates for me at the Rocky Mountain Cancer Center.
I should know by next Monday or Tuesday; if the appeal is rejected, potentially I could appeal myself or simply choose to start the drugs. I really hope I don’t have to make that choice, but we’ll see how it goes!