My life is filled with conflict. Fortunately, I dig conflict. Being a self-proclaimed Drama Queen, I thrive on conflict. Conflict becomes me. Okay, you get the drift.
When it became almost clear that rociletinib, the CO-1686 trial drug aka poksceva, had started to differ with me as to its purpose in my well-being, my awesome Onc, Dr Brevity, decided to requisition the services of Guardant. Guardant is the noted high-tech company that analyzes human blood to determine the types of mutated cells that are coursing through the veins of a cancer patient. Dr Brevity said he wanted to know what happened to the cancer cell that was once identified as T795, a mutation developed out of my EGFR in exon 19 deletion to resist Tarceva. Cancer cells do learn to outsmart cancer drugs!
I asked for the results of Guardant’s lab analysis as soon as it became available. Like the Good Doctor, I wanted to know what new nasties were parading in my system.
I read the report with great interest. The only problem was, I did not understand a thing about analysis of DNA, genes, and molecular pathology. Well, what do I know about molecular pathology? I’m a civil engineer; I’m into sewers. But I got the hang of what the report was saying: Those analysts did not know what to make of the results either because there was not enough material in my blood, consequently, they did not know what treatment to recommend. So, now, a whole slew of us including Dr Brevity, the analysts, the CO-1686 trial sponsor, its employees and associates, and me, know more than what we did before Guardant came into my existence. Zip, zero, nada. And my insurance company put me and only me on notice that they will not pay for the lab’s analytical services. In other words, you, Ms Senior String-Bikini Babe, shall pay. The scenario reeks with conflict of interest! The insurance company’s interest in my funds conflicts with my interest in not paying for anything whenever possible.
Well, I happen to be a veteran of conflicts. In public events, when the emcee asks veterans in the audience to stand up and be recognized for their patriotic service to the country, I attempt to join those who rise, but a companion always pulls me down and puts me in my place.
I read the letter of the insurance company word for word and found I have 60 days to file an appeal. I can name a relative, friend, attorney, doctor, or someone else to act as my representative. The most logical representative is Dr Brevity because he was the reason for the payment denial, which, by the way, was given: Medical records requested were not received. In order to determine financial liability or medical necessity medical records are required to assist in a clinical determination. As these records have not been received, this claim is not payable by the insurance company.
It was my turn to put somebody else on notice. And I did. Voila!
(to be continued)
I’d be glad to hear your experience if you have any on insurance payment denial of Guardant’s services.