“If I had received proton therapy, I am confident I would not be suffering from these side effects and I would have maintained a much higher quality of life during and after treatment. Insured patients should not have to pay the price for insurers who care nothing about a patient’s health and care only about the bottom line.”
I was 58 years old and had retired from my career in law enforcement when I was diagnosed with human papillomavirus (HPV) related oropharyngeal cancer — cancer on my throat. I asked my local ENT doctor about my treatment options and sought out the opinion of cancer experts at MD Anderson Cancer Center in Houston.
After examining my case, doctors at MD Anderson decided I was a good candidate for proton therapy because of the location of my cancer – positioned near my esophagus, thyroid, brain stem and other vital, healthy tissues. Learning about proton therapy, I was optimistic about the clear benefits, including protecting healthy tissues from excessive radiation and maintaining my quality of life during treatment. When I heard from my insurer, my optimism faded.
Although I had two seemingly good health insurance policies – one for my retirement from the police force and one with my new employer, both underwritten by the same company – I was flat out denied proton therapy treatment. I started the process of appealing my insurer’s decision, even winning my first appeal after they denied payment because they defined proton therapy as “experimental.”
But my insurer fought back, this time claiming there was no evidence that proton therapy was a better treatment option than (less-expensive) traditional radiation therapy. I tried going directly to my primary insurer to plead my case – this resulted in a telephone conversation with a nurse representing the insurance company, which was a total waste of time. The nurse confirmed my suspicion: that the insurer wasn’t concerned at all about my health 10-15 years down the road, they only cared about their short-term costs. “Who knew if they would even be my insurer in 10 years?” she said. In other words, my medical needs might be someone else’s problem, not theirs.
I thought, well just maybe my secondary insurance will step up and assist me, but that was also a dead end as my secondary insurance was the underwriter of my primary policy.
Time is not a friend to cancer patients. I was exhausted by the insurance appeal process and felt I had no other choice, so I proceeded with traditional radiotherapy treatments.
Today, my thyroid is shot. I am on thyroid medications and will be for the rest of my life. As a result, my metabolism has declined, I have gained weight and I am tired all the time. And I missed eight weeks of work while undergoing treatment.
While I am nine months cancer free, I still have a huge level of frustration. If I had received proton therapy, I am confident I would not be suffering from these side effects and I would have maintained a much higher quality of life during and after treatment. Insured patients should not have to pay the price for insurers who care nothing about a patient’s health and care only about the bottom line.