Last Resort Insurance Strategies
If things turn ugly with the insurance company and you are willing to fight the fight, here are some thoughts:
Consider Contacting Media (perhaps a local news station that has a consumer advocacy arm)
Consider Local Legislators (to discuss insurance regulation and how your child is being affected)
Find Out the Name of the Medical Director
"May I please find out the name of the Medical Director that is reviewing my child's case?"
It may be possible for your oncologist or the proton center staff to connect with the Medical Director and provide more information or a "plan of care" that will describe how proton fits into the overall treatment plan.
Consider Hiring an Attorney
"I am considering hiring an attorney to help expediate my claim. May I please have the names and titles of all employees responsible for denying my child's claim so far so I can give them to my attorney? We would also appreciate any background information that will demonstrate each person's qualifications for denying my child's radiation oncology case."
If you really want to be wicked, you can also request their home addresses explaining you want to be sure the if there is any communication you want (such as a supeona) to be sure it is delivered to the correct address. When confronted with how or why this can happen, you explain your attorney will probably be pursuing an emergency medical necessity as described in their insurance handbook. Of course, you truly do need to have consulted with an attorney and be prepared to follow-through. These insurance companies won't tolerate threats or abuse. All of this needs to be handled in the same professional manner you would handle any other legal matter. At the end of the day, your insurance plan is a contract and attorneys can review the contract, and ensure your rights come first.
No one wants things to get ugly, but a denial means you need to appeal. Appeals take time. Lots of time. There are many attorneys and patient insurance advocacy firms that will help you. Don't give up too soon! Read everything we have on this site on the insurance tab.
Contact us if you need additional assistance. See the contact us tab.