Teen Denied Cancer Treatment by Insurance Company Fought Back in Amazing Way

Inspiring 20

Last year, for the first time in my long illustrious career as a health insurance company premium payer, I needed a small medical procedure. So imagine my surprise when I was denied. "Deemed medically unnecessary," said my rejection letter. Imagine my surprise that a health insurance company could override my doctor in what was deemed medically necessary. Luckily, this wasn't a life threatening condition -- just one that was making my life extremely uncomfortable. But imagine getting that same letter when your life is on the line. That's what happened to 18-year-old Lorelei Decker, whose insurance company, Blue Cross/Blue Shield, rejected her bid for cancer treatment. But this time the health insurance bigwigs were messing with the wrong teen.

Lorelei suffers from Hodgkin's lymphoma, a cancer of the lymph node system. Lorelei's cancer has been resistant to chemotherapy and now she has a tumor in her chest. Doctors suggested a last ditch stem cell transplant. But then the BCBS rejected this treatment as "medically unnecessary."

I can see it both ways here. If you're a company, and your main concern is the bottom line, then paying for expensive treatment that may not work isn't optimal. But if you're a patient or a patient's family, of course, you say, "Give me whatever you've got!" End of story.

After the rejection, Lorelei and her mom took to Twitter. Lorelei's mother, Andrea Decker, sent out the first salvo, tweeting:

All hell's about to break loose. BCBS DENIED Lorelei's transplant. No words for how angry I am. I guess it's cheaper to let her die.

The family started the hashtag #ApproveLorelei. Several hundred people retweeted and used the hashtag to express their outrage. Soon it was trending in Oklahoma, where Lorelei lives.

By the next day, the insurance company had suddenly changed its tune about Lorelei's treatment being "medically unnecessary." Imagine that! Lorelei thinks the change of heart came solely as a result of the attention surrounding her case. She says:

Typically people don't fight on social media or don't publicize the issues that they're having issues with insurance coverage, and it's just up to them to call and reapply or mail it in, and it's all on them. But when there is a level of publicity there, there's a level of urgency to defuse the situation, and so you're kind of put on the front burner, finally.

So maybe we all need to take to Twitter the next time we're denied medical care.

Have you ever fought your insurance company?


Image via LoreleiDecker.com

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Michi... MichiganMom602

This happens every single day - all of the time.  On average, an insurance carrier will routinely reject 30-35% of all submitted claims and 40-45% of submitted pre-auth requests.  They are counting on the laziness of most medical offices to just accept the denial and move on.  Almost anything will get approved if you appeal it and almost every denied claim will be reprocessed if you appeal.  They are a business and want to make millions just like any other business. 

Teal Chastain Blacksten

One thing that's nearly as important to a business as the bottom line is PR. No business wants to risk bad PR, especially in this time of social networking.

nonmember avatar Amy

My son needed a helmet to straighten his head after birth. He met every single criteria under my insurance requirements (trust me, I checked), had 9 separate doctors & nurses say he should get it, & Blue Cross denied coverage (after treatment began). As a stay at home mom, but licensed attorney, a big, fat 30 page document with exhibits came their way. It was approved the following month.



I felt like they just wanted to see if I was lazy & didn't respond! So irritating.

Sky Lar

Umm... you realize that a stem cell transplant is going to have zero effect on her metastatic sites right? Her problem is the cancer cells that have already spread and are resistant to chemotherapy. Adding in new stem cells won't change that. It would be like having an engine problem in your car and trying to fix it by changing the tires. It doesn't make sense. I don't doubt that there are instances of insurance companies putting profits over patient care but this one of them. If you are going to report it - do it right.

Sky Lar

And by the way - I think that it is unethical for her doctors to even suggest it when they have to know this won't work. They are taking advantage of the ignorance of their patients in a desperate situation just to line their own pockets. Not. cool.


 

nonmember avatar Carrie

One thing that people generally fail to take into consideration these days is that a huge bulk of insurance companies these days work primarily with self insured accounts rather than the fully insured sort. What this means is that when a company is "fully insured" it means that they're opting into a plan designed by the company that's providing the plan. They pay the premiums (as do employees, but believe me, your employer pays), but they're largely playing with the insurer's money. However, in self insured accounts, your employer itself is paying until they hit a deductible, just like you. At that point a re-insurer kicks in and picks up the tab. But what that means is that your employer is the one designing your plan. For those of you who have self insured plans (and believe me, a lot of you do), your employer is the one telling us that we can't approve a claim or that we can only pay it at cut rate compared to what someone on another plan gets paid on. In the self insured world, we dgaf what claims we pay. We'd be more than happy to pay all of your claims at 100%. Your employer is telling us we can't. It's not always the insurance company that's the bad guy, just because our name is on the card doesn't always mean that the final word comes from us.

Tempeted Tempeted

A very, very good point Carrie. Luckily I work for a hospital who designates my pan. I haven't had anything denied even things like my tubal ligation and my husband's reconstructive surgery for his nose. I can see though, how they could deny things like that. What an unfortunate situation all around. Good for the family for sticking up for themselves even for a transplant that more than likely won't improve her situation. So sad, 18 is so young to die. 

Rosas... RosasMummy

Sky Lar- stem cell treatment that introduced new immunlogical cells previously suppressed by self recognition of the tumour would work. Doctors don't just say 'let's insert some random stem cells into u and see what happens' knowing what stem cells are and what cancer is doesn't give you any where near enough knowledge to know how this treatment is intended to work.

cherylam cherylam

we just had our prescription plan refuse to pay for a drug that treaats my diabetes, saying it wasn't even in their formulary.  After a testy half hour conversation between myself, my dr and the insurance company... they decided to cover it.  Idiots would rather see someone on insulin, that is not good, rather than a drug that keeps you off it.

lobus lobus

So glad I have Tricare. Anything Ive wanted or needed under the sun for me and my family has been given. No copays either...seems like the government can do a few things right...

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