Blue Cross of Southern California vs Cancer Patients

If you have Blue Cross of Southern California and if you have advanced cancer then you may be in serious trouble. I say this because of the experiences my patients have been having in getting reimbursed for expensive cancer chemotherapy drugs. It is no surprise that the newer biological chemotherapy drugs are very expensive but it is a big surprise when you find that the medical insurance company, which you have been paying for years, refuses to reimburse you for treatment. These newer chemotherapy drugs are expensive but very effective. The insurance carriers are very sneaky in how they delay payment. They actually torture you as you try to fight your cancer. Here is how they do it.

You may get a letter from the insurance carrier stating that they have decided that you do not qualify for the expensive cancer fighting drug. Mean time you may very well be responding positively to the drug. This allows the insurance company to initiate a time consuming and stalling tactic that will initiate your appeal process that may take many months (the delay they are hoping for). Mean time you are undergoing chemotherapy and your bill for the drug so far may be well in the $80,000-100,000 range.

Who is paying for the drug until your insurance company coughs up the money? Your oncologist is footing the bill until your insurance company reimburses for its administration. Now how many patients like you do you think your oncologist can afford to "finance" while Blue Cross drags its feet? Not many! That means that the next patient who requires an expensive biological chemotherapy drug may not be able to get it until Blue Cross meets its obligation.

Is this a new phenomenon? YES! It is as new as the new and expensive chemotherapy drugs. The reimbursement delays have at least two beneficial effects for your insurance company: 1) the company holds on to large amounts of money for longer periods of time allowing the money to accumulate interest in their accounts and 2) they discourage your oncologist from offering an expensive drug to patients at least as an out patient thus leaving him two choices: 1) admit you into the hospital to shift the burden of drug finance to the hospital and 2) use the less expensive and less active older drugs many of which may have more side effects.

So what can you do about this? I think you have to complain to your congressman and the state insurance commissioner. Let your insurance carrier know that you know what they are doing and that you and your family will hold them responsible if you are unable to continue receiving the drug because of their stalling tactics. If you are forced to discontinue an effective, life saving cancer fighting drug because your insurance company is withholding payment, and if your tumor progresses during this time, I would hold them directly responsible.