Horizon Blue Cross Blue Shield of NJ: Reverse my husband's death sentence
Neil and I have been married for 22 years and have two beautiful young daughters. Our worlds were turned upside down in 2005, when he was diagnosed with a blood cancer called multiple myeloma in 2005. Neil thrived under his treatment plan until recently -- the chemotherapy just stopped working.
The doctor said that Neil needed two transplants in order to put his cancer in back in remission -- one with his own cells and a second with a donor's cells. The first transplant was completed on March 1st. Three days later I called the doctor to find out if a donor had been identified for the second transplant, only to find out that our insurer, Blue Cross Blue Shield of New Jersey, won't let it happen!
Blue Cross Blue Shield has the nerve to say that my husband's transplant "was not medically necessary." I can assure you that this 2nd part of the transplant is not only medically necessary, it is essential to saving my husband’s life. And time is of the essence if the second transplant isn't completed within 8 weeks of the first transplant, the process will not work and our insurer will have sentenced Neil to death. Since then, we've lost valuable time trying to find a donor match for Neil.
I got a letter in the mail saying that I had the right to appeal the decision within 72 hours. I have called Blue Cross Blue Shield every day since then, but no one has ever returned my calls. I have never reached a live person to discuss this denial.
Neil is being sent home from the hospital TODAY, and I am beginning to lose hope. Blue Cross Blue Shield New Jersey must immediately reverse their denial of the procedure and offer an expedited process to find a donor match so Neil can complete the second part of his transplant as planned.
I am writing this letter to request your reversal of a denial of heathcare services. Your reversal of this decision is literally a matter of life and death for Neil Roof.
Neil was diagnosed with Multiple Myeloma in 2005 and has been thriving under his treatment plan. Recently, after 7 years of success, the chemotherapy stopped being effective. In order to put Neil’s cancer back into remission, the oncologist deemed it necessary for two transplants, one with his own cells and a second with donor cells, the allogenic. While these transplants are long , & can be painful, the decision to go forward with the treatments were based on the oncologist’s reports and statements that both of these transplants were necessary for Neil’s future.
Neil completed the first transplant on March 1, 2013. Three days later, Neil's wife learned that BCBSNJ had denied the Hackensack UMC request for the second part of the procedure. The denial rationale was that the procedure “was not medically necessary”. Neil's doctors have said this second transplant is not only medically necessary, it is essential to saving his life.
Time is of the essence with this procedure. The second transplant needs to be completed within 8 weeks of the first transplant or the process will not work. Neil still needs time to find the donor match, and each day the denial continues is another day of this process lost.
I request an immediate reversal of the denial for the procedure and an expedited process to find a donor match so Neil's second transplant can be completed as planned.