ST. PETE, Fla. — We recently sat down with Rachel Roth-McKnight at her home in St. Pete. Rachel smiled as she tussled her new curls.
“I’ve got these chemo curls now,” she said with a laugh.“The last time, I had no hair, and now it’s coming back,” she said, smiling.
Rachel’s hair isn’t all that’s changed.
“That's one of the things my husband and I joke about,” she said.“Because I look better, I must be better. He's always like, but you're healthy now. You look so good,” she said with a chuckle.
Breast cancer patient speak out
We first met Rachel 6 months ago after cancer had taken its toll.
“I feel like there is cancer everywhere. I feel like a ticking time bomb,” Rachel told us at the time.
Rachel was among five women we spoke with back in March. They had all been diagnosed with breast cancer and were all dealing with some type of denial from their health insurance company for cancer treatments and screening recommended by their physicians.
'I feel like a ticking timebomb': Breast cancer patients share stories of insurance denials
In Rachel’s case, her list of initial denials was lengthy.
“I was denied the mesh. I was denied radiation. I’ve also been denied PET scans and an MRI,” she told us.
And, like all the women we spoke with during that interview, their denials seemed almost impossible to understand.
“All of us have been denied life-saving measures. Just make it make sense,” Rachel said through tears.
Today, though Rachel’s hair is growing back, her cancer journey isn’t over.
“This isn’t about getting better, I’m also fighting to cover my treatment!”
After her double mastectomy in December, doctors found more cancer. The mom of two is back in chemo. Since she also tested positive for the BRCA gene mutation, making her more susceptible to other cancers, her doctor is recommending she undergo a radical hysterectomy.
Surgery is set for December.
“I just didn't ever expect something like this in my life,” she said.
What Rachel also never expected was the ongoing battle she’s been fighting just to get her insurer to pay for the treatment she needs.
“I feel like this isn't just about getting better and fighting the cancer. I'm also fighting them to cover my treatment. Almost like every major thing has been either a denial or a delay,” she told us this month.
From her recent chemo and radiation therapies to her doctor-prescribed hormone suppressants, Rachel says, getting her insurance carrier, Cigna Healthcare, to approve coverage for her cancer treatment continues to be a maddening struggle of repeat phone calls, paper pushing, administrative delays, and doctor blaming by her insurer.
Rachel recalled a recent phone conversation she had with a Cigna representative after a series of delays.
“I told her, I honestly feel like you would rather I die because I'm cheaper dead,” she said.“I think what I'm realizing is there's no good insurance. An HMO, PPO, none of it matters. At the end of the day, we are all at their mercy and they get to be nameless, and they get to be faceless,” she explained.
We reached out to Cigna for a response to Rachel’s claims. A spokesperson said they would get back to us, but never did. They did, however, reiterate their plan to make the approval process easier for patients. Read more here.
Change on the horizon?
Since the murder of UnitedHealthcare’s CEO last year, health insurance companies have vowed to improve their patient claims process.
Shortly after our first group interview with Rachel, Cigna announced it would stop denying coverage for a surgical mesh that’s become a popular off-label treatment in breast cancer reconstruction surgeries.
Major insurer approved coverage for popular breast cancer treatment following investigative reports
And this summer, Cigna was among a handful of top insurers that announced it would reform its pre-authorization process so patients could get treatment faster.
Among the changes are reducing what claims need pre-authorization and answering claims in real-time.
Implementation is expected next year.
Will it make a difference?
Dr. Jay Wolfson is a health care policy expert at the University of South Florida. Wolfson believes these changes could result in a noticeable difference to patients if done properly.
“There are always going to be horror stories and patients that fall through the cracks,” explained Dr. Wolfson. “Those individual cases are sad, but they don’t represent the behavior in the system. The fact is, the behavior in the system over the past 20 years has been built up toward obstacles in getting timely review and approval and services for some categories of care, and that can be fixed,” he said.
“I shouldn’t be focused on anything but my health and my family.”
“All I want insurance companies to do is do what we pay for,” said Rachel.
Eventually, all of Rachel’s claims got approved, but now, she fears, getting insurance to pay for her hysterectomy will be the next battle amid her ongoing fight with cancer.
“I’m just mad that it's become this part of my life when I shouldn't be focusing on anything else but my health and my family.”
Share Your Story with Katie
Katie LaGrone focuses on making sure Florida’s laws actually work and her investigations have gotten results. If you know of a policy or law that’s not working how it’s intended, send Katie a message below.
.
After a tip from a concerned homeowner near Lake Kissimmee, the Tampa Bay 28 I-Team is pulling back the curtain on Florida’s multi-million dollar gator trade—the farms, the hunts, the designer handbags—a system where even the state takes part in the cut.
