Insurance company denies doctor's recommendation for cancer treatment

David Starzyk. Credit: KMOV

ST. LOUIS (KMOV.com) -- In October, David Starzyk underwent surgery to remove his left lung because of cancer.

"The diagnosis was a rare sarcoma that ended up in the lung," Starzyk said.

His doctors at Siteman Cancer Center made plans for radiation treatments in case cancer cells were also in his other lung. Doctors wanted to use a type of treatment that shoots a narrow beam of radiation instead of the conventional treatment for sarcomas, which shoots radiation over a wide area and could cause serious complications.

Starzyk said, "The only remaining lung could suffer scaring and a form of pneumonia as a result of the radiation. And as far as the heart, it can experience narrowing of the arteries and it can impact my atrial fibrillation as well."

Blue Cross Blue Shield of Illinois denied coverage for the more precise radiation treatment despite a letter from his radiation oncologist, Dr. Brian Baumannn, who is also an assistant professor of radiation oncology at the Washington University School of Medicine.

Dr. Bauman wrote, "These complications could be potentially devastating."

News 4 contacted the insurance company to ask why it would deny the coverage despite the risk posed by the procedure that would be covered. The company said privacy rules prohibited it from talking about Starzyk's case.

But in a statement said:Our medical team reviews the latest scientific data on medical treatments to create medical policies that determine benefit coverage.Late Monday, Starzyk received word that a fourth appeal that went before an independent review board was denied.

"Very frustrating, extremely," said Starzyk.

He's scheduled to begin radiation treatments on Tuesday.

Copyright 2018 KMOV (Meredith Corporation). All rights reserved.

News 4 Reporter

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