Stereotactic Radiosurgery (Trilogy) scheduled

Stereotactic Radiosurgery (Trilogy) scheduled Thursday, Wednesday legal hearing to see if insurance pays!

How quickly a week passes – and this was a full one. I have now scheduled the Trilogy treatment for next Thursday the 28th at 2:00 pm. In preparation for that treatment I was scheduled for a PET scan and CT on Monday, but the PET scanner was down. Tuesday I was NPO again for the scan and went through the process but the images were not adequate. So on Wednesday, I had my 3rd NPO day and finally got successfully scanned! And some people wonder why there is weight loss associated with this cancer!

Actually my weight is holding up pretty well, only 5 pounds off my regular. And I am still able to eat normal meals, just in smaller portions. And in spite of spending lots of hours in the clinic and hospital, I am keeping up with most of the regular meetings, hospital rounds, though still sleeping lots more than usual. The chemo schedule is interrupted for 4 weeks in order to have radiation without excessive side effects. And thankfully the pain intensity and frequency continues to diminish. My medical oncologist attributes the improvement to the chemo, I just know it’s an answer the prayers of many.

The final stage of appeal for the insurance to pay for my treatment is a hearing by an Administrative Law Judge in the office of Medicare Hearings and Appeals – which will take place by telephone on next Wednesday morning at 11:00. I just got the papers and instructions about that today, so I will have some homework to prepare my case and also to line up at least one of my doctors to testify as well. The issue is not how much it costs, as the cost of Trilogy is substantially less than traditional radiation. Rather it’s a loophole which says that the costs of “investigational or experimental” treatments or devices are not covered by Medicare and therefore not required coverage by insurance. So although Trilogy is an FDA approved medical device, and has been in use for a couple of years with improved results compared to standard external beam radiation, Medicare continues to consider this as experimental treatment. Ironically while this restriction is couched in terms of protecting the patient from being subject to unproven treatment, all the doctors I have consulted with agree that this is the treatment of choice for my particular situation! So possibly this is a case wherein reason can prevail through the hearing process. We are praying for God’s intervention is this because we feel that we and future patients with similar needs deserve t this treatment when it is preferred. The radiation oncologist says I just got the cancer 10 years too soon!

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Thus, my new agenda after learning of the hearing next week, is to prepare my case and line up the testimony of my doctor. Believe me this will take most of the time available as the Medicare regulations are extensive and all new to me! Thanks again for keeping us in prayer for the hearing, as well as that the radiation will be guided by God and accurate in destroying the cancer cells yet not harming any of the surrounding organs or blood vessels. Even though the radiation is “stereotactic”, the tumor is lying adjacent to the duodenum and wrapped around the superior mesenteric artery!