Insurance turned its back when she needed it most |

Insurance turned its back when she needed it most

Tonya Bina
Sky-Hi News

Breast cancer at long last decided to coil itself on a branch of my family tree.

From a routine mammogram last March, an early cancer was detected in my 46-year-old sister’s right breast.

Although it was caught early, the type of cancer she had was an aggressive form, and doctors told her there was a good chance it could become invasive in the future.

So at the Mayo Clinic in Rochester, Minn., she underwent a lumpectomy, considered the clinic’s treatment protocol for a patient with no family history of breast cancer. Six weeks of prescribed radiation followed the surgery in her hometown.

October is Breast Cancer Awareness month, which has particular meaning to me this year as I’m ecstatic to report my sister has since received a clean bill of health.

But, near the end of her series of radiation treatments, she was handed a devastating blow to her financial well-being.

Her insurance company, BlueCross BlueShield out of Nebraska, denied her claim for the radiation treatment – a pending bill of $42,000.

The reason, insurers said, was that the type of radiation used was considered “investigative” and “experimental.”

The hospital’s oncologist has twice appealed, arguing that the type of radiation used is standard and is widely accepted.

“It still hasn’t been resolved,” my sister said on Sunday. “My doctors said that it wasn’t my fault that they were denying this, that the hospital should have checked on the insurance. I had called and checked on my insurance before surgery and it seemed as though it would all be covered except for the deductible and co-payments.”

She has long held insurance through her work, and as the responsible big sister, had even invested in a supplemental cancer insurance a long time ago, which ended up paying for incidentals.

“And what if I did know that insurance wouldn’t cover this form of radiation before I started treatment?” she continued. “Then I am put in a position of the insurance company dictating the quality and type of treatment against the advice and expertise of my radiation oncologist.”

It’s one thing to have insurance companies slithering through loopholes to shirk their responsibilities when a customer truly is in need of health coverage; it’s quite another when insurance companies insist on playing doctor, claiming they know what’s best for a particular patient more than the patient’s medical team.

Cancer is one of the five most costly medical conditions in the United States, according to the Agency for Health Care Research and Quality.

And I imagine the costs associated with health care are in part due to the resources hospitals are forced to expend going to bat for patients and, many times, eating costs when patients are forced to pay out-of-pocket.

Compiled by the Kaiser Family Foundation in partnership with the American Cancer Society, a 2009 report concludes that “even when people have private insurance, they may not be protected from high out-of-pocket costs if they are diagnosed with cancer. These costs, along with the cost of insurance premiums, can potentially force cancer patients to incur debt in order to pay for the care they need or forgo or delay lifesaving treatment.”

Gaps in the current private health insurance system “leave cancer patients and others with serious illnesses vulnerable even when they have coverage,” the study states.

Dana Dzwonkowski of the American Cancer Society’s Cancer Action Network said it’s not clear whether the health care reform bill will address situations like my sister’s.

“While the law includes multiple provisions that will improve access, affordability, and adequacy of care for cancer patients, any specific provisions that may help people in a situation like your sister are currently being worked through the regulatory rule-making process,” she said.

Forget a “government takeover” of health care – the way I see it, we already are victim to the insurance company takeover of health care.

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