News 2 I-Team: How to battle insurance companies

CHARLESTON, SC (WCBD) — Mt. Pleasant resident Jeff Howe and his two daughters understand the fight against cancer. Jeff’s wife died five years ago from breast cancer.

In November of 2016, Jeff was also diagnosed. But, his fight is against more than just the disease.

jeff-breast-cancer-fundraiser

“I noticed I got some pain in my right hip. Then, it got a little worse and it turned into a limp,” Jeff explained.

Doctors discovered a tumor in his femur that was the size of two baseballs.

“The tumor was much more aggressive than they thought it was going to be,” he said.

It turns out that tumor metastasized from a very small tumor on his lung. The doctor recommended two radiation treatments; one for the leg and a very intense form for the lung.

“The idea is that it not only reduces pain, but it eliminates the cancer,” said Nancy Howe, Jeff’s 25-year-old daughter.

She travels from Atlanta monthly to take care of her dad. More recently, though, her time is spent on the phone with the insurance company, Blue Cross Blue Shield of Georgia. It denied coverage for Jeff’s radiation, saying it was not “medically necessary.”

“It’s draining and defeating,” said Nancy.

“We’re doing what we can to come back and help out, but when you have to spend hours on end on the phone with the insurance company instead of helping our father, that’s not what we want to be here to do.

Charleston attorney Christy Allen helps patients fight for medical coverage. She says not everyone needs an attorney.

“All health insurance claims and denials have some avenue for appeal,” said Allen.

Allen says a denial letter should come with an explanation of benefits. It should be a document that explains why your insurance denied the coverage and how many days you have to appeal.

Patients then can then have your doctor write an appeal further explaining why the treatment is necessary.

Jeff still questions the process.

“My biggest question is, if a doctor has several routes he can go, and he chooses one over the other … these are doctors that have a lot of experience … Then, they have the insurance company telling them no you can’t do that,” said Jeff.

Allen says to avoid a denial, patients should review the details of their insurance plan. They should understand what your insurance WON’T pay for, and then talk with a doctor about the best route to take.

“There may be ways to make the order of treatment consistent with the manner of the insurance in order to be covered or covered at a higher level,” said Allen.

Allen says it’s fairly common for people to be denied insurance coverage, so it’s important to keep fighting.

“Sometimes it takes several calls; you have to go through several people. It is a frustrating process, but if you keep at it, pay attention to the deadlines, you will be able to file your appeal,” she said.

Jeff and Nancy appealed and eventually did get approved for his treatment coverage.

He celebrated his final dose of radiation last week.

“Right now, I’m a little weak, but not so weak, I can’t hop around on the walker and some crutches,” Jeff said.

Nancy says if anything, the treatment gives them optimism.

“He is just in such a better mood,” said Nancy.

“I’m hoping that a few months down the road we can just be done with it. I hope we can just put this behind us,” she said.

The South Carolina Department of Insurance can help. If you’ve exhausted all individual appeals, the agency can take your case further.

You can also find advice on how to appeal and how to pick the right plan on its website

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