In the past twelve months, RCCS has successfully recovered close to two million dollars for cancer patients who were originally denied medical benefits – unfairly – by several health insurance companies. Although the Rofeh Cholim Cancer Society (RCCS) is primarily known for subsidizing health insurance premiums for cancer-stricken members of our community, its newest service, the Patient Services Division, was created in response to the pleas of many patients struggling with the insurance giants. The amounts of money being denied can be astounding and, sometimes, overwhelming.
Many of these cases entail patients who are referred by medical experts to out-of-state, specialized cancer centers. Often, insurance companies refuse to cover these treatments, forcing patients to undergo treatment in hospitals with less expertise in their particular cancer, an unacceptable option in the face of acute life-and-death illnesses. The difference in treatments could be in excess of a quarter million dollars, but RCCS will “go to bat” for patients’ rights, enabling them to seek the treatments that they are entitled to.
Many such cancer patients credit RCCS for facilitating the surgeries and treatments that were warranted, which ultimately saved their lives.
A recent case: A New York cancer center offered an RCCS patient standard radiation which carries a potential risk to surrounding healthy tissue. A relatively new form of pinpoint radiation, highly recommended by several specialists, was available at a cancer center in Massachusetts. However, the cost there was considerably higher than the standard treatment. The patient’s insurance company denied the doctors’ recommendations, stating that standard radiation, although potentially more dangerous, would suffice to eradicate the malignancy. RCCS challenged the insurance company’s denial, making the claim that the patient’s policy does provide coverage for the preferred treatment.
After multiple appeals, the insurance company executives overturned the initial denial and approved the full course of treatment which would have cost the patient $125,000!
These massive amounts of recovered benefits are all the more important in light of the current economic downturn. The recession has not slowed down cancer, and requests for RCCS financial assistance have increased considerably as more and more cancer-stricken members of our community need help maintaining their insurance.
Numerous RCCS patient assistance cases remain outstanding; many of them are nearing completion, with a favorable outcome expected. At this time, due to limited and strained resources, RCCS can only help patients with cancer, r”l, may they all have a speedy Refuah Shleimoh B’soch She’ar Cholei Yisroel.
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