Denied….but not defeated

Standard

Got the phone call today from Kaiser’s expedited review.

226ASP6179944780

This was not what we were hoping to hear.

I was able to ask about an appeals process.  So I will be getting the information on that tomorrow.  And we will give the appeals process a shot.

In the meantime, there is another situation I haven’t talked about before on the blog.  Kevin is a firefighter, and many types of cancers are actually considered job related diseases and as such, worker’s compensation eligible.  Testicular cancer is on this list of presumptive on the job cancers.  Of course we have filed all of the correct paperwork for this process and seen an independent medical evaluater and are currently in the waiting for an answer period.  The independent doctor has not yet submitted his write up to the City of Santa Barbara, and once he does, they will have a few weeks to accept his recommendation and make a decision.  We are confident and believe this will be a worker’s compensation case, and when it does, that would open the doors to see doctors that are outside of Kaiser’s network.

The independent medical evaluater has up  to 6 weeks to complete his evaluation.  We have been told that once the city receives the word from the doctor, they have 2 weeks to respond.  So, we have been hoping that Kaiser would give us a yes so that we could keep moving forward in a more timely manner.  But in the meantime, we are hoping that maybe things can move along with this process a little more quickly.

Unfortunately, we don’t have an unlimited amount of time to wait.  The further away from chemotherapy Kevin gets, the higher the likelihood that the cancer will begin to duplicate/grow again.   If that were to happen, then he would not be eligible for surgery any more and the next course of action is called salvage chemotherapy – or the high dose chemotherapy with stem cell rescue.  I have mentioned this procedure in a previous post.  This is not a pleasant option, and it may be a step that would be unnecessary if the surgery is done first.

So, here is the game plan as of tonight.   We will begin the appeals process of this denial for treatment.  We will call the Kaiser surgeon to find out what the next steps would be to be able to get a date scheduled with him.  We anticipate there will be a few appointments and some waiting time for this as well.  In the meantime, we will be hopeful that we get an answer from the city that will allow Kevin to seek treatment from the best doctor in a timely manner, or that the appeals process is expedited and we receive a positive response from that avenue.  But we have to be moving forward and so we will do what we need to schedule surgery with the Kaiser surgeon and continue to hope that we will get some yes answer from the appeals process or from the City of Santa Barbara.

Dont-lose-hope.-You-never-know-what-tomorrow-will-bring

 

6 thoughts on “Denied….but not defeated

  1. John Carrillo

    Thank you for the up dates please tell Kevin and everyone in the family, though we are not there to hug you and yours we feel your pain everyday and pray it all goes well .. God bless keep the faith ..

  2. Sending hugs and love….so disappointing because Kaiser’s quickness helped save Tim’s life.All I can say is maybe trust them…Tim’s T.C. got quickly rated as job-related. If you need his attorney’s name, let me know.

  3. Mary Ellen Collins (Aunt)

    Unbelievable that the terrible impact of an illness only grows due to the burden of paperwork and policy. You are all an inspiration in hope and faith and remain in my heart and prayers.

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