Bucks County resident Paul O’Hara was quick to react when his health insurer claimed they couldn’t cover his prescription cancer medication, writes Joshua Sidorowicz for CBS News. 

O’Hara has treated his chronic myeloid leukemia with Sprycel for over a decade. 

He had a history of poor reactions to other medications. So when his insurance denied coverage, O’Hara and his oncologist began searching for solutions. 

Paul O’Hara first appealed the denial with his insurance company, a process many people are unaware they can pursue. The Kaiser Family Foundation found that 44 percent of appeal cases were overturned in favor of the patient.  

“Very often that first level of denial is going to be reversed,” said Rob Field, an expert in health care law at Drexel University. “And even if it isn’t, there are often further layers of appeal, often to a medical director and then many insurance companies will have an external appeal process.” 

Patients can request that their doctor write a letter to their insurer explaining the need for the treatment. Medical records should also be sent as further proof. 

Field mentioned alternative ways to seek approval, including requesting help from your state’s insurance commission. An insurance advocate may also be able to offer assistance. 

O’Hara eventually appealed to Sprycel’s manufacturer, Bristol Myers Squibb, and received a year’s worth of medication for free. 

Read more about Paul O’Hara’s battle for his lifesaving medication and how he navigated insurance denials in CBS News. 

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