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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Comments 20
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.
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.
I felt like they just wanted to see if I was lazy & didn't respond! So irritating.
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.
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.
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.