Dear Blue Shield of California,
I doubt I’m your “member of the month.” Since my diagnosis with breast cancer at a young age, the costs of my surgeries, medications, tests, and doctor visits have likely soared into the millions.
In the United States, we are fortunate to have access to some of the world’s best healthcare. As a breast cancer survivor, I rely on cutting-edge technology and treatments, collaborating with my medical team to ensure I can be present for my children’s graduations. However, the healthcare industry often prioritizes profits over providing affordable and accessible treatment for its members.
Despite holding a premium Blue Shield of California PPO plan at a considerable monthly cost, I still face out-of-pocket expenses for numerous tests and medications every month, in addition to my hefty premium.
What I never anticipated was needing to battle Blue Shield of California for coverage that I am legally entitled to receive. The American Cancer Society states, “The Women’s Health and Cancer Rights Act (WHCRA) protects many women with breast cancer who opt for breast reconstruction after a mastectomy. This federal law mandates that most group insurance plans covering mastectomies must also cover breast reconstruction.” This law has been in effect since October 21, 1998, and is overseen by the United States Departments of Labor and Health and Human Services.
Recently, I was scheduled for a revision surgery following my double mastectomy. Just two days prior to this important surgery, which coincidentally fell on February 4th—International World Cancer Day—I was informed that Blue Shield of California had denied the procedure. This denial added significant anxiety to an already stressful situation, especially as it appeared to contravene the Women’s Health and Cancer Rights Act.
Faced with two choices—reschedule or challenge the denial—I chose to fight. I felt a surge of anger. I was angry about my cancer diagnosis, the necessity of my double mastectomy, the upcoming revision surgery, and the worry it caused my children. Most importantly, I was furious that my healthcare provider, to whom I pay a substantial monthly fee, was denying me coverage. I felt completely abandoned. I also empathized with other women who might not be aware of their rights and who may have received similar denial letters.
With only 24 hours before my surgery, I decided to take action. Recognizing that the typical appeals process would not work within my tight timeframe, I sought a more radical approach. I identified the names of every member of the Blue Shield of California executive team, and through a bit of internet sleuthing, I discovered their email formats. I sent personalized letters to each executive.
Almost immediately, five Blue Shield of California executives responded, expressing concern and promising to escalate the issue for resolution. I had their attention.
Over the next six hours, I worked tirelessly with a patient liaison named Alex, who was knowledgeable and compassionate. Together, we coordinated a peer-to-peer call involving the Blue Shield doctor who initially denied my surgery and my personal physician, who understands my medical history intimately. Ultimately, my surgery was approved just 14 hours before I was due to check in at the hospital.
While I was relieved to have the approval, I was still upset. I was upset that the process had been so arduous. I felt anger for other breast cancer survivors who might have their revision surgeries denied and simply accept it as another cruel aspect of battling cancer. I was frustrated for women who might not realize they can contest such denials, or who don’t have the time or energy to fight for their healthcare rights.
Following the approval of my surgery, I sent another email to the executives who had initially responded to me. Some offered perfunctory replies, thanking me for bringing the issue to their attention. However, I want Blue Shield of California to understand the following:
- My breast cancer diagnosis was not a choice; it was life-altering.
- I should not have to fight for medically necessary procedures that are critical to my survival.
- I am protected by federal law and should not have to remind my healthcare provider of this to get the coverage I deserve.
- I worry about other women who may lack the energy or knowledge to challenge denials in such a “David versus Goliath” scenario.
- A simple photo could have expedited my surgery approval. Instead of sending a denial letter that induces anxiety, consider using a “pending further information” approach—this would seem far more humane.
- Alex, the patient liaison who assisted me, exhibited remarkable care and empathy. He deserves recognition, as we need more individuals like him in healthcare, not just faceless denial letters.
- While I appreciate you addressing this “oversight,” I can’t help but wonder if denying coverage is a strategy to save costs, as it seems to benefit your bottom line when members don’t contest denials.
- I urge you to reflect on this example of how the system failed and to implement changes that ensure communication and healthcare services are worthy of your members.
- As a cancer survivor, I will require ongoing testing and procedures. I shouldn’t have to engage in another battle for coverage; I’m exhausted, and each procedure takes a toll on my mental and physical health.
I hope you never find yourself in a position where you must fight for necessary healthcare. However, if you’re dissatisfied with your insurance provider’s response or face an urgent health issue, consider reaching out to the regulatory agency that oversees your plan. For California residents, this would be the DMHC or CDI. For those outside California, you can contact the consumer hotline for guidance on which agency regulates your plan.
Blue Shield of California has commented, “We cannot comment on any member case due to federal privacy laws. However, we take access to care for our members very seriously and will always work with them to help ensure they receive the care they need.”
For more information, you can explore this resource on women’s healthcare rights, or read about the Women’s Health and Cancer Rights Act. Additionally, check out intracervicalinsemination.com for expert insights on this topic.
In conclusion, I urge Blue Shield of California to reconsider how healthcare is delivered and ensure that women like me are treated with the respect and care we deserve.