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My Mom Had 34 Rounds of Radiation to Go Before Her Insurance Company Deemed It ‘Medically Unnecessary’

It was December 2. I woke up, did some things around my apartment, and then called my parents like I do every day.

I could tell my mom was upset, and I didn’t have to ask why before she said she got a letter in the mail saying that she was denied health care coverage for her upcoming radiation treatments.

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My mom was diagnosed with stage 3 breast cancer back in March. She has since endured six intense rounds of chemotherapy, a double mastectomy, and — as of December 2 — two out of the 36 rounds of radiation her personal doctors said she needs.

My Mom Had 34 Rounds of Radiation to Go Before Her Insurance Company Deemed It 'Medically Unnecessary'
Dearly

But it was December 2 that she told me she was going to stop radiation. Why? Because a doctor associated with her health care plan deemed the 36 rounds of radiation “medically unnecessary.”

How can a doctor who has never personally met my mom, examined my mom, or walked with her throughout this entire journey deem her radiation “medically unnecessary?” What did they see in her case file that the doctors she has been with since her initial diagnosis didn’t?

How does this doctor, who has never looked my mom in the eyes, get to make her cry, get to make her frustrated, get to deny her what her team of doctors that has been with her since March deems necessary?

Look, my mom doesn’t want the 36 rounds of radiation. It comes with a lot of potential side effects, but she also didn’t want the six rounds of chemotherapy or the double mastectomy. Unfortunately, that’s the hand she’s been dealt, and she handled every step of this journey like an absolute champion.

According to my mom’s personal team of doctors, when it comes to treating breast cancer, they base treatments off the diagnosis, not how you respond to treatments along the way.

My Mom Had 34 Rounds of Radiation to Go Before Her Insurance Company Deemed It 'Medically Unnecessary'
Dearly

Being that my mom was diagnosed with stage 3 breast cancer in March, that qualified her for radiation.

According to my mom’s personal team of doctors, it doesn’t matter that chemotherapy shrunk the mass that was in her breast and some of the lymph nodes in her chest, or that her team of surgeons were able to remove the large lymph node from her armpit during her double mastectomy.

My mom has stage 3 breast cancer, and because of that, her doctors — the doctors who have been with her since day one eight months ago — believe she needs radiation to ensure that by the end of this whole process, my mom is cancer-free and remains that way.

Why does a doctor who has never shaken my mom’s hand get to take that sense of peace away from her?

Why does this doctor, who did nothing but see my mom’s name on a stack of files, get to send her journey to a screeching halt? Why is this in the hands of anyone else other than my mom’s oncologist and radiologist?

Of course, my mom can still get the radiation, but she would have had to do so on her own dime and without the aid of the health care she pays for.

A stranger shouldn’t have the power to make my mom cry.

My Mom Had 34 Rounds of Radiation to Go Before Her Insurance Company Deemed It 'Medically Unnecessary'
Dearly

It’s not fair that she was diagnosed with cancer, and it’s certainly not fair that her health care gets to dictate what’s medically necessary and what’s not.

Luckily, her team of personal doctors — a team that knows what’s best for my mom in the long run — fought for her personal well-being. My mom’s radiologist didn’t just send an email fighting for coverage, he got on a personal phone call with the doctor who deemed her radiation “medically unnecessary” and changed his mind.

In the end, the insurance company rescinded its initial denial and accepted the claim.

This is all to say thank you to all of the doctors, nurses, and surgeons who work tirelessly — not for themselves, but for the betterment of their patients. My mom wouldn’t be where she is today without you.

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