Latest news with #appeal
CBS News
an hour ago
- Health
- CBS News
Insurance denied Pennsylvania man cancer medication. Here's how he still got it.
When Paul O'Hara's health insurer denied him coverage for his life-saving cancer treatment, he wasn't willing to take no for an answer. The Bucks County, Pennsylvania, man credits his survival to the prescription medication Sprycel, which he says he's used to treat his chronic myeloid leukemia for the past 12 years. "Every morning it's the first thing I take," O'Hara said. "It has little to no adverse side effects." But O'Hara said he was recently informed his insurance would stop covering the medication until he first tried and failed on a cheaper drug. With a history of adverse reactions to the few other leukemia treatments available, O'Hara said he and his oncologist feared switching from a successful treatment posed too much risk. "If I go off of it for any period of time, it can weaken the response," he said. "So that's why this can be a life or death situation because this could stop working for me." Appealing denials Health insurers deny an estimated 450 million claims each year, according to a 2024 survey by health care improvement company Premier Inc., which is about one out of every 10 claims filed. Rob Field, an expert in health care law at Drexel University, said insurers count on the fact that most people don't realize they can appeal a denied claim. New analysis from the Kaiser Family Foundation reveals that consumers rarely appeal denied health insurance claims, with fewer than 1% of denied claims appealed. But when claims are appealed, it's often in the patient's favor. KFF found in 44% of cases, the original decision was overturned. "Very often that first level of denial is going to be reversed," Field said. "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." When appealing, Field recommends asking your doctor to write a letter explaining to your insurer why you need the treatment or service they're denying. He said you should also ask them to provide medical records to help support your claim. "It's the squeaky wheels who get the most out of health care," Field said. Other options to get approval If the appeal process doesn't work for you, Field said consumers can get creative. One strategy Field said he's seen used is to ask your company's human resources department to contact the insurance company on your behalf. An insurance advocate, a professional who can help you navigate the complexities of health insurance and claims, might also be able to help, Field said, but know they might charge a fee to do so. In some cases, you might also be able to request help from your state's insurance commission. For example, Pennsylvania launched an independent external review panel in 2024. In its first year, the state said the program overturned half of the denials it reviewed. But before you request a review, you must go through an internal appeal with your health plan. Field warns that whatever you do, it's a process that can be time-consuming and stressful. "So you've got to be prepared for that and decide in advance that it's worth it," he said. Finding success O'Hara said the stress of trying to get his medication has started to take a toll. "This has been an awful month," he said, recalling how sick he was in the first few years before finding successful treatment. "There's a lot of people that are just going through cancer and getting denied these treatments and they don't know where to turn." After exhausting his appeals, O'Hara said his oncologist went a different route and applied for coverage directly with the drug's manufacturer. O'Hara was provided a one-year supply of medication from Bristol Myers Squibb at no cost. Many pharmaceutical companies offer patient assistance programs where you can apply to get certain medications at a lower cost or no cost. "You don't have to take no for an answer," he said. Do you have a money question, a consumer issue, or a scam story you want to share? Email InYourCorner@
CTV News
17 hours ago
- CTV News
Bellefeuille files notice to appeal murder conviction in OPP officer's death
A photo showing Alain Bellefeuille walking back in court after being found guilty. May 24, 2022. (Natalie van Rooy/ CTV News Ottawa) Weeks after he was found guilty of first-degree murder in the death of Ontario Provincial Police Sgt. Eric Mueller and the attempted murder of two other officers, Alain Bellefeuille has filed a notice of appeal seeking to have the convictions overturned. In the notice of appeal signed on June 12, Bellefeuille states he wants to appeal both the convictions and sentences. He was sentenced to life in prison with no chance of parole for 25 years for the murder of Mueller and 20 years in prison for each count of attempted murder to be served concurrently. Bellefeuille lists an 'error in law by judge, unreasonable verdict by jury, conflict with jury during entire trial' as the grounds for the appeal. A jury found Bellefeuille guilty of all charges on May 24, believing, beyond a reasonable doubt, the Crown's position that Bellefeuille intentionally ambushed the officers and shot them seconds after they entered his Bourget, Ont. home in the middle of the night on May 11, 2023, during a wellness check. Mueller was killed, Const. Marc Lauzon was critically wounded and Const. François Gamache-Asselin was injured. No hearing date has been set.
BBC News
19 hours ago
- BBC News
Max and Mason's murderers appeal for earlier release
A man and two teenagers jailed for the murders of two Bristol boys in a case of mistaken identity have appealed to have their sentences and Mason, who were 15 and 16, died from stab wounds after being attacked outside Mason's home in Knowle West on 27 January Tolliver, 16, and 17-year-old Kodishai Westcott, who were each detained for a minimum of 23 years, both hope to have their sentences Court of Appeal has also confirmed that 45-year-old Anthony Sook, who drove the teenagers to commit the crime and was ordered to serve a minimum of 38 years in jail, has filed an appeal. Max and Mason were killed after being wrongly thought to be responsible for bricks being thrown at a house in Hartcliffe earlier that evening on 27 teenagers spotted the two best friends while being driven around Knowle West by Anthony Snook, 45, looking for "revenge".All five were convicted of two counts of murder following a six-week trial at Bristol Crown Court.A 15-year-old boy and a 16-year-old boy, who cannot be named for legal reasons, were detained for life with minimum terms of 15 and 18 years respectively.A Court of Appeal spokesperson said: "We have been advised by the court office that the court has received an application for permission to appeal against sentence for Anthony Snook, Riley Tolliver and Kodishai Westcott."
Yahoo
19 hours ago
- Yahoo
Ex-Pc sacked for ‘aggressive' arrest is appealing against dismissal, force says
An ex-police officer who was sacked because of his 'aggressive' detention of a 15-year-old boy is appealing against the disciplinary ruling against him, his former force has confirmed. Lorne Castle was dismissed by Dorset Police after an independent disciplinary tribunal found that he had committed gross misconduct in relation to the arrest of the youth in Bournemouth town centre on January 27 2024. The ex-police constable had admitted misconduct in relation to breaching the standards of professional behaviour relating to authority, respect and courtesy, conduct and use of force but denied gross misconduct. A Dorset Police spokesman confirmed that the force had been notified by Mr Castle of his intention to appeal. He said: 'We can confirm we have received notification of Lorne Castle's intention to appeal. 'As the formal appeal process is under way, we are unable to comment further.' Following the disciplinary hearing in May, the force said that Mr Castle had acted 'inappropriately' as he detained the teenager after receiving reports of two assaults in the seaside town. The force said in a statement: 'Pc Castle was seen to use unnecessary and inappropriate words towards the boy and place both his hands on his throat. 'The panel found that Pc Castle failed to act with self-control, did not treat the boy with courtesy or respect. 'His shouting, swearing, finger pointing, taking hold of the boy's face and throat and suggested use of leg restraints was not necessary, reasonable or proportionate.' A video clip of the incident, released by the force, shows the officer tackling the boy to the ground before taking hold of the teenager's face and throat while repeatedly swearing and shouting at him. The boy can be heard shouting and crying 'what have I done' and 'what did I do' before the officer shouts 'stop screaming like a little b****, do you understand that? Shut up'. The teenager also screams 'my f****** neck, get off me, I don't want you on me', while Mr Castle is on top of him. The officer later shouts 'stop resisting or I'm gonna smash you, do you understand?' and says the boy is being arrested on suspicion of assault. Speaking on LBC radio, Mr Castle, a 46-year-old father-of-three said that he had received thousands of messages of support. But he said that he felt that people were questioning his nature despite previously having '10 years of exemplary service' and having previously received a bravery award from the Humane Society.
The Independent
20 hours ago
- The Independent
Ex-Pc sacked for ‘aggressive' arrest is appealing against dismissal, force says
An ex-police officer who was sacked because of his 'aggressive' detention of a 15-year-old boy is appealing against the disciplinary ruling against him, his former force has confirmed. Lorne Castle was dismissed by Dorset Police after an independent disciplinary tribunal found that he had committed gross misconduct in relation to the arrest of the youth in Bournemouth town centre on January 27 2024. The ex-police constable had admitted misconduct in relation to breaching the standards of professional behaviour relating to authority, respect and courtesy, conduct and use of force but denied gross misconduct. A Dorset Police spokesman confirmed that the force had been notified by Mr Castle of his intention to appeal. He said: 'We can confirm we have received notification of Lorne Castle's intention to appeal. 'As the formal appeal process is under way, we are unable to comment further.' Following the disciplinary hearing in May, the force said that Mr Castle had acted 'inappropriately' as he detained the teenager after receiving reports of two assaults in the seaside town. The force said in a statement: 'Pc Castle was seen to use unnecessary and inappropriate words towards the boy and place both his hands on his throat. 'The panel found that Pc Castle failed to act with self-control, did not treat the boy with courtesy or respect. 'His shouting, swearing, finger pointing, taking hold of the boy's face and throat and suggested use of leg restraints was not necessary, reasonable or proportionate.' A video clip of the incident, released by the force, shows the officer tackling the boy to the ground before taking hold of the teenager's face and throat while repeatedly swearing and shouting at him. The boy can be heard shouting and crying 'what have I done' and 'what did I do' before the officer shouts 'stop screaming like a little b****, do you understand that? Shut up'. The teenager also screams 'my f****** neck, get off me, I don't want you on me', while Mr Castle is on top of him. The officer later shouts 'stop resisting or I'm gonna smash you, do you understand?' and says the boy is being arrested on suspicion of assault. Speaking on LBC radio, Mr Castle, a 46-year-old father-of-three said that he had received thousands of messages of support. But he said that he felt that people were questioning his nature despite previously having '10 years of exemplary service' and having previously received a bravery award from the Humane Society.
