How to Fight Insurance Companies that Refuse to Pay for Anal Cancer Procedures

How to Fight Insurance Companies that Refuse to Pay for Anal Cancer Procedures

Question:

I am looking for any peer-reviewed articles regarding anal cancer screening studies, even with preliminary results, which substantiate the effectiveness of preventive screenings as relates to anal cancer.

My insurance will pay for some “emerging or experimental” treatments in areas such as cancer, etc, which look promising but may not yet have produced concrete recommendations or generally-accepted treatment guidelines.  I’d like to find some peer-reviewed articles I can submit with my claim, to get them to call this “preventive”, and so fully paid-for.  Does anyone have any links to such articles published in any medical journals?  Thanks!

Answer from Nelson:

There is nothing better anywhere in the world than this info on anal cancer guidelines. NY State is the only place worldwide where they recommend high resolution anoscopies and infrared coagulation (IRC).  The info has all the references you need for a doctor to write a good letter to fight the insurance company.
There is a study that may or may not be approved to follow people for 7 years with and without IRC to prove to insurance companies that (and if) IRC works to prevent people from progressing into anal cancer. But many companies (and Medicare) are paying for this now.  The key is finding a doctor who is willing to write a good medical necessity letter if you get denied, like it sounds you did.

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