Advocating with insurance and hospital to cover cost of BCG

2 years 5 months ago #60699 by Alan
I don't have a lot of experience with insurance complaints but, here is a start and something you can do on your own. I would start with the hospital administration, whoever wrote your insurance policy, adding complaints to the state board of insurance, possibly your state's attorney general office, and your local papers ombudsman (troubleshooter). It often will take a month or more to get some kind of response which hopefully will clear you to have the BCG covered. Being a standard procedure I do not understand why it is not covered.

DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.
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2 years 5 months ago #60698 by RosieF
My boyfriend went through his 6 BCG treatments, during a very, very stressful time, for reasons unrelated to his cancer. He did really well with the treatments though we haven't had the next scope. That will be at the end of this month.

We went to a hospital that accepts his aca plan, as does his urologist. But we just found out that none of the BCG treatments were  covered under his insurance which I simply cannot understand. We assumed, being in network with his doc and hospital, that these would be covered. It looks like the hospital may have given us some kind of discount.

Naturally, we want to challenge this, and get financial assistance if we can. Does anyone here have information that can help about how to contest this kind of thing? And does anyone have any experience with ACA policies that might be a little more complete in coverage? We've been really happy with this aca silver plan up till now. But we don't know that his BCG treatments are over yet. And it is really scary to think we will need to pay for these treatments each time he needs thm.

Thanks for any help.

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