PRAIRIE VILLAGE, Kan. — A Prairie Village woman contacted FOX 4 because her insurer was refusing to pay for breast cancer treatment she’d already had. The company said it’s “investigational”. Others said it’s not.
In February, Jill Montaleone learned she had stage one or early stage breast cancer.
“I was convinced I had to get a double mastectomy to make sure I’d never get breast cancer again,” said Montaleone.
But doctors recommended much more conservative treatment, a lumpectomy and brachytherapy. A device is placed in the cavity where the tumor was removed to deliver radiation. It’s done for five days twice a day compared to up to six weeks of external beam radiation.
“It just seemed like the best choice for me,” she said.
But after the treatment had already started, Montaleone received a letter form Blue Cross Blue Shield of Kansas City saying brachytherapy would not be covered because it’s investigational and lacked evidence of efficacy or safety.
“All my doctors knew about it and thought it was a standard procedure,” said Montaleone.
Brachytherapy has been widely used, typically for small, early stage breast tumors, for more than 15 years.
Shawnee Mission Cancer Center told Blue KC that the insurer had routinely covered it for many years.
In a statement to FOX 4, the cancer center director, Becca Bell, said, “We advocate for our patients to receive insurance coverage, particularly in situations such as this when the patient received standard and long-standing treatment.”
But Blue KC denied Montaleone’s appeal.
“I’m still wondering if I’m going to have to pay $74,000 because they’re not gonna cover it,” she said.
FOX 4 contacted Blue KC on Wednesday morning, and that afternoon, Montaleone received an e-mail containing a letter that was dated Wednesday. Blue KC said the denial was an “administrative error”. Montaleone had met all the criteria for brachytherapy, and Blue KC will pay for the treatment.
“I really feel it’s their responsibility to pay for it. Not Shawnee Mission’s. Not mine. It’s theirs,” she said.
She said she hopes her story will motivate others who are fighting insurance denials to keep fighting because you can win.