Has anyone ever been denied IMRT by insurance?! It has now been several weeks since we found out my dad’s tumor pressing on his heart is no longer stable and is slowly enlarging. So far from 4.2 to 4.9 cm but that was several weeks ago and could be changed by now. He has a 5 inch blood clot because of the SVC syndrome caused by the tumor pressing on right atrium and ventricle of his heart. Radiation was held as tumor was stable with chemo, but that tumor is now slowly enlarging. It is also pressing into his bronchus causing shortness of breath. Proton therapy was recommended, however the radiation mapping showed IMRT and Proton was so similar in radiation spill out given the angle of the beams for his tumor. Proton was denied by insurance so IMRT was agreed on as the radiation oncologist said the IMRT plan he has devised for my dad is an excellent plan and one he would want his loved ones to receive were it him. Time is also VERY critical!! It was submitted to insurance for IMRT, 15 treatments for tumor control of the chest tumor pressing into his heart and near and on critical organs. Insurance just denied my dad last week for IMRT stating “not medically necessary”! Has anyone heard of this???? Dr said standard radiation would be devastating to my dad given the placement and location of his chest tumor on heart and bronchus. We are beyond upset.
The dr did a peer to peer review with insurance and the denial decision was still upheld. Last week I wrote a 4 page letter for my dad along with 30 pages of medical records to submit to insurance for patient claims appeal. Insurance is Blue Cross Blue Shield Florida. I don’t know how they can do this to people with cancer. 😢 I have been researching like crazy but I’m so at a loss on what to do or where to go from here. Dealing with insurance isn’t really getting anywhere and time is running out.