Sweet, grateful tears as I write this. Waves of relief... It's awfully personal, but I wanted to share good news and celebration ... in honor of the balance... for all the hard work we have each put in for David, his life and his pain (or if you've been thru the gamut, in terms of health care and medical coverage. This issue is so up for everyone at the moment.)
I just got a call . The oncologists who treated David in Durango have been wondering how they were going to get paid for all the office visits, chemo treatments and hospital rounds. Insurance company's arms were crossed these last few months... "we're sorry, we dont cover that" ... They said the approach was experimental and research based.
I pasted below some of my response letter
... gripping with injustice and raw with loss but somehow pulled this through... and...
... IT WORKED!
The call I just hung up was to tell me the insurance company will be covering everything... everything except one office visit !
For all the letters and calls over the last few months to banks, credit cards, utilities, Dr offices and insurance companies, I CANT TELL you the relief that SOMETHING came back with affirmation. And knowing the team of docs and staff will be properly covered! Uah!
Huge!
Thanks for listening,
with love, Ananda
Sept. 22, 2009
Re: Request for Secondary Internal Review in response to initial Grievance Response from Golden Rule
Attached: Five photos, in chronological order, of patient's tumor over the course of four months.
Dear Golden Rule Grievance Administrator:
I have received a copy of your letter addressed to SW Oncology regarding the initial review determining benefits for services provided by them to patient David La Chapelle. The letter states no benefits are available.
The photos included consist of five images of David, profiling the squamous cell cancer tumor on his neck, spanning from March 4, 2009 to the day he passed away, July 21, 2009.
The initial review states the reason for a decline of benefits is that the treatment in question (David's chemotherapy) by Southwest Oncology would be considered "investigational, experimental or for research purposes" . The photos are relevant to your second review in that they reveal, without a doubt the successful and complete shrinking of the very large tumor. Let the photos show the very sound and relevant treatment plan carried out by the professionals of SW Oncology.
It was their long-lived body of experience, their qualified and competent skills as doctors, not to mention their up-to-date knowledge base (in a field moving at break-neck speed, that of oncology), that their plan of treatment for David was as successful as it was for entirely shrinking his large tumor. Their methods were, in my opinion (and I have lost my partner and best friend here), sound, safe and not based on experimental purposes or for the purpose of research and investigation. Rather, they were based on experience and education, not to mention the mysterious yet valid skill-set of intuition; an important ally for all doctors. As I say, in a field of information moving as fast as oncology, it is a doctor's key responsibility to go with the best plan for the condition, whether it is or is not yet widely accepted by "most doctors" as your letter indicates. And they must balance that, at every moment, with the "approved" or " accepted" mainstream, which, we all know comes with faults, such as being even slightly outdated.
The motive for treating David with Abraxane/Erbitux is that it was in the best interest of the patient, your client, David La Chapelle, as it exposes the rest of the body systems to the least amount of unnecessary toxicity. Given the mission statement repeated in each of the letters I have received from your offices, you "have made customer service of (y)our top priorities". If that is true, I am confident you want for your clients what doctors want for their patients: sound, safe treatment. Anything else would be a disservice to the customer you are so very dedicated to keeping a "high priority".
Thank you for the time you have given to reading this letter. Please consider me available for any further questions anytime.
Sincerely,
Ananda Elise Foley
Designated Representative for David La Chapelle
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