“I found myself in the fight of my life after I was diagnosed with breast cancer at the age of 22. Unlike most people my age, I was suddenly forced to grapple with a life-threatening disease, as well as a callous insurance company that has denied payment for my doctor recommended treatment.”
I found myself in the fight of my life after I was diagnosed with breast cancer at the age of 22. Unlike most people my age, I was suddenly forced to grapple with a life-threatening disease, as well as a callous insurance company that has denied payment for my doctor recommended treatment.
With a lot of hope for the future, I started chemotherapy and underwent a mastectomy in January 2018. But when the results of a routine genetic test came back, I found out that I am highly predisposed to secondary cancers due to a genetic condition. My doctors told me that proton therapy was considered the best option because it would significantly reduce the risk of a secondary cancer. While I was a little unsure about receiving radiation initially, I decided to pursue it after learning how proton therapy would be beneficial in preventing a recurrence.
To my shock, my insurance company had other plans. They denied my claim for proton therapy based on outdated 2012 clinical guidelines, which have since been updated to recommend proton therapy for breast cancer patients like me with other co-morbidities.
Following my denial, a peer-to-peer review between the insurer and my physician took place to discuss the claim. However, it was clear that the insurer’s representative was not qualified to review my case. In fact, he wasn’t even a radiation oncologist! Even more upsetting, we soon learned the insurer representative denying payment may be the owner of several “cost-containment” companies. It is so frustrating to only be viewed as a dollar sign instead of a person!
I have since started treatment at California Protons while we continue to fight for approval. Proton therapy can significantly reduce the risk of a secondary cancer for me, so why isn’t my doctor’s order enough to convince my insurer?
I am in sharing my story to shine a light on unfair denials insurers are using to block patient access to doctor recommended treatments.