My dad was diagnosed with cancer a week before Thanksgiving. To say that we were hit by a truck would be putting it mildly. My father is only sixty-eight, far too young to receive such devastating news. I’ll be blogging more about this as his treatment progresses because there have been some snags—for lack of a better description—that involve Medicare, scheduling, and the general attitude among the medical field that I want to discuss in finer detail.

Today my question is this: Do you think that your doctor should have the final say in your treatment or should your insurance <insert company name here>?

My dad has metastatic melanoma in his lungs and liver. Melanoma is not treated with radiation or chemotherapy anymore. Today it’s treated with either immunotherapy, which helps the body fight it on its own, or if the melanoma has a mutated gene (BRAF) it can be treated with a new medicine that targets the specific mutated cancer. If my father is found to have this mutation, his oncologist believes that the treatment for it works faster than immunotherapy. The plan was for the oncologist to order more pathology on the biopsies taken from his liver to determine whether or not the mutation was there. Once the report was back from the pathologist, the oncologist would meet with my dad and a protocol for treatment was to begin. His appointment was planned for yesterday.

Keep in mind that through this whole process, a weekend or holiday would interfere with scheduling. So even though the oncologist would say we needed a test or scan done ASAP, we were still waiting a week in between these “ASAP” tests and appointments. Frustrating doesn’t begin to cover it.

After some confusion and delays, my parents finally met with the oncologist yesterday for the results. Here’s where the question above comes into play. The pathology report was sent directly to MEDICARE, not to my father’s oncologist, so the doctor has no idea whether or not my dad’s melanoma carries any kind of mutation. It will take Medicare (read GOVERNMENT) two weeks to process this information and get back to the doctor on whether or not THEY will APPROVE his treatment for the mutated melanoma, if he indeed has it. Let me say it again; the TREATING PHYSICIAN does not have access to the pathology report until after Medicare has read and processed it.

Am I the only one who thinks this is wrong? Granted, there’s only a fifty-fifty shot that my dad has this mutation. Thank goodness that his oncologist will begin immunotherapy treatments—once every three weeks—beginning next week (eh hum, this will be discussed in another blog), as a proactive measure for now. If the report finally comes back saying he has the mutation, he will finish out the immunotherapy and then begin the new treatment.

Again, am I crazy to think that that report should’ve been handed to the DOCTOR first and then submitted for insurance and not the other way around?

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