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Cancer-fighting nurse fights insurance company for treatment

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    Colorado (KCNC) — An emergency room nurse in Colorado is in the midst of a healthcare battle as her insurance won’t cover a treatment doctors say could cure her cancer.

“I have non-Hodgkin’s lymphoma, stage two,” Hollie D’Arcey, a nurse with UCHealth said. “It’s a moderately growing cancer and it’s typically incurable.”

Hollie was diagnosed in July with the immune system lymphoma, and at times felt her future looked grim.

“I was very frightened,” she told CBS4’s Kelly Werthmann.

Yet Hollie found a glimmer of hope when she learned about proton beam therapy. It’s a highly targeted radiation therapy, according to the Mayo Clinic, that is ideal for patients with tumors close to vital organs. Since Hollie’s tumor is in her chest, she worries traditional radiation would affect her heart and lungs.

“[It’s] kind of like a pencil beam that goes right in and it stops at my lymphoma,” Hollie explained.

However, the treatment isn’t available at any hospital in Colorado, so she used her own money to travel to the Mayo Clinic in Arizona for a consultation. She said her insurer, Anthem, paid for the out-of-state consult. A doctor there told her proton beam therapy is the best option for treatment and could potentially cure her cancer.

“Right then and there I cried in his office,” Hollie said. “I was like, ‘Okay. This is it. This is what I want.”

Yet what Hollie wants – and what her doctor recommends – is not what her insurance wants.

“Within 24 hours of [Anthem] getting the request from the doctor they denied it,” Hollie said, showing CBS4 the multiple letters she received from her insurance provider.

Hollie was denied not once, but three times.

“They’re saying [the proton beam treatment] is not medically necessary,” she said of Anthem’s refusal to pay.

In an appeal letter to Anthem, Hollie’s doctor at Mayo Clinic explained that proton beam therapy has been used on thousands of patients for decades, it’s also FDA approved. However, Anthem quickly responded and said “medical studies do not show that treatment works as well as other treatments for this type of cancer.”

Yet Hollie is refusing to give up.

“I have to get treatment and I intend to fight until I get the insurance company to pay for it,” she said. “If [Anthem] is saying it’s about money, it’s not true. [The Mayo Clinic] has made the cost the exact same as traditional radiation.”

Anthem did release a statement to CBS4 about Hollie’s case, saying:

We understand a cancer diagnosis is unsettling, and we are sympathetic to the concerns of Ms. D’Arcey and her family. Our mission is to help our members battling this disease access safe and effective, evidence-based medical treatment that can improve their health.

Our medical policies reflect current scientific data and clinical thinking. Medical policies on new or existing technologies, such as proton beam therapy, are based on scientific evidence published in peer-reviewed medical literature and based on data that these technologies may improve health outcomes. Our Medical Policy and Technology Assessment Committee, composed of physicians from various specialties–including physicians in active practice not employed by Anthem — meets multiple times during the year to evaluate and update our medical policies.

The requested treatment did not meet the criteria for coverage according to our guidelines, and based on that, the request for proton beam therapy was denied. An appeal of this decision was heard by a radiation oncologist, who upheld the original determination. There are alternative medical treatments that are safe, effective and evidence-based that have been shown to be successful in treating this type of cancer.

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CNN

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