Metro man fights insurance company for coverage of clinical trial

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OKLAHOMA CITY – David Thompson has a lot of reasons to stick around.

“I’ve got six kids, a grandchild," David said. "I hope to see more grandchildren."

And, he sure is trying.

When he was first diagnosed with Stage IV Non-Hodgkin’s Lymphoma, he was only given a 10 percent chance of survival.

“David’s a fighter, so David beat cancer. He beat lymphoma. He went into remission. So, he got a stem cell transplant,” said David’s wife, Kathy Thompson. “And, that bumped his chances of long term survival to 50 percent.”

Decent odds, but David’s been approved for a clinical trial at MD Anderson for the drug Keytruda, which could bump those odds all the way to 80 percent.

“Thirty percent more chance of survival, I mean that’s incredible,” David said.

David is ready to go.

There’s just one problem. His insurance company, Blue Cross Blue Shield of Oklahoma, has denied the coverage for the trial.

The actual drug is covered by the sponsor of the clinical trial, but the Thompsons need their insurance to cover routine patient care services while participating in the trial, such as hospital visits or lab tests.

“When Blue Cross denies David, they deny my family and this community, and I’m just not going to allow that,” Kathy said.

Kathy took to social media with the hashtag 'Approve David Now,' and it’s taken off like wildfire.

“The hashtag 'Approve David Now' is trending in Oklahoma, so I think that my kids should be proud that their mom who just now got a Twitter account is trending,” Kathy said.

Kathy said the insurance company is treating her husband more like a number rather than a person, something she’s combating in her posts.

“Part of my social media campaign has been putting David’s face out there, so every picture I put is a picture of David," Kathy said. "Because, David is a person. He’s a human being."

It’s urgent for David because time is not on his side.

Kathy said doctors told them he must start the drug within 60 days of his stem cell transplant. That would be next week.

“We are not a family without David, and we need him here with us,” Kathy said.

Kathy said they’ve been with Blue Cross Blue Shield of Oklahoma for about three decades, faithfully paying premiums the whole time.

She’s fighting for her husband but also for other families.

“If Blue Cross can deny us a covered benefit, they’ll deny any of you a covered benefit,” Kathy said.

State Insurance Commissioner, John Doak, has gotten involved and is working to help resolve the situation.

Blue Cross Blue Shield of Oklahoma sent us this statement:

"Due to privacy laws, we cannot comment on the specifics of any individual’s case.

Blue Cross and Blue Shield of Oklahoma (BCBSOK) works hard to ensure patients have access to safe, effective and evidence-based care and treatment they need. In the case of clinical trials, BCBSOK covers the usual and routine patient care for a condition that customarily would be provided outside of a clinical trial. These usual and routine patient care services may be 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.

Items not covered by BCBSOK in a clinical trial include:

  • 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;
  • 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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