MARTIN COUNTY, Fla. — A Martin County man battling terminal cancer is hoping his struggles with his insurance company could prompt changes for other patients in the future.
Joe Warner was diagnosed in April with a terminal Bile Duct cancer, called choloangiocarcinoma.
His sister, Sheryl Warner, just wants him to be at peace and without pain. Managing Joe's pain is their priority.
Joe says it’s almost constant.
“Day to day, no less than a 4 or 5,” Joe said.
Some days, he says the pain is an 8 or a 9.
“The sharper pains come and go. But, then pretty much it’s a constant pain,” Joe said.
The remedy is pain medication, such as morphine or oxycodone.
“It makes it go away for the most part,” Joe said.
Recently, his oncologist gave him a prescription for pain medication. When Joe went to a pharmacy to fill it, he ran into trouble.
“The pharmacy told him that they could not fill it because the insurance won’t take care of it,” Sheryl said.
Sheryl says Joe uses Blue Cross Blue Shield for his insurance coverage.
She called the company to understand why his medication wasn’t being approved.
She learned there can be a delay in approvals, despite the critical need.
“I said, 'You don’t understand. My brother has cancer, stage-four cancer. He’s in pain,'” Sheryl said.
She said the insurance provider explained they work with a third party vendor, “and they have to go through them. I said, 'Well, how many days are we talking about?' They told me it could take up to 15 days, or maybe 30 or 60.”
Four days after getting the prescription, with no luck getting it approved through insurance, Joe could not handle the pain, he said. He ended up spending more than $130 out of pocket, without using his insurance, to get some relief.
“I don’t think it’s fair,” Joe said.
Blue Cross Blue Shield ended up approving his prescription nearly two weeks later.
Sheryl learned her brother is not alone.
“In the doctor's office, the nurses proceed to tell me this is a regular occurrence. They not only have to wait for their pain medication, but they also have to wait for their nausea medications and other medications,” Sheryl said.
She does not know the solution to get cancer patients their pain medications sooner, but hopes to be a driver for policy or procedure changes.
“There shouldn’t be a delay for anybody that has that kind of cancer,” Sheryl said.
Paul Klundig, Senior Director of Public Relations for Florida Blue said in an email to WPTV:
I cannot comment directly on this member’s case due to privacy laws. But I can tell you that Florida Blue works very closely with doctors and health care providers across the state to ensure our members are receiving the care they need in a timely manner. Regarding prescription drugs requests and approvals, once a physician submits a prescription request for a member, we process those requests as quickly as possible.