Who couldn’t use a little good news in today’s economy?
A Poway man with a rare debilitating skin disease happily got his—when he learned that the state sided with him in a fight against his insurance company, our media partner the North County Times reported.
Mark Buenconsejo, 51, had filed for a request for coverage with Cigna Healthcare but was denied. The experimental treatment, they told him, was no more beneficial than standard treatment.
Buenconsejo’s dreams of undergoing the experimental treatment in Seattle were dashed--$350,000 is a high price to pay for a professional painter whose disease provides plenty of hurdles, the paper reported.
But there was light at the end of the tunnel. A Managed Health Care official wrote in an independent medical review dated Feb. 26 that the experimental treatment could actually help Buenconsejo more than conventional treatment.
“In your case, the independent providers determined that the service you requested is likely to be more beneficial than any available standard therapy,” wrote Regan Wong, a compliance manager for the department. “This decision overturns the original denial by Cigna Healthcare of California. The service must be authorized within five working days.”
Talk about good news. Buenconsejo needed an answer, and fast. His disease, called scleroderma can cause skin to tighten and attack internal organs. It could kill him within five years.
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Although he has gotten around the monetary challenge, Buenconsejo is still not out of the woods. He is still looking for a bone marrow donor match for his treatment.
"Right now, we feel like we got over the biggest hurdle," he told the North County Times. "This has been going on since September of last year, the denials and everything. I'm pretty sure people have gone through it a lot longer, but we're really, really happy."
