Fredericton patient fights kidney cancer AND his private insurance company

A few weeks ago we heard from a patient in Fredericton, New Brunswick with what seemed like an unusual case. His medical condition was quite straightforward: after having taken a first-line therapy for quite some time (four years), he now needed second-line therapy. His oncologist in New Brunswick, along with specialists in Halifax and Toronto, had recommended that he begin Afinitor/everolimus.

That’s where is trouble started. Now, some of you will remember that we celebrated earlier this year (July) when the New Brunswick government announced funding of Afinitor in the second-line for those patients on the public drug program. This patient didn’t need the government’s plan, because he has been paying for private drug ¬†insurance ever since he retired (normally a good move in anyone’s book!)

However, this time the wheels of the insurance company were turning slowly, if indeed they were turning at all. Although the NB formulary had added Afinitor in July, the insurance company had not yet decided whether to add the drug to its list of drugs covered. And so they kept him waiting… and waiting… and waiting while they reviewed the case. Weeks turned into months while he waited for bureaucrats within the insurance company to decide whether he could have the drug or not.

On the patient’s behalf, KCC wrote to the insurance company and we were told that a decision (positive or negative) would be made by the end of the month. In the meantime, we had put the patient in touch with our contact in the media. A front-page story appeared today in The Daily Gleaner in Fredericton:

http://telegraphjournal.canadaeast.com/front/article/1459946

As an addendum to the news story, it’s worth noting that a 5 pm yesterday, the patient was called with the news that Afinitor had been approved for him, at least for 4 months.

Unfortunately the stress and anxiety caused by the insurance company cannot be undone. Nor can the tumour progression that happens when advanced kidney cancer patients go without needed treatment. Surely someone in these organizations can show a little compassion and expedite a request when it is for a life-threatening condition.

Surely that’s why we buy private insurance in the first place — to cover us when we need it most.

 

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One thought on “Fredericton patient fights kidney cancer AND his private insurance company

  1. It sort of feels like: “you’re damned if you do, and damned if you don’t.” In my mind, I feel he did all the right things to ensure that he would not have to scrabble for the drug treatments he might need somewhere down the road. Instead, it seems they just shelved his request without anyone taking note that he was a cancer patient who needed a timely answer.

    We seem to be needing advocacy groups for everything these days; one person has no power, and an insurance company with little compassion or desire to help, will leave you hanging. It begs the question of WHY did the insurance company have lead feet? I’d sure like to know what their motivation was.

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