Insurance Denied When Most Needed

Santa Barbara Independent

Mariam Tariq SAT, MAR 30, 2019

Healing a Broken Health-Care System by Holding Insurers Accountable

Recently, the state Supreme Court affirmed a $91 million fine against United Healthcare, scoring a major victory for California patients who were wrongfully denied access to care by the insurance giant. The scale of violations by the insurer — topping more than 900,000 improper denials — demonstrates the power imbalance between patients and insurers.

While I was not one of the 900,000 denials, I learned firsthand how daunting a fight with an insurer can be when I was diagnosed with breast cancer at age 21. I assumed my health-care insurer would approve my physician-recommended care. I was wrong. Now, I’m joining others and calling on Congress to hold insurers accountable for providing cancer patients access to the treatments they need.

My experience ended well, but my journey shows what’s wrong with a system where broken insurance processes make it nearly impossible for cancer patients to receive the best care. While cancer interrupted my senior year of college at UC Santa Barbara, my insurer’s actions caused me the most stress. I eyed treatment bills for thousands of dollars and was terrified of the financial burden this could put on my family.

At the heart of my insurance fight was proton beam therapy. My doctors ruled out traditional radiation treatment as too risky because of a genetic susceptibility to secondary cancers. Proton therapy’s precision would target my tumor and minimize radiation exposure to healthy tissue, significantly reducing my risk of secondary cancer. It was a no-brainer to everyone but UnitedHealthcare.

My initial proton therapy request was met with a denial letter that cited outdated clinical guidelines from 2012 and called the treatment unproven and unnecessary. However, the guidelines had long been updated to recommend proton therapy for breast cancer patients.

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