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Title : Recommendations on how to fight Insurance and Drug providers
link : Recommendations on how to fight Insurance and Drug providers

Recommendations on how to fight Insurance and Drug providers

Hello All

I wanted to solicit the group on ideas to fight the silly rules of my insurance and convince drug providers to support my doctors request.

Quick background:

This June will be my 4 year anniversary of GBM resection and Standard of care treatments.

Since then, I have had a couple of re-occurrences battled with additional resections and DNX2401 trial, including Keytruda infusions.

My last resection was in October of 2018 and since then I have been getting CCNU every 6 weeks, Keytruda every 3 weeks and completed 10 rounds of additional radiation.  Basically stable MRI's since the radiation.

after the last resection, my NO prescribed tragresso and Optune.  Both have been denied thru 3 rounds of appeals.  Also since I am still working I do not qualify for any financial assistance from Optune or lilly. 

So any good recommendations to battle the bureaucracy? My company does provide a Health advocate but they are only good for contacting the insurance company for status on appeals.  They do not provide any assistance with fighting for approval.

My NO and his team have been very helpful with submitting all the appeals and necessary supporting documentation but with out success. I am stuck in this grey area where I have completed the SOC and the only available treatments available are off label non FDA approved for GBM protocols that the insurance company will not pay for.

So thanks in advance for any recommendations.

Marc

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