Pretty much the same thing happened to my dad. He was diagnosed with a rare type of blood cancer. The insurance company denied monoclonal antibodies (as recommended by his oncologist) and would only pay for a complete bone marrow transplant, which would have been highly traumatic at his age. All based on a "standard of care" that at that point was 15 years old... and which was originally written by a committee chaired by my dad's oncologist (who presumably knows something about the best way to treat this condition in 2022.)
They didn't reverse the decision until we got a lawyer who knew the ins and outs of the appeals process. Thankfully, we were able to work through that fast enough for treatment to be effective... there's no way we could have paid out of pocket.
The ability of an insurance company to unilaterally deny treatment, or determine what type of treatment a patient receives, is obscene and should be categorically illegal. There is no instance in which a medical bureaucrat should should be able to, sight-unseen, overrule a patient's own doctor.
They didn't reverse the decision until we got a lawyer who knew the ins and outs of the appeals process. Thankfully, we were able to work through that fast enough for treatment to be effective... there's no way we could have paid out of pocket.
The ability of an insurance company to unilaterally deny treatment, or determine what type of treatment a patient receives, is obscene and should be categorically illegal. There is no instance in which a medical bureaucrat should should be able to, sight-unseen, overrule a patient's own doctor.
It's so frustrating.