So getting this transplant covered by insurance has been a crazy experience! But hopefully this info will help somebody out there:
Nov 4- paperwork was submitted to Blue Cross Blue Shield of Michigan(BCBSM) for approval of my stem cell transplant
Nov 13- they denied 🙅♂️ it
In the week of Nov 16- an expedited internal appeal was requested (cuz my MS seems to be getting worse day by day) Both the neurologist and the hematologist at Cleveland Clinic wrote letters on my behalf.
Nov 24- That appeal was also denied 🙅♂️ BCBSM said I could submit an expedited external appeal. This appeal would go to the Michigan Department of Insurance and Financial Services.
Since this was my last possible attempt at reversing the denial, I tried to attack the insurance from all directions:
1. Personal– I wrote them a letter explaining why I desperately needed this treatment.
2. Medical– The Bone Marrow Transplant doctor and neurologist wrote letters explaining the medical reasoning behind this. They included 3 articles from JAMA Neurology, European Society for Blood and Marrow Transplantation(EBMT) and Biology of Blood and Marrow Transplantation (BBMT). These articles all support HSCT for MS patients.
https://jamanetwork.com/journals/jamaneurology/article-abstract/2771920
https://www.bbmt.org/article/S1083-8791(19)30139-9/fulltext
https://www.nature.com/articles/s41409-019-0684-0
3. Political– I wrote letters to my representatives at the Michigan government. The external review was being done by the Michigan Dept. of Insurance and Financial Services(DIFS), a government entity, so I thought this could help. I did hear back from Senator Dayna Polehanki’s office. They made sure that DIFS was aware of my case and was assigned to an analyst.
4. Insurance– I had to figure out how they think 🤔 so I got myself a patient advocate( thank you Nancy!). My advocate was David Mair from Soter healthcare (https://soterhealth.com/) who understood HSCT’s role in MS. He also used to work for insurance companies, so he knew exactly how to fight this. I reached out to him at the very last minute. He usually takes 1 week to go through all the documents and write an appeal. But he did me a HUGE favor and drafted a well written letter for me in a couple of hours.
Dec 2- My appeal was submitted, and I kept my fingers crossed 🤞
Dec 4- Received a phone call from DIFS saying that the denial was reversed!
Dec 7- BCBSM sent a letter to Cleveland Clinic stating my stem cell transplant will be covered! YEA!!!
🥳😀😀😀😀🥳