Clinical Trial Approval

Sorry I haven't posted in a while.

We have spent the last week wrestling with our insurance company layers....

But today, we finally got word that UHC has approved covering the clinical Trial.

So, We all will be traveling to Houston this weekend for meeting the doctor and the first treatment.

We (mostly Karen) have been fighting two fronts.

1 - Clinical Trial approval.

For this, MD Anderson was told it could take up to a month to approve. I had previously been told it should only take 48 hours. Turns out this was a separate "Cancer Support Services" group run by OptumHealth Complex Medical Conditions group for United Health Care. They told me to have MD Anderson contact them, but at that time, I didn't understand this was a separate company and not actually United Health Care. So, MD Anderson contacted the wrong group. I was expecting that they would know the correct place to contact and that United Health Care would at least forward them to the correct group. But, no, we had to make the connections ourselves to get anything to happen.

2 - Votrient prescription

The backup plan drug that was prescribed since the trial was not approved quickly was denied by my prescription plan. Of course, we didn't even learn it was actually denied until almost a week later, and then not from CVS caremark, but from the CVS Specialty pharmacy (separate group)... It is amazing how many layers...

This was under appeal after getting the Doc to send a letter of Medical Necessity, but now has been dropped with approval of the trial.

Danaher, Gilbarco's parent company actually contracts a "Patient advocacy" service that was of help after several rounds of getting them to understand the players involved...:

Steve and Karen

MD Anderson

Nurse and PA

United Health Care

OptumHealth - Contract Cancer resource services for UHC

CVS Caremark - prescription plan

CVS specialty pharmacy (separate from Caremark)

Danaher Patient Advocacy

Wake Forest Baptist

Oncologist

Imaging dept

Pathology dept