New bill prompts insurers to stop playing doctor – Marin Independent Journal

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When doctors identified a tumor growing in my father’s lungs last August, we knew that any chance we had of beating his cancer would be rooted in the team of specialists caring for him and acting quickly. Curing my father’s cancer, however, was completely at odds with the goals of his health insurer.

From the start, virtually every treatment and test his doctors said he needed required prior approval. Prior authorization requires physicians to obtain approval from a health insurance company before prescribing drugs or performing medical services.

State Senator Richard Pan, who is a medical doctor, has a bill pending in the California Legislature that will change this broken system. Senate Bill 250 will allow patients like my father to get the treatments they urgently need without unnecessary delays from insurance companies by requiring insurers to consult with doctors to determine which services require clearances and streamlining the process to allow physicians to provide treatments and services based on their patients’ needs.

Even before my father’s treatment could begin, his doctors struggled to get approval for a biopsy that would detect early signs of cancer and provide a more accurate diagnosis.

Ten weeks later, diagnostic tests showed that my father had metastatic melanoma. He was referred to an oncology specialist, where again there was a delay in getting approval for other diagnostic tests – a positron emission tomography (PET). Four weeks later, the scan showed that her cancer had already spread to her adrenal gland, hips and lungs.

His team of doctors kept spirits up and came up with an immunotherapy treatment plan.

In January, I was thrilled to have my father transferred to the state-of-the-art Keck Hospital at the University of Southern California, offering expert care and testing for metastatic melanoma. However, each new treatment or scan was met with an obstacle course of pre-approval denials, appeals, and final approvals from my father’s insurer.

I worked hand in hand with his team of specialists, who kept his insurance company on speed dial. I vividly remember spending three and a half hours one day in March trying to seek appeals against his refusal of an MRI and PET scan requested by his doctors.

Time is your most precious resource when it comes to cancer, and I spent my time — the last months of my father’s life — fighting with his insurance company.

Still, we remained hopeful as his doctors scrambled to enroll him in a clinical trial that would guarantee him immediate treatment, rather than the repeated delays of the prior authorization process. But in early April, an MRI showed his cancer had spread to his brain and he would no longer be eligible for the clinical trial.

Dad’s doctor told us not to give up. We did not do it. But he was then referred to a radiation oncologist to continue with another form of treatment – radiation therapy. The removal was refused. Called. Reversed. It was too late. Dad passed away on April 27.

I wish Senate Bill 250 was in place in time to help my father.

Vivian Gonzales is a public health nurse living in Los Angeles. Distributed by CalMatters.org.

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