By Consumers For Quality Care, on October 30, 2019
Photo by Heidi de Marco/KHN
As an emergency room nurse, Hollie D’Arcey is accustomed to being in hospital. Unfortunately, in July, D’Arcey’s experience changed when she was diagnosed with Stage II Non-Hodgkin’s Lymphoma. D’Arcey had been feeling tired but did not think too much of it until an MRI and biopsy confirmed she has cancer, The Denver Channel reports.
“I had no idea, it was really hard to take. It was scary,” said D’Arcey.
She met with a radiation oncologist to put together a treatment plan. After her initial appointment, D’Arcey got a second opinion and began researching an alternative treatment called proton beam therapy. Proton beam therapy is a type of radiation that has the ability to deliver therapeutic doses of radiation with greater accuracy than traditional treatment.
D’Arcey says that her insurance company, Anthem, covered a visit to an out-of-state clinic which specializes in proton beam therapy. The consultation brought good news.
“They said this is the best treatment for you,” said D’Arcey. “I just feel like this is the best thing for me, I know it is. When a doctor says to you this is what I would do for my wife, or my child, or me. I don’t hear that and I work with doctors all day long, they don’t say that.”
D’Arcey and her doctor submitted a treatment plan to Anthem. The plan showed that because her cancer is located so close to her esophagus, lungs, heart, breasts, and spine, proton beam therapy is the best choice of treatment.
“It was denied immediately with 24 to 48 hours so I think we kind of expected that, he said sometimes we have to fight for this stuff and not to be discouraged,” said D’Arcey.
Her doctor appealed the decision, but it was denied again. A second appeal resulted in yet another denial. In a statement, Anthem said that the therapy was denied because D’Arcey’s treatment did not meet the criteria for their coverage guidelines. Consumers for Quality Care has previously highlighted consumers’ difficulties getting proton beam therapy approved by their insurers. Despite the denials, D’Arcey still believes that the therapy is the right treatment for her.
“Dealing with cancer is hard enough and dealing with the insurance company on top of that is just, it’s too much. It’s way too much,” said D’Arcey.