I Fought the Insurance Company and Won!

Months ago, I wrote an article for CURE regarding the denial of an insurance claim and a short time later, wrote a follow-up article. Today, I’m writing to share the end of that saga with you and to let you know persistence pays off because I fought the insurance company and won!

Shortly after bilateral mastectomies and lymph node removal, my oncologist noted severe swelling in my upper arms and trunk region. He gave me news I didn’t want to hear. He said I had developed lymphedema. Lymphedema is a painful condition where lymphatic fluid pools in the extremities and other areas of the body where the normal flow of lymphatic fluid is disrupted.

I went through months of massage therapy performed by a certified lymphedema therapist only to receive temporary relief. I performed manual lymphatic drainage on myself at home, but it didn’t relieve the swelling. As the fluid continued to build, my doctor ordered a recirculating compression pump. He felt this was the best option available to aid in dispersing the fluid and easing the pain in my arms, but there was a problem. The pump Dr. F originally ordered was denied me the insurance company. They considered it medically unnecessary and told me I'd have to take another model that should work just as well. Without much choice, I agreed to accept the eight-chamber model and tried it for several months with no success. The eight-chamber model was designed for someone suffering from lymphedema swelling in only their arms from about the bicep area down toward their fingertips. It did not address upper arm and trunk swelling.

My doctor noted the continued swelling in my body. He commented on it and asked why I wasn't using the pump he’d ordered for me. I explained about the insurance company denial letter I’d received. I told him the letter from the insurance company stated the pump he’d chosen was considered medically unnecessary. Although I didn’t have the specific pump Dr. F had prescribed, I continued to use the eight-chamber pump in hopes of reducing the swelling.

To make a long story very short, I kept praying for things to work out so I could get the 15-chamber recirculating pump. My doctors kept writing letters to the insurance company giving information about my medical condition and doing everything they could to substantiate the claim. After five-and-a-half months of persistence, I got the call today telling me the original pump Dr. F ordered had been approved and is on its way to me! I was also told I would have no copay! Isn’t that amazing?

These pumps are extremely expensive ranging from $2,000 and up. It's no wonder the insurance companies don't want to pay for them, but I am extremely grateful for diligent doctors and their willingness to help me fight the insurance company. I'm grateful we have a good insurance company but they don't really have the medical knowledge to determine what is and isn't medically necessary.

I can't wait to receive this new pump and get some relief from this uncomfortable swelling. One thing I’ve learned throughout this whole ordeal is the importance of being your own best advocate. If you are turned down by your insurance company for medical equipment or treatment, don’t just take it lying down…fight! If you don’t feel like you have the information you need to fight on your own, get your medical team involved. Let them provide documentation or whatever is necessary to influence the insurance company’s decision. Most people who work for insurance companies are not medically trained. They do not have the ability to fully understand a patient’s needs. Medical doctors go through years and years of schooling to be able to diagnose and treat their patients. As victims of cancer, it’s our right to have the very best treatment and care available. Sometimes we have to fight hard to get it.