Opinion

Cancer: Hold insurers accountable for denying patients care

Photo illustration of medical equipment. (Image: ESB Professional, via Shutterstock)

When I was diagnosed with breast cancer last year at the age of 22, I was terrified.Fortunately,I had excellent doctors who promptly developed a treatment plan that they felt would help me survive this horrible disease. I was optimistic we would be successful in beating the cancer, and I put my trust in them and my health insurer, whom I assumed would pay for the care my physician team recommended. But, I was wrong.

My insurance company has entirely ignored my doctors’ medical expertise and flatly refused to pay for the physician-prescribed treatment. I’ve learned that my plight is not unique, that there is a systematic failure to hold insurers accountable for unfair delays and inappropriate denials of recommended cancer care. California’s insurance commissioner, Dave Jones, can fix this.

Almost immediately after I learned I had cancer, I started chemotherapy and underwent a mastectomy in January.Next, radiation treatment was recommended, but traditional radiation would be too risky because of an unrelated genetic condition I have which makes me susceptible to secondary cancers.

The good news was that my doctors thought I was a perfect candidate for proton therapy and recommended I begin treatment right away. Proton therapy is an FDA-approved treatment that targets cancer cells by controlling proton beam radiation. Because it is more precise than traditional radiation, proton therapy minimizes damage to healthy tissues and reduces the threat of harmful side effects. After consulting with my doctors, I was optimistic about the future.

Even though proton therapy was deemed medically necessary and has been proven effective in treating breast cancer, United Healthcare denied payment for my claim. They justified this upsetting decision by citing outdated guidelines from 2012—guidelines which have long been updated to recommend proton therapy for breast cancer patients like me with secondary conditions.I was shocked that they could get away with using outdated information to make a potentially life-or-death decision.

At this point, I thought United Healthcare couldn’t stoop any lower, but again I was wrong.

Even after my doctors arranged a peer-to-peer review with United Healthcare to discuss the denial and my specific medical condition, they continued to deny payment. Even more frustrating was that the insurance representative deciding my fate was completely unqualified to review my case and knew nothing about proton therapy.

Astoundingly, I am just one of many patients who are forced to endure this added trauma as they seek to treat their cancer. In fact,more than 60 percent of cancer patients whose doctors prescribe proton therapy are initially denied by private insurers.

It infuriates me to know that in California and across the country, there are many more patients like me who have been unfairly denied the care their doctors recommended. That’s why I’m joining with other patient advocates calling on our state insurance commissioners to adopt and enforce the Cancer Patients’ Timely Treatment Bill of Rights, which would hold insurers accountable for providing fair, timely, and transparent access to cancer treatment.

These common-sense principles ensure that insurance companies like United Healthcare make transparent determinations based on accurate, up-to-date information. As the state insurance commissioner, Mr. Jones can and should make it clear that California will no longer tolerate unethical business practices that deprive cancer patients of the care they need and deserve.

When news broke of another insurer’s negligence in California earlier this year, Mr. Jones promised to launch an investigation into their disregard for the well being of the patients they represent. I urge him to go further by adopting and enforcing the principles of the Cancer Patients’ Timely Treatment Bill of Rights.

While most young women my age are focused on going out with friends and finishing college, I find myself in the fight of my life. It’s hard enough fighting cancer; I shouldn’t have to fight my insurance company too.

Ed’s Note: Mariam Tariq is advocating with other cancer patients along with the Alliance for Proton Therapy Access.She is currently undergoing treatment for breast cancer at California Protons in San Diego.

 

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