My name is John M. I have advanced Cholangiocarcinoma (liver bile duct cancer). I am being treated at The James by a wonderful medical oncologist, and his treatment plan is shrinking my tumor, with a potential for a very good partial response and even complete response. Unfortunately, Quantum Health, who is the plan administrator for my Anthem insurance, is denying further treatment as recommended by my oncologist. Specifically, they have declined to approve the combination of continued chemotherapy of gem platinum durva (immunotherapy and two chemo drugs), referencing a clinical trial that stopped this protocol after a fixed period of time. The trial Quantum references as the basis of their denial, was for patients enrolled with gall bladder, intrahepatic, and extrahepatic, NOT cholangiocarcinoma. Given my BRCA gene status, my oncologist recommends individualized treatment ensuring receipt of platinum as my tumor continues to shrink (over 40% from discovery to my last CT scan of May 2025), with the majority of this response coming from the platinum chemotherapy. My oncologist has appealed twice, with both oncologists contracted with Quantum agreeing with his assessment. However, Quantum administrators choose to ignore this and continue to deny gem plat durva. My doctor continues to appeal, and I continue to work through the process with Quantum, but I am reaching out through social media as a desperate alternative attempt to get the lifesaving care I must have. Quantum, please work with these very knowledgeable health professionals to look into my case further. This is quite literally a matter of life and death. Please restore my faith in your company and your stated "Human-Centered Approach" and respond. read more
