Claim denials discussed in Hampton by Jesse Jackson and cancer survivors
Imagine how you would feel if you were diagnosed with life-threatening cancer. Alone?
Paralyzed? Scared?
Now, imagine if your insurance company denied you the life-saving treatment prescribed by your doctor. How would you feel then? Angry? Betrayed? Powerless?
When this happened to Jack Weber’s wife, Dianne, he decided to fight back. As Jack described at an August 31st press conference at the Hampton University Proton Therapy Institute.
In Weber’s speech at the Institute, he made it clear that the insurance company picked on the wrong family.”
Anthem BlueCross BlueShield, Jack & Dianne’s insurance company, denied both her initial claim and two additional appeals despite her doctor’s insisting that her condition was “urgent and life-threatening” and could not be “effectively treated without proton therapy radiation.”
Why would an insurance company deny a critically ill patient access to treatment recommended by medical experts?
Many believe that cost is a significant factor. But, insurance companies themselves claim that the denials are because proton therapy is an “experimental treatment.” This is despite the fact that it was first developed in the 1950s, is FDA-approved and has been used in hospitals for nearly 30 years.
Locally, the Hampton University Proton Therapy Institute (HUPTI), the brainchild of Hampton University President Dr. William R. Harvey, has already treated over 2,000 cancer patients since it opened its doors in 2010, with over 150,000 having been treated worldwide.
Inequities in society overall, as demonstrated in cases such as these, were on the Reverend Jesse Jackson’s mind when he visited HUPTI on September 20th.
A 2014 study found proton therapy as the recommended treatment for patients like Dianne Weber, and Anthem was denying Dianne’s claim based on “inaccurate and out-of-date information.”
Cancer Treatment and the Law
Even more glaring to Jack was Anthem’s violation of Virginia law. In February 2017, Virginia legislators passed a bill that prohibits insurance companies from evaluating proton therapy differently than other cancer treatments like x-ray radiation and chemotherapy.
Despite being turned down three times, Jack continued to fight because as he noted, it was
“pretty clear that something fishy is going on here.” With the help of Dianne’s doctors, Hampton University, HUPTI, and the Alliance for Proton Therapy Access, the denial of Dianne’s claim by Anthem was overturned by Virginia’s State Corporation Commission’s Bureau of Insurance
“It’s not about my wife,” Weber said at his August 31st speech.
“We won because we pushed harder than everybody else. But it shouldn’t have to be this way.”
Bill Thomas, the Associate Vice President of Governmental Relations at Hampton University, echoed Jack’s sentiments and pointed out the mortal consequences.
The insurance companies are “dragging you out and dragging you down the road.”
During the press conference, Jack Weber estimated that approximately eighty percent of patients who are denied by insurance companies just accept the decision, which enables the insurance companies to make a higher profit on their treatment.
Weber said, “There are a lot of people out there who don’t have the connections. Don’t have the money. Who don’t have the doctors who care as much and those people are the ones being hurt the most and that’s a crime.”
At the August 31st press conference, Ben Lambert, a prostate cancer survivor and former patient at the HUPTI facility, was denied proton therapy for prostate cancer by Anthem, summed up the thoughts of many.
“For any insurance company to not cover proton therapy in 2017 is absolutely outrageous. If the doctors say proton therapy is the right choice, then it should be covered. End of story.”
Ben Lambert’s mother, a registered nurse, echoed the same sentiment:
“It’s a crying shame. You’ve paid for your insurance. You’ve tried to do the right thing. And then, they as a whim say it’s not eligible.”
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