Insurance Approvals for Cancer Related Tests

In Breast Cancer, Recent Posts by Barbara Jacoby

So, you are dealing with breast cancer and already you find that your life has been forever changed. You are scared and can’t begin to wrap your head around all of the decisions that you will have to make but you are counting on your medical team to at least be able to direct your testing and treatment. Then you find out that the test that your oncologist has recommended and to which you agreed will not be covered by your insurance company following the response that is received following their approval process review.

No decision maker sitting at an insurance company will ever be able to make a decision regarding a patient’s treatment that is better than that of the recommending medical professional.Barbara Jacoby

If you think that this is an exception in the treatment process for most patients, you might want to reconsider your thinking. I have been finding an average of at least one such complaint from cancer patients each week and their stories have become more disturbing recently. For instance, the one that I received just a few days ago contained a decision based upon three major points that included very basic pieces of information about the patient that were wrong, including her incorrect age that in this case, was a major consideration for the test. Another one that I was discussing with a patient a few weeks ago resulted in the denial of a test for her based upon a completely inaccurate assessment by the insurance reviewer of a patient’s status even after numerous calls and pleas and information provided by her oncologist.

Then I came across an article that apparently supports what I have been hearing about from patients across the cancer spectrum. Oncologists, who have the most intimate knowledge about their patients, have been working overtime to get approvals for the tests that they know that their patients need. And in many cases, the patients also are jumping through hoops in order to get the tests that have been recommended in order to make the best decisions possible about their future treatments in order to have the best outcomes. And for more patients whose tests are being delayed and/or denied, those delays may make the difference in receiving timely treatments that would have provided a better outcome or may have kept them alive.

While many insurance companies are now basing their decisions on recommendations that have been established as “general” or “established” guidelines, no person or his/her cancer or particular situation will necessarily fit into what is consider as “normal”. If an oncologist is in need of a certain test for a patient, the doctor’s decision should be the primary consideration. No doctor should be placed in a position where (s)he is compromised in their work decisions when they are the ones who have the most intimate knowledge of their patient. It has been my experience that if the doctors are given the information that they have requested in order to provide the best treatment possible for their patients, the costs to the insurance company may actually be much lower for the patient and the insurance company in the long run as it was in my own case.

It is time that decision making be returned to the doctor and patient in order to bring about the very best results and outcomes possible. No decision maker sitting at an insurance company will ever be able to make a decision regarding a patient’s treatment that is better than that of the recommending medical professional. And it seems that insurance adjuster will always decide on the side of their employer, especially when it may result in benefits to them on a personal basis. And how bad is this situation when you hear about how some such adjusters having admitted that they didn’t even review their cases before issuing their determinations. Knowing that these decisions might just result in whether a cancer patient will live or die, it seems to me that the insurance companies should allow the doctor to decide what is in the best of interest of their patients.

Barbara Jacoby is an award winning blogger that has contributed her writings to multiple online publications that have touched readers worldwide.