"People all say that I've had a bad break, but today - today I consider myself the luckiest man on the face of the Earth." -- Gary Copper (Lou Gehrig, "Pride of the Yankees")
Monday, February 28, 2011
Now we wait....
We met with the appeals committee this afternoon! Blake thinks it went well & that we couldn't have done anything different. It's out of our hands now! They will make the decision today and will let us know "in 10 days."
Thursday, February 24, 2011
Local Surgical Oncologist
We met with an IHC Surgical Oncologist yesterday, Dr. Bowles. What a terrific person. Dr. Bowles' did her fellowship at MD Anderson Cancer Center in Houston, Texas where (among other things)she participated in HIPEC surgeries. So, she has hands-on experience with this procedure. However, she does not currently do HIPEC surgeries here as she (also) believes they should only be done at large centers of excellence such as UCSD and Dr. Lowy. She's familiar with Dr. Lowy and feels he's an excellent Surgical Oncologist.
Dr. Bowles also said that if she was asked to perform -only- the tumor debulking (CRS) surgery, she wouldn't do it even though she technically could. She does not believe that the surgery is beneficial without the hot chemo (HIPEC.) She feels the tumors would come back and that the hot chemo is necessary to have hope in the *( long term outcome of the procedure.
Dr. Bowles was so, so very kind and was willing to write a letter of opinion for us to give the Appeal panel this Monday. We received it this evening and it's very objective and informative and states that she believes Blake is an excellent candidate for the entire procedure. We already have a letter from Dr. Whisenant and expect to receive a letter from Dr. Lowy's office tomorrow. Dr. Lowy was also supposed to talk with SelectHealth's medical director today, I hope to hear that the discussion happened.
We hope the Appeals panel will make their decisions based on information that's been provided by Blakes doctors. I know this is pretty cynical but, do you think they'll even read them?? I mean, seriously! The appeal written to the "Grievance Committee" contained a lot of good, valuable and valid information (actual peer reviewed studies) and they didn't seem to pay much attention to it.
Well, as I said before - I have no idea how this will turn out. UCSD said that if it doesn't get approved that we should contact the UCSD finaicial department and look into private paying for the procedure but there is absolutely no way we could even begin to pay for the procedure - it's an insurmountable cost.
Like I've said before, we just have to have hope, I just don't know what more we can do.
Blake is still pretty tired but seems to be on the up-swing from getting chemo last week. It sure will be nice for him to not have chemo again for a while!!
Love to all, Kathy
Dr. Bowles also said that if she was asked to perform -only- the tumor debulking (CRS) surgery, she wouldn't do it even though she technically could. She does not believe that the surgery is beneficial without the hot chemo (HIPEC.) She feels the tumors would come back and that the hot chemo is necessary to have hope in the *( long term outcome of the procedure.
Dr. Bowles was so, so very kind and was willing to write a letter of opinion for us to give the Appeal panel this Monday. We received it this evening and it's very objective and informative and states that she believes Blake is an excellent candidate for the entire procedure. We already have a letter from Dr. Whisenant and expect to receive a letter from Dr. Lowy's office tomorrow. Dr. Lowy was also supposed to talk with SelectHealth's medical director today, I hope to hear that the discussion happened.
We hope the Appeals panel will make their decisions based on information that's been provided by Blakes doctors. I know this is pretty cynical but, do you think they'll even read them?? I mean, seriously! The appeal written to the "Grievance Committee" contained a lot of good, valuable and valid information (actual peer reviewed studies) and they didn't seem to pay much attention to it.
Well, as I said before - I have no idea how this will turn out. UCSD said that if it doesn't get approved that we should contact the UCSD finaicial department and look into private paying for the procedure but there is absolutely no way we could even begin to pay for the procedure - it's an insurmountable cost.
Like I've said before, we just have to have hope, I just don't know what more we can do.
Blake is still pretty tired but seems to be on the up-swing from getting chemo last week. It sure will be nice for him to not have chemo again for a while!!
Love to all, Kathy
Wednesday, February 16, 2011
FINAL appeal
Our FINAL Appeal is on 2/28 at 3:30. The last time we met with the insurance company was a "Grievance meeting" not a formal appeal. This FINAL Appeal will be heard by a panel of 3 people. A few insurance company employees will be there to "answer any questions." Who knows what will come out of the appeal - but I have to be optimistic that they'll do the right thing.
Blake had chemo again yesterday (#32) & also had an appt with Dr. Whisenant. Dr. Whisenant really believes that SelectHealth is being/will be fair and does have Blakes best interest in mind. Apparently, they've been presented with at least 4 requests for HIPEC in the last 3 months. 2 were for appendix, 1 colon (Blake) and I don't remember the other one. The appendix cases have been approved - but only after an appeal. Appendix cancer is the 1st cancer they started doing HIPEC on so I'm not surprised they were approved.
Dr. Whisenant seems to be laying the ground work so that we won't be devastated if this doesn't get approved. I guess that's a good thing. If Blake doesn't get this procedure it doesn't mean that he'll just immediately go down hill. For now, chemo is still working and keeping the cancer in check and would (hopefully) continue to do so (preferably f-o-r-e-v-e-r!) Constant chemo is just so rough on him. Breaks my heart.
After the pump is disconnected tomorrow, Blake will be on an official chemo break until after the surgery. If it's approved, we'll head down to San Diego the 3rd week of March, if it's completely denied again, they'll put him back on chemo.
March is colon cancer awareness month. If you are 50 or over, PLEASE get a colonoscopy! Thank you.
Love, Kathy
Blake had chemo again yesterday (#32) & also had an appt with Dr. Whisenant. Dr. Whisenant really believes that SelectHealth is being/will be fair and does have Blakes best interest in mind. Apparently, they've been presented with at least 4 requests for HIPEC in the last 3 months. 2 were for appendix, 1 colon (Blake) and I don't remember the other one. The appendix cases have been approved - but only after an appeal. Appendix cancer is the 1st cancer they started doing HIPEC on so I'm not surprised they were approved.
Dr. Whisenant seems to be laying the ground work so that we won't be devastated if this doesn't get approved. I guess that's a good thing. If Blake doesn't get this procedure it doesn't mean that he'll just immediately go down hill. For now, chemo is still working and keeping the cancer in check and would (hopefully) continue to do so (preferably f-o-r-e-v-e-r!) Constant chemo is just so rough on him. Breaks my heart.
After the pump is disconnected tomorrow, Blake will be on an official chemo break until after the surgery. If it's approved, we'll head down to San Diego the 3rd week of March, if it's completely denied again, they'll put him back on chemo.
March is colon cancer awareness month. If you are 50 or over, PLEASE get a colonoscopy! Thank you.
Love, Kathy
Wednesday, February 9, 2011
Scan results
Blakes PET scan results show that the tumors have decreased in size - or - are no longer visable! YAY! At least we know the chemo is working!
No word on the appeal - yet.
Surgery is still scheduled for 3/25
Hope everyone is well!
No word on the appeal - yet.
Surgery is still scheduled for 3/25
Hope everyone is well!
Saturday, February 5, 2011
Last appeal
Hi all! It's official - we've advised the insurance company that we intend to submit our final appeal for HIPEC treatment.
Dr. Whisenant believes Blake will benefit from CRS weather it is followed by HIPEC or not. He said that he would not have recommended the surgery 2 years ago - but is so amazed by how well Blake is doing that he said - why not? Go for it! BUT.... The insurance company is implying that the cytoredcutive surgery (CRS) aka tumor "debulking" will NOT be covered weather HIPEC follows or not. I'm not sure if they're doing this because they think Blake will try to receive the HIPEC anyway (private pay) or if they don't understand that CRS would normally be covered as a standard treatment! I guess you just have to always fight for what you want! Nothing comes easy does it?
Last Wednesday while getting another chemo treatment, we were talking with the chemo nurse about how good Blakes blood work was! It's amazing that, with all the chemo that's been thrown at him, Blake has never had to have chemo delayed, receive a "booster" shot (like neulasta or procrit) or anything because of low/weak blood work! I'm starting to worry that people are going to figure out that he IS Superman!! :)
A PET scan is scheduled for Monday..... I look forward to hearing that it's ALL GOOD because his tumor marker increased this time from 3.1 to 4.0.... Please pray for a good scan. Thanks!
Love, Kathy
Dr. Whisenant believes Blake will benefit from CRS weather it is followed by HIPEC or not. He said that he would not have recommended the surgery 2 years ago - but is so amazed by how well Blake is doing that he said - why not? Go for it! BUT.... The insurance company is implying that the cytoredcutive surgery (CRS) aka tumor "debulking" will NOT be covered weather HIPEC follows or not. I'm not sure if they're doing this because they think Blake will try to receive the HIPEC anyway (private pay) or if they don't understand that CRS would normally be covered as a standard treatment! I guess you just have to always fight for what you want! Nothing comes easy does it?
Last Wednesday while getting another chemo treatment, we were talking with the chemo nurse about how good Blakes blood work was! It's amazing that, with all the chemo that's been thrown at him, Blake has never had to have chemo delayed, receive a "booster" shot (like neulasta or procrit) or anything because of low/weak blood work! I'm starting to worry that people are going to figure out that he IS Superman!! :)
A PET scan is scheduled for Monday..... I look forward to hearing that it's ALL GOOD because his tumor marker increased this time from 3.1 to 4.0.... Please pray for a good scan. Thanks!
Love, Kathy
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