Time running out for metro man fighting insurance company

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OKLAHOMA CITY - The past 24 hours have been a roller coaster of emotions for David and Kathy Thompson.

“No one is working on our behalf right now,” said Kathy Thompson. “We don’t know where to turn. There doesn’t seem to be anywhere for us to turn.”

David Thompson fought and beat Stage IV Non-Hodgkin’s Lymphoma and then had a stem cell transplant.

That transplant gave him a 50% chance of long-term survival.

But, he was approved for a clinical trial at MD Anderson in Houston for the drug Keytruda.

Doctors say that drug could potentially bump his chances of survival up to 80%.

But his insurance company, Blue Cross Blue Shield of Oklahoma, has denied him coverage for the clinical trial even though his policy has that benefit.

The cost of the actual drug is being covered by the trial sponsor, but the Thompsons need Blue Cross Blue Shield of Oklahoma to cover the related patient care costs during the trial for things such as hospital stays and lab tests.

On Monday, the Thompsons thought their problem had been solved when State Insurance Commissioner, John Doak, called to tell them they’d been approved.

The family had turned to his office for help.

“We’re glad Blue Cross is stepping up to the plate to take care of this issue and get you in this clinical trial,” Doak said over a phone call to Kathy Thompson.

“I was very relieved and I was happy and I was ready to jump up and down,” said David Thompson.

But a mere thirty minutes later, a call from Blue Cross Blue Shield of Oklahoma took the wind out of their sails.

“She did not have the understanding that David was approved and that she would have to look into that and she would call us back,” said Kathy Thompson.

And, to make matters worse, the Thompsons just found out they have to be at MD Anderson to begin the clinical trial in just two days.

“We have to be in Houston on Thursday,” said Kathy Thompson.

We spoke by phone to Deputy Insurance Commissioner Mike Rhoads.

“Time is of the essence at this point,” said Rhoads.

Rhoads says there was confusion initially over exactly what the Thompsons needed Blue Cross Blue Shield to cover and that caused the false approval call.

They are working to right matters now.

“We’ve asked for an update this afternoon from Blue Cross and Blue Shield if they are successful at reaching MD Anderson,” said Rhoads.

“Where is the holdup? Are they just running out the clock? It sure feels that way to us because we’re running out of time and they know it,” said Kathy Thompson.

The Thompsons say they plan to drive down to Houston on Wednesday afternoon no matter what.

But, they say if the coverage is ultimately denied, they will have to come back home.

Blue Cross Blue Shield of Oklahoma sent us this statement on Tuesday:

"At Blue Cross and Blue Shield of Oklahoma (BCBSOK), we understand the concern of any member facing a health crisis. We know that every minute can count when it comes to providing treatment. While we cannot give specifics on this member’s case, BCBSOK is actively working to facilitate discussions with the member and the health care provider. As a member-owned company, our role is to advocate for the member – and that is what we are doing.

In the case of clinical trials, BCBSOK covers the usual and routine patient care that customarily would be provided outside of a clinical trial as long as the services are considered medically necessary for members who are enrolled or participating in a clinical trial. This includes items such as hospital visits, imaging or laboratory tests, and medications.

In the case of clinical trials, BCBSOK does not cover the investigational treatment, device, or service itself, which is typically covered by the trial’s sponsor, such as the National Cancer Institute or a pharmaceutical company; items and services that are provided solely to satisfy data collection and analysis needs and that are not used in the direct clinical management of the patient; or a service that is clearly inconsistent with widely accepted and established standards of care for a particular diagnosis.

BCBSOK has case workers that engage with members to work through benefit coverage issues to provide high-quality care to its members and to help navigate through the health care system."

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