Cover the Trial

Aug 10, 2012 by Brooke McMillan

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“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” -Martin Luther King Jr.

You may have heard us use the phrase “Fight Like Hell” in various campaigns and videos over the past year. The inspiration for this campaign came from an individual named Brian Rose. Brian is 34 years old, a minor league baseball coach, newlywed, Austin resident, and a LIVESTRONG Cancer Navigation Center Client. We featured Brian in a campaign last year as someone who has benefited from the LIVESTRONG Navigation Services. He was diagnosed with stage 4 melanoma last year and, like many young men, did not have health insurance. We were able to get him set up with a plan in spite of his diagnosis and he has been receiving treatment for his cancer. The treatment is no longer working.

But there’s hope…with a twist. Brian qualified for a clinical trial at MD Anderson in Houston (just three hours from home). The initial outcomes from the trial are incredibly promising even with advanced stages like Brian’s. Brian’s doctor is ready to treat him, Brian himself is ready for treatment and his wife Lupe is ready to care for him and all his friends and family are ready to support him. Here’s the catch: his insurance company will not cover the first part of the clinical trial which costs $70,000. And without the first part, the second part (which HAS been approved by the insurance company) won’t work. Yep, that’s right. The $200,000 second half of the clinical trial is covered, but the insurance company is hung up on $70,000.

This blog is not intended to shame an insurance company into paying for Brian’s care. If we did that we would need all 90 staff members at the foundation writing blogs day and night to cover just a fraction of the stories out there. The purpose is to highlight something incredibly important. There is a human being behind that denied claim. There is a man who wants the chance to be a good husband and to someday be a father. There is an awesome coach who wants to get back to his team and a cancer advocate who wants the chance to share his voice. We do not need to shame. The Affordable Care Act states that an insurance company “may not deny (or limit or impose additional conditions on) the coverage of routine patient costs for items and services furnished in connection with participation in the trial”. So please, insurance company, do the right thing. Cover his Trial. Cover the whole trial and do it now, because every day Brian wakes up there is a new lump or a new growth and every day you deny his coverage is a day that is lost in his fight against cancer. And anyone reading this, please support Brian in his fight. Read more about Brian’s story or contribute to his care at www.HowsBrian.com.

To anyone facing similar challenges, the Lance Armstrong Foundation is here for you just as we are here for Brian. We have expert staff who know how to shake the trees and make the phone calls and submit the paperwork work to get claim denials overturned. We will do the same for you. Call 1-855-220-7777 or go online to get the help you need.

Fight Like Hell, Brian!