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My Mom Had 34 Rounds of Radiation to Go Before Her Insurance Company Deemed It ‘Medically Unnecessary’

Dearly

It was December 2. I woke up, did some things around my apartment, and then called my parents like I do every day.

I could tell my mom was upset, and I didn’t have to ask why before she said she got a letter in the mail saying that she was denied health care coverage for her upcoming radiation treatments.

My mom was diagnosed with stage 3 breast cancer back in March. She has since endured six intense rounds of chemotherapy, a double mastectomy, and — as of December 2 — two out of the 36 rounds of radiation her personal doctors said she needs.

Dearly

But it was December 2 that she told me she was going to stop radiation. Why? Because a doctor associated with her health care plan deemed the 36 rounds of radiation “medically unnecessary.”

How can a doctor who has never personally met my mom, examined my mom, or walked with her throughout this entire journey deem her radiation “medically unnecessary?” What did they see in her case file that the doctors she has been with since her initial diagnosis didn’t?

How does this doctor, who has never looked my mom in the eyes, get to make her cry, get to make her frustrated, get to deny her what her team of doctors that has been with her since March deems necessary?

Look, my mom doesn’t want the 36 rounds of radiation. It comes with a lot of potential side effects, but she also didn’t want the six rounds of chemotherapy or the double mastectomy. Unfortunately, that’s the hand she’s been dealt, and she handled every step of this journey like an absolute champion.

According to my mom’s personal team of doctors, when it comes to treating breast cancer, they base treatments off the diagnosis, not how you respond to treatments along the way.

Dearly

Being that my mom was diagnosed with stage 3 breast cancer in March, that qualified her for radiation.

According to my mom’s personal team of doctors, it doesn’t matter that chemotherapy shrunk the mass that was in her breast and some of the lymph nodes in her chest, or that her team of surgeons were able to remove the large lymph node from her armpit during her double mastectomy.

My mom has stage 3 breast cancer, and because of that, her doctors — the doctors who have been with her since day one eight months ago — believe she needs radiation to ensure that by the end of this whole process, my mom is cancer-free and remains that way.

Why does a doctor who has never shaken my mom’s hand get to take that sense of peace away from her?

Why does this doctor, who did nothing but see my mom’s name on a stack of files, get to send her journey to a screeching halt? Why is this in the hands of anyone else other than my mom’s oncologist and radiologist?

Of course, my mom can still get the radiation, but she would have had to do so on her own dime and without the aid of the health care she pays for.

A stranger shouldn’t have the power to make my mom cry.

Dearly

It’s not fair that she was diagnosed with cancer, and it’s certainly not fair that her health care gets to dictate what’s medically necessary and what’s not.

Luckily, her team of personal doctors — a team that knows what’s best for my mom in the long run — fought for her personal well-being. My mom’s radiologist didn’t just send an email fighting for coverage, he got on a personal phone call with the doctor who deemed her radiation “medically unnecessary” and changed his mind.

In the end, the insurance company rescinded its initial denial and accepted the claim.

This is all to say thank you to all of the doctors, nurses, and surgeons who work tirelessly — not for themselves, but for the betterment of their patients. My mom wouldn’t be where she is today without you.

What do you think?

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  1. This is what’s wrong with insurance company’s, they have people who apparently DO NOT LOOK AT THE PATIENT they just do what they want to save their company money. This is so sad when these people have enough on their shoulders with their illnesses, then to be told they are worth being treated??? KARMA

  2. 1. CALL THE INSURANCE CO AND TELL THEM YOU WANT TO SPEAK WITH THE “HIPAA CMPLIANCE/PRIVACY OFFICER.(BY FEDERAL LAW THEY HAVE TO HAVE ONE)
    2. THE ASK THEM FOR THE “NAMES AS WELL AS THE CREDENTIALS OF EVERY PERSON ACCESSING YOUR MOTHERS RECORDS TO MAKE THAT DECISION OF DENIAL. BY LAW YOU HAVE A RIGHT TO THAT INFORMATION.
    3. THEY WILL ALMOST ALWAYS REVERSE THE DECISION VERY SHORTLY RATHER THAN ADMIT THAT THE COMMITTEE IS MADE OF LOW PAID HS GRADUATES, LOOKING AT “CRITERIA WORDS” MAKING THE MEDICAL DECISION TO DENY YOUR CARE. .EVEN IN THE RARE CASE IT IS MADE BY MEDICAL PERSONNEL, IT IS UNLIKELY THAT IT IS MADE BY A BOARD CERTIFIED DOCTOR IN THAT SPECIALTY AND THEY DO NOT WANT YOU TO KNOW THIS!!!!
    4. ANY REFUSAL SHOULD BE REPORTED TO THE US OFFICE OF CIVIL RIGHTS (OCR.GOV) AS A HIPAA VIOLATION. HOPE THIS HELPS AND GOD BLESS YOUR MOM.

  3. This happens all the time with insurance companies. I am a retired radiation therapist/medical dosimetrist. I also was a dept manager and dealt with billing. They discriminate against women when IMRT treatments are recommended for gyn cancers. It’s ok for prostate cancer but not gyn. IMRT helps avoid uninvolved pelvic organs and still target the tumor. Patients have less side effects. So is a man’s bladder or rectum more worthy than a woman’s. The insurance doc always cites that there are no long term studies showing better outcomes. Well at the time studies were still not completed. But common sense and observing patients tolerating treatments so much better than with the old treatment techniques and surviving, makes it hard for radiation oncologists not to recommend it. Remember, First do no harm. Insurance companies are out for profit and are a mirror of socialized medicine.

  4. I lost my sister due to this type of decision making. She had MS and suffered from severe Asthma She was then diagnosed with ovarian cancer which had spread to her intestines.She went thru multiple rounds of chemo and three surgeries, and this took a large toll on her system. At this point, her insurance company decided that the asthma inhaler she was dependent on was too expensive and offered her one less expensive alternative. Well it was less expensive because it was less effective. She began struggling for breath, and coughing and choking constantly, and the force of the coughing blew out several arteries which had been weakened by the chemo. She literally bled to death. This is what happens when the insurance companies are allowed to make medical decisions based purely on maintaining their profits.

  5. So sad the troublle you have to go through for medical care in the United States. The heartbreak and sorrow surrounding this diagnosis is bad enough. The fight to beat this disease is hard enough . Tthen you have to fight insurance companies for your right to live. This is crazy. I wish we vould find a way to change it. But our thoughts and prayers are with your family. Cathy OConnor

  6. It’s sad how insurance companies have the powers that they have. Health care was so much better when your doctor called all these shots since he was on the front Iine.

  7. So sad that your mom and your family had to endure this extra stress and fight for her care. Thanks, Sara, for your reports on what you and other people dealing with terminal illnesses have to go through with insurance companies.

  8. Once again the insurance company is the one who is able to determine the treatment we receive. Renee you are strong, determined and loved. We will continue to offer prayers and support for you and your family Hoping that your doctors and their staff can change the insurance decision. Thanks Sara. From a cancer survivor

  9. Well I’m so glad that things worked out for the better for your mother and your right nobody has the right to make your mother cry or deny her medical when she has cancer that was just wrong on there part. God Bess you Mom

    Julie Robledo

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