OKLAHOMA CITY – Fourteen months ago, 18-year-old Lorelei Decker, was diagnosed with Hodgkin’s Lymphoma.
Rounds of chemotherapy and radiation did not work.
A stem cell transplant using her own stem cells failed.
She has a deadly 12 centimeter tumor wrapped around her heart and lungs.
Tuesday afternoon, Lorelei Decker would tell you cancer was not her biggest battle, insurance was.
Lorelei’s family has Blue Cross Blue Shield of Oklahoma for their medical insurance carrier.
The Decker family was shocked to find out Tuesday afternoon that BCBSOK denied her most recent claim, a request for a second stem cell transplant.
“Who is insurance to get to decide who lives and who dies,” Lorelei said. “Since when do we have to fight cancer and fight insurance?”
Blue Cross denied the request from cancer treatment center MD Anderson citing that the procedure was not “medically necessary.”
“They’ve placed the value on my life,” she said. “They know the money it costs to do the stem cell transplant. ‘Lorelei Decker… she’s not worth it.’ It’s extremely medically necessary. It’s not experimental. Doctors say I need it. I pay for coverage. It should be covered.”
The Deckers are quick to point out a major difference between Lorelei’s previous stem cell transplant and this one.
Last year doctors transplanted her own stem cells into her body; this time they plan to use donor stem cells.
Lorelei’s oldest sister, Hannah Decker, is a match.
The family had already booked plane tickets and a hotel in Houston for Hannah to travel this week for her stem cell donation.
All of the reservations were canceled when BCBSOK denied the claim.
Lorelei and her mom, Andrea Decker, launched a Twitter campaign Tuesday afternoon.
They asked Twitter followers to tweet to Blue Cross Blue Shield of Oklahoma with the hashtag #ApproveLorelei
Then, about 24 hours after the denial, Blue Cross Blue Shield of Oklahoma called again.
“I spent about 30 minutes on the phone with Blue Cross Blue Shield and MD Anderson had talked to the medical director and it had been reversed it is now approved,” Lorelei’s father Kevin Decker said.
The following is a press statement from Blue Cross Blue Shield of Oklahoma:
“As a member-owned company, Blue Cross and Blue Shield of Oklahoma takes all member concerns seriously. We are committed to protecting our member’s privacy and – following state and federal privacy laws – we are not permitted to disclose details of any individual member’s health care without their authorization.
“We have an established medical review process to ensure that our members receive appropriate, necessary and effective care. In general the process may include predetermination/preauthorization, an initial review policy determination by an internal medical doctor, a peer-to-peer review (a discussion between the member’s doctor and a Blue Cross doctor to exchange pertinent information) and an appeals process that offers a clinical review by a specialty doctor, often a third party.
“BCBSOK respects the roles of our members and their doctors in making treatment decisions; however, we must adhere to the plan certificates and regulatory guidelines that direct us regarding coverage decisions, determining what therapies are of proven efficacy, and evaluation of unusual therapies.”