Michele Brough was diagnosed with Stage 3 breast cancer in April, and naturally, her doctor reached out to her healthcare insurer, Anthem Blue Cross and Blue Shield to get pre-approval for a medicine that would help improve her immune system so she could endure chemotherapy better.
After her insurance granted her the benefits for the services, she began undergoing chemotherapy around mid-May, wherein an injection of the pre-approved drug called Neulasta Onpro had to be administered every session. This drug helps the production of white blood cells that fight off infection.
But, after her second round of treatment, her oncologist informed her that her insurance, Anthem Blue Cross, was actually not covering her injections, leaving her with a cost of $7,000 for every shot.
After talking to the insurance company, they were as astounded by the answer they were given. According to Anthem Blue Cross, they have pre-approved the drug, but only if Michele gets it through the online Express Scripts herself, and she should give herself the shots.
According to the patient, the insurance company never informed them of these rules, and her oncologist refuses to administer a drug that was not bought from their pharmacy due to safety and legal reasons.
Absurd insurance denial stories have always been around, but Anthem Blue Cross definitely took this to another level. Approving only a part of the patient’s treatment, and for reasons way beyond comprehension.
Michele’s breast cancer is an advanced form of the disease, but the American Cancer Society places the five-year survival rate at 72% with proper treatment
Her husband was so confused as to why a patient would be personally responsible for giving herself her own booster shots. Additionally, we all know that once a patient has started chemo, there’s no turning back. Even if they were $14,000 in debt after that second round of shots, stopping, for them, was definitely not an option. After the third round, Anthem still denied that claim, leaving them at $21,000 in debt.
For the fourth and final round of chemo, Michele’s oncologist decided to cut the drug, hoping that her immune system is now strong enough. Luckily, she has responded well to the chemo treatments, but that still doesn’t change the fact that they were still extremely indebted.
Michele’s husband appealed the charges to Anthem, but weeks later, he was still not getting anything from the insurance company, so he came to a news reporter to seek for help.
After a few days, Anthem has finally admitted that they were in the wrong.
According to the company spokeswoman Leslie Porras, after they were informed about the issue regarding Michele’s oncology drug, they started working to analyze what exactly happened, and had found that the claims have not been processed correctly.
It’s so unbelievable that it had to take a news reporter to be involved for them to take care of the matter. Soon, the Brough’s were contacted by Anthem Blue Cross and told them that they will be covering the three shots in full.
In situations like this, it’s best to call a professional patient advocate, who can navigate the healthcare system, including billing and payment concerns. A number of insurance plans cover the cost of a patient advocate, but if not, they might charge on an hourly basis.
Local patient advocates can be found on the National Assn. of Healthcare Advocacy Consultants website or through the Alliance of Claims Assistance Professionals.