It took more than two years, multiple appeals and too many telephone calls and letters to count, but Amy Gardner Turek finally got approval for her health insurance to cover the breast-cancer treatment that’s saving her life.
She wants to encourage others in similar situations not to give up when an insurance company denies their claim.
“Don’t stop fighting,” she said. “Don’t let them bully you.”
Her health insurance, through her husband Brad’s employer, at first paid for the Herceptin treatments. But then a larger company bought the company where Brad works. That meant a new insurance company, too.
The new company, Meritain, a division of Aetna, called her treatment “not medically necessary and experimental/investigational.”
Each Herceptin treatment and ancillary expenses – doctors administer the drug into a port – costs $32,000, and she’s treated every 21 days.
It’s been seven years since Amy, 36, was first diagnosed with breast cancer. She had a mastectomy and reconstructive surgery, but the disease spread to her lungs and liver.
She’s been in remission several times, but more recently, doctors found lesions on her brain.
She’s considered Stage 4.
After the insurance denial, the couple filed a series of appeals, all of which were rejected. It’s an ordeal that’s continued for about two years.
But her husband’s employer, Engineered Wire Parts, decided to cover her costs “out of contract,” meaning it’s not obligated to pay under the terms of the health insurance plan.
Walter Cherniak, an Aetna spokesman, said Engineered Wire Parts is self-insured. It pays Meritain to administer the health insurance plan.
The drug company that makes Herceptin is covering the cost of the medicine.
“That left her responsible for the administration of the drug,” Cherniak said. “The plan sponsor has agreed, outside the terms of the contract, to pay for the administration.”
The health insurance comes through the parent company of Brad’s employer; employees don’t pay a contribution toward health insurance.
Amy’s treatments continue. The brain lesions have shrunk, and Amy says she feels great. She says the treatments are working.
Herceptin is approved by the U.S. Food and Drug Administration to treat some types of advanced-stage breast cancers, according to the website, breastcancer.org.
Despite all she’s been through, Amy won’t let the disease, the bills or the back and forth about insurance get her down.
“I haven’t even missed a day of work,” the stylist at Diva’s Hair Salon said.
She attributes her upbeat attitude to her faith.
“I truly believe God leads you to where you need to be,” Amy said. God also teaches patience, she said.
“It is not in my time. It’s God’s time,” Amy said.
The couple met while Amy’s cancer was in remission. Just two months into their relationship, though, it came back.
“I told him, ‘This is not an easy journey. If you decide to bow out, I get it,’” Amy said.
He stuck around.
“He told me he looked forward to it,” she said.
He wanted to be there for her.
“It’s hard,” Brad said. “It amazes me how she stays so positive with everything that’s on her plate.”
A deluge of emotions – fear, anger, worry, sadness – floods as he thinks about everything the woman he loves battles. He knows she’s strong.
“But I know how scared she is,” Brad said.
Listening to her husband, Amy wipes away tears.
Brad touches her leg, gives a half-smile.
“Of course it’s scary, because people die from cancer every day,” Amy acknowledges.
“But other people beat it and live with it.”
While the couple has grappled with the insurance company, others, family, friends, St. Joseph Cancer Center in Warren, patient advocates, Amy’s doctors and Brad’s employer have been understanding and supportive through the ordeal.
The couple have learned a lot and wants to share that information with others dealing with similar problems.
Many people who get notification of denial of insurance coverage just give up, not wanting another fight as they combat the disease.
Amy believes people need to speak up to make sure they get the right information. Ask questions, research online and reach out to advocacy groups, she advises.
That’s how she learned about all the available resources.
Don’t be afraid to challenge decisions you think are wrong, Amy said, adding,
“Be your own advocate.”