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I am looking for help from people who have appealed an insurance company non-coverage decision based upon a determination of trial as "investigational and experimental". I am stage IIIC ovarian cancer and MD Anderson has recommended a Stem Cell Transplant with high dose chemo. While I am interested in appeals that have been granted, I think info on denied appeals could be useful. Thanks.
The suggestions on the NCI website might be helpful. They specifically address the appeals process.http://www.cancer.gov/clinicaltrials/understanding/insurance-coverage
What insurance company do yo have?
This is Cigna policy info regarding transplants:
http://www.cigna.com/customer_care/healthcare_professional/coverage_positio ns/medical/mm_0321_coveragepositioncriteria_stem_cell_transplant_ovarian_ca ncer.pdf
This Aetna policy info regarding transplants (it looks like they approve for Germ Cell OvCa):
http://www.aetna.com/cpb/medical/data/600_699/0635.html
I have Humana. They say they have never had a request for a SCT from an ovarian cancer pt. Did you have this done?
Some states have specific laws regarding insurance companies and their obligation to pay for certain charges that would be incurred while on a clinical trial...please check into it...good luck!
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