David Thompson’s doctors say a clinical trial will increase his chances of survival. But his insurance company denied the claim.
For the past seven months, David Thompson has been fighting for his life. Diagnosed with Stage 4 Non-Hodgkin’s Lymphoma, Thompson was given only a 10 percent chance of survival. After chemo and a stem-cell transplant, his chance increased to 50 percent.
Now, Thompson’s doctors at MD Anderson in Houston offered him a spot in a clinical trial.
“This is supposed to up my odds according to my doctor at MD Anderson about 25% to 30% which is huge,” said Thompson.
“This is a significant increase and yet BCBS denied us,” added his wife Kathy.
Thompsons say BCBS not only denied them, but essentially went dark. So, there was no way for them to appeal.
David has to be in Houston Thursday morning in order to participate in the trial.
“We don’t have much time to wait anymore, our waiting is almost over,” said Kathy.
On Friday, Kathy started a Twitter account and through social media her fight has caught the attention of thousands, including the Oklahoma Insurance Commissioner.
“We immediately began to work on this and contacted Blue Cross Blue Shield,” said Mike Rhodes the Deputy Insurance Commissioner.
Rhodes said BCBS reversed the denial. The issue now is who pays for the treatment plan once David goes into the trial.
“Certainly the cost of the drug is not covered, but the after-care and the care of the treatment is covered by the benefit plan,” said Rhodes.
The cost of the drugs is typically paid for by the drug company in a clinical trial. Kathy said despite what Deputy Commissioner Rhodes says, she’s still concerned about how much BCBS will cover.
A Blue Cross Blue Shield of Oklahoma spokesperson said due to privacy laws, they cannot comment on the specifics of any individual’s case.
They did, however, provide News 9 with the following information when it comes to coverage of clinical trials:
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.