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Kaiser Denied Liver Cancer Surgery From Out Of Network Surgeon

Liver Cancer research, treatment and diagnosis discussion

Kaiser Denied Liver Cancer Surgery From Out Of Network Surgeon

Postby Bearchan » Mon May 30, 2016 1:21 am

I was wondering if you could help figure out what I can do to help my family member out. I have a family member that is 63 and was diagnosed with stage 3 liver cancer 2 weeks ago. Kaiser has said she was not a candidate for a liver transplant or surgery. She is currently at home. We have found a surgeon in San Diego saying that he is very confident that he can perform surgery on her and improve her situation immensely. Due to the surgeon being an out of network she was denied. But She was hospitalized 3 months prior to the cancer diagnoses and was misdiagnosed by Kaiser. First they said she had benign tumors and then when she was hospitalized this time around they have concluded that it is Liver Cancer. Are we able to use that in our formal appeal? Please any advice would help
Bearchan
 
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Kaiser Denied Liver Cancer Surgery From Out Of Network Surgeon

Postby Lyndon » Mon May 30, 2016 6:51 am

I was wondering if you could help figure out what I can do to help my family member out. I have a family member that is 63 and was diagnosed with stage 3 liver cancer 2 weeks ago. Kaiser has said she was not a candidate for a liver transplant or surgery. She is currently at home. We have found a surgeon in San Diego saying that he is very confident that he can perform surgery on her and improve her situation immensely. Due to the surgeon being an out of network she was denied. But She was hospitalized 3 months prior to the cancer diagnoses and was misdiagnosed by Kaiser. First they said she had benign tumors and then when she was hospitalized this time around they have concluded that it is Liver Cancer. Are we able to use that in our formal appeal? Please any advice would help
Lyndon
 
Posts: 41
Joined: Sun Apr 06, 2014 8:42 am

Kaiser Denied Liver Cancer Surgery From Out Of Network Surgeon

Postby chozai39 » Mon May 30, 2016 11:52 am

Hi Jacklyn!

Definitely appeal with any information you can come up with........usually the only way they will approve an out of network Dr is if there is no Dr in their network than can do the surgery.  

You might want to find out why Kaiser said she was not a candidate for surgery and also appeal that..........why would one Dr in network say this and an out of network say different.  Get a letter from the out of network Dr stating that this surgery will help her.  This may help her appeal.  I am sure it is just a cost issue for Kaiser.

Good Luck!

Tricia  
chozai39
 
Posts: 209
Joined: Mon Feb 11, 2013 12:05 pm


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