Update by user Sep 12, 2017
I know these things have to be edited for the site, but I am not loving how it broke up my paragraphs. Completely slaughtered the rhythm/clarity of this review... : /
Original review posted by user Sep 12, 2017
Oooooooookay. I jumped through hoops w them for over a month before finally talking a panel of strangers into covering a clinical trial route that is my legit only option*, and not available in my home state.
These trials are already mostly funded, because duh, that's how clinical trials work. They are research trials, so the money comes from whoever is sponsoring the research. BUT...after convincing them that it WAS necessary for me to receive this treatment, they are refusing to cover the biopsies, MRI, and CT scans necessary to START the treatment. I just...
I mean, is this not sort of darkly comedic? I almost respect these ***. *I have tried chemo, more than once. My tumors are chemo-resistant.
Surgery is not an option. Radiation will not do anything because of their placement. Immunotherapy is my best bet, and the only trials available for my specific cancer are currently taking place at Dana Farber in Boston, MA. (I'm a WI resident.) In order just to get this far with Molina, I had to be part of a conference call wherein they asked me to plead my case.
(This was after rejecting my claim 3 times) I told a room full of people--NONE of whom were my doctors, and only ONE of whom even WAS a doctor--the incredibly personal details pertaining to my ovaries/uterus/ life. It was...really pretty gross. Though I suppose it would have been even worse in person. I have tried contacting them.
Their party line for my advocates at Dana Farber is that the biopsy and CT scans are not medically necessary, because they covered these things a few weeks back for a different trial. That trial fell through because of the pathology of the tumors themselves. For this trial, I need results from fresh tests that are measuring slightly DIFFERENT things. To reiterate: clinical research trials are already mostly funded.
Just...just a reminder. They have not had to cover ANY trial as of yet. ...I've been going without treatment for 6 months now, bc I had to wait for a slot to open up/a green light on the 2nd trial. These tests need to happen in order for the trial team to work with my tumors/make decisions about things like dosages, progress, etc.
They are medically necessary. I cannot start treatment without them. Every time I need something it's another few days or even weeks that go by fighting w these people. I'm 32 years old and have people helping me fight.
I can't imagine where I'd be right now if I were elderly or alone and didn't have advocates, or access to advocates. What I don't understand, truly, on a FUNDAMENTAL level, is that covering these things would actually BENEFIT them, cost-wise. So let's take emotion/the fact that this is my best shot to live and I'd really LIKE to live out of the equation. Let's talk $$$ since that's the language they necessarily speak, since they're a for profit company.
I'm not holding that against them. But, think about it: The longer I go untreated, the worse my tumors get, the worse my pain gets, the more pain meds/appointments they have to cover for me, and the less likely it is that I'm able to continue working and paying my bills. I'm currently still able to work but it's becoming more and more unfeasible. On the other hand, if they cover these initial tests and I'm able to start the trial, and it's as successful as it's shown to be with other patients, the LESS *** they'd have to take care of for me!
It's not like I have a laundry list of ailments. I have one that just happens to be a ***: chemo-resistant, granulosa cell tumors. Which they are currently paying to treat the SYMPTOMS of, only. Wouldn't it make more sense for them to help me get RID of them entirely??
I've personally never had a bad experience w the customer service reps, only with the policies themselves, so I'll refrain from shooting the messengers here. ...also, the image below is not a 100% accurate depiction. Nor is it meant to insult anyone who works for this company and, for some reason, REALLY LOVES his/her job........ ALSO, also...this is just how things stand as of 1:13 am on 9/12/2017.
It could change over night, who knows.
A miracle could occur. But this site does not let you take down or edit prior posts easily, so I'm adding this as a disclaimer.
Product or Service Mentioned: Molina Healthcare Customer Care.
Reason of review: being rejected .
Monetary Loss: $7200.
Preferred solution: I just want to be able to start a treatment you've already agreed to cover, but to do this, I need scans, biopsies, and MRIs covered as well. That's all. I'm not looking for EXTRA, I'm looking for what's necessary. .
I didn't like: Not enough characters to explain.