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PITTSBURGH (KDKA) — A KDKA Investigation finds a family that took on a big insurance company and just learned they won.
John Petok struggles to walk and fights for every breath. The 55-year-old is a shadow of the man he was – more than 50 pounds lighter than he was months ago.
Petok has Stage 4 stomach cancer. His medical records give him nine months to a year to live. The one hope, according to his doctors, is surgery that must be done immediately.
“If I don’t have this surgery done within six months to a year, I will not be living,” he said. “I will die from this and I don’t want to die.”
In a letter written by UPMC, Petok’s doctors write: “Significant delays in treatment may result in death from tumor progression.”
In denying the surgery, Petok’s insurance carrier Aetna responds: “Clinical studies have not proven that this procedure is safe and effective for treatment of the member’s condition.”
“We’re working on borrowed time right now,” Ken Fryncko, the family’s attorney, said. “The longer we wait, less likely we have of success helping Mr. Patok expand his life.”
Attorneys for the Patok family filed and lost two appeals, citing study after study suggesting the surgery is effective. The last appeal was what’s called an external review.
UPMC sources and family members confirmed on Monday that after months and a number of appeals, an external review panel has just agreed to allow Petok to have the procedure.
Petok family members are pleading with people in the same position to keep appealing and exhausting all resources.
Aetna released a statement on their decision.
“While our initial determination resulted in a denial for experimental reasons, we expedited an external review to determine whether an outside expert would recommend this treatment for this particular member, given his circumstances and a current view of the medical evidence. As a result of that review, we have approved this treatment. We know the family is going through difficulties and we sympathize. We wish the family and Mr. Petok well.”
Petok is now scheduled for surgery April 15. His doctors suggest this procedure could extend his life five to 10 years.