Insurer Goes Against Doctor’s Recommendation, Denies Cancer Treatment Coverage

By Consumers for Quality Care, on February 9, 2018

A St. Louis man is fighting his insurance company after it went against his doctor’s treatment advice and denied his treatment for lung cancer, KMOV reports. After undergoing surgery to remove his left lung, David Starzyk’s doctor developed a treatment plan for his other lung.

His doctors at Siteman Cancer Center made plans for radiation treatments in case cancer cells were also in his other lung. Doctors wanted to use a type of treatment that shoots a narrow beam of radiation instead of the conventional treatment for sarcomas, which shoots radiation over a wide area and could cause serious complications.

More conventional treatments could cause Starzyk’s remaining lung to get pneumonia, restrict the arteries in his heart, or cause atrial fibrillation.

Starzyk’s insurance company, Blue Cross Blue Shield of Illinois, denied the claim, even though his doctor included a note in his file calling the complications “potentially devastating.”

Starzyk has appealed the decision four times, to no avail. His radiation treatment scheduled to begin in the coming days.

“Very frustrating, extremely,” said Starzyk.