“We appealed the first denial, and the staff at SCCA pulled together the terms of my insurance and the science proving the treatment’s value. With this additional information, my insurer granted the second appeal.”
As a workers’ compensation judge in Anchorage, Alaska, I spend my days listening to workers’ compensation disputes. In those cases, employees seek wages and benefits from insurance companies after suffering injuries on the job. But I was surprised to find myself fighting my own case against an insurance company in the spring of 2017 when I was denied the right to have proton therapy treatment.
After five years of remission from right-sided breast cancer, doctors discovered a second primary tumor in my left breast. During my first round of treatment in 2013, I had traditional radiation and chemo. I knew that too much radiation could have harmful side effects, so I was looking for alternative forms of treatment. I went to the Seattle Care Cancer Alliance (SCCA) to talk about options. They suggested chemo, and after I finished, my surgeon told me that I had responded well but needed additional radiation to attack stray cancer cells.
My radiation oncologist said that I was a strong candidate for proton therapy. The treatment would avoid possible damage to the heart and lungs. I was very enthusiastic because it meant less tissue being exposed to radiation.
Fortunately, SCCA has a proton therapy center (the closest one to Anchorage). First, I needed to get approval to qualify for their program. It turns out that that was the easy part.
I then had to get my insurer to sign off on the treatment. I was prepared for the insurance company to deny the claim initially. And they did, calling it experimental. The insurer called an oncologist as a witness who actually minimized proton therapy’s value. I was shocked! But SCCA told me from the beginning they would stand beside me throughout the process, and they did.
We appealed the first denial, and the staff at SCCA pulled together the terms of my insurance and the science proving the treatment’s value. With this additional information, my insurer granted the second appeal.
The State of Alaska was terrific about letting me work remotely as much as possible throughout treatment. Since my proton therapy treatment ended in May of 2018, I have been cancer-free.
I’m still on the bench every day. I wouldn’t necessarily say that being a litigant, in this case, has changed the way I do my job because I have always had compassion for the disabled or those who need assistance. But I do think I have more empathy now.
I am so grateful that I could get this treatment and that the people at SCCA helped me navigate the process.