Baton Rouge – A Fight Against Cancer and Insurance Challenges
After facing multiple rejections from his insurance company, one man chose not to wait any longer for cancer treatments that might buy him time or even eliminate his condition. James and Rebecca Kolcologne are now encouraging others to persevere in similar situations.
In January 2021, James Kolcologne was diagnosed with stage 4 colorectal cancer, which had spread to his liver. He underwent 46 rounds of chemotherapy and had five procedures to treat the liver tumor. Blue Cross Blue Shield Nebraska later denied coverage for a sixth ablation, citing an existing lung nodule as the reason.
“There’s nothing in my medical chart indicating lung cancer,” James stated.
Although he resumed chemotherapy, each round made him feel worse for longer. Earlier this year, they came across Histotripsy, a non-invasive ultrasound procedure designed to destroy cancer tissue. After learning he was a candidate, his doctor submitted the necessary paperwork to the insurance for approval.
“It was denied within an hour,” Rebecca recalled.
Their appeal also faced rejection. Unfortunately, many insurers classify Histotripsy as “experimental” or “investigational,” despite it being recommended by physicians.
Dr. Philip Boudreux, a professor of surgery at LSU Health Science Center and part of the rare cancer program at East Jefferson Hospital, manages Histotripsy at Omega Hospital in Metairie. He has performed at least 60 treatments over the past year.
“There’s ample data showing it’s safe and effective, yet I spend most of my day conversing with insurance companies,” Boudreaux shared.
While about half of Medicare and insurance providers recognize and approve Histotripsy, the Kolcologne family has lived the unfortunate opposite experience.
“Why subject him to treatments that are damaging? His quality of life diminishes with each round of chemotherapy,” Rebecca explained.
Consequently, the Kolcolognes decided to take matters into their own hands. On August 8th, James underwent the Histotripsy procedure.
“We’ve met others who’ve had this procedure and are now cancer-free,” Rebecca noted.
The therapy cost about $50,000, an expense they felt was worth it to improve James’s quality of life.
“How many more lives could be saved with timely treatments?” Rebecca pondered.
They remain hopeful that this decision was made at the right moment.
Boudreaux mentioned that there are surgeries available to remove tumors, but they often come with additional risks. What sets Histotripsy apart is that roughly 30% of patients experience what’s called an “Abscopal Response”—localized cancer treatments that can also shrink tumors in other areas, essentially acting like a vaccine against cancer and offering hope for those in need of a liver transplant.
Despite many insurer rejections, Boudreaux reports an uptick in approval rates recently. He shared that he had to present a patient’s case before a judge after they had waited six months for insurance approval.
“Once familiar with this technology, you’ll see potential applications in various parts of the body. It’s in trials for renal tumors now,” he added.
There are ongoing histology tests abroad for pancreatic tumors, and it could even serve as a non-invasive alternative to amputation for treating bone tumors.
“This could pave the way for treating brain tumors non-invasively. I think this will become a vital tool for addressing various tumors across different sites,” Boudreaux said.
In response to inquiries, Blue Cross Blue Shield Nebraska stated they couldn’t comment on patient compensation or benefits due to the HIPAA Privacy Act.
