Peritoneal Mesothelioma Patient Wins Battle with Insurer, will Receive Surgery to Extend his Life
Battling cancer is daunting. but it’s a battle John Petok is ready to take on after fighting his insurance company for treatment.
John was diagnosed with peritoneal mesothelioma. Caused by exposure to asbestos, peritoneal mesothelioma is a tumor arising from the thin membrane lining the organs of the abdomen–such as the stomach and intestines–and the abdominal cavity itself.
Peritoneal mesothelioma is a rare and aggressive cancer, but his doctors at UPMC were hopeful that surgery could extend his life 5 to 10 years. Without it, he was given a prognosis of 6 to 12 months.
However, his hopes for a positive outcome were dashed when his insurance carrier, Aetna, denied the surgery, stating “Clinical studies have not proven that this procedure is safe and effective for treatment of the member’s condition.”
Petok, his family, and doctors began a battle, not against Petok’s cancer, but his insurance carrier. They went through the initial internal appeal process at Aetna. Petok’s doctors from UPMC wrote in support for John’s surgery that “significant delays in treatment may result in death from tumor progression.”
The Petoks and their attorney filed and lost, not one, but two internal appeal processes.
Like most cancers, early detection and diagnosis are crucial to achieving a positive outcome. “We’re working on borrowed time,” their attorney said.
Finally, after several months, the appeal process moved to an external review panel. At this review, medical professionals outside of the insurance company reviewed Petok’s case and the recommended surgery.
On March 28, the panel agreed with the surgical procedure recommended by John’s doctors for treatment of his peritoneal mesothelioma. Now, John can battle his cancer, instead of his insurer.
The Petok family hope that others facing similar struggles will push through the appeal process. Their husband, father, and grandfather, John, is scheduled for surgery on April 15.