Fighting My Insurance

My oncologist at St. Peter's said something like, "I'm a good oncologist, but the people at Sloan Kettering and Dana-Farber, they're the elite of the elite." Then he told me to go see one of them.

Easier said than done. My insurance is an HMO, and Sloan Kettering isn't in my network. Back in August, the same insurance company already turned down a referral to NYU for my heart. My doctor at Bassett wrote that request. I let them. I wish I'd written that one myself.

Here's what most people don't know. New York law says if your HMO doesn't have anyone in its network with the right training and experience for your case, it has to send you to someone who does.

So this time I wrote the letter myself. I did a ton of research and made it as thorough as I could, so all my oncologist had to do was sign it. I found the cracks, the places where my insurance company's network couldn't give me what my case actually needs. Every one of them was true and factual. That's what the letter was built on.

I just wanted someone who's spent a career on my type of lung cancer to look at my case and tell me if we're missing something.

If they said no again, the backup was Dana-Farber in Boston. Online second opinion, about $3,000 out of pocket. I didn't want to spend it. Every dollar I spend on this is a dollar Charlotte won't have when I'm gone.

And the waiting pissed me off. When you might only have 8 to 12 months left to live, every week you wait on an insurance company is a week you don't get back.

Then I heard back.

Approved.

My letter worked. The same insurance company that said no in August said yes. I'm heading to Sloan Kettering on October 20 for my first consult. That's the same day as my PET scan, so I'll probably have to reschedule it.

If you're on an HMO and your doctor tells you to go see the best, don't take the first no. Write the letter yourself. Search your own network, find out who's in it and what they can't handle, and use that to prove your case.

Stuck on one? Reach out through my contact page. I'll help.

I'll tell you what Sloan Kettering says.