PHOENIX (KTVK/KPHO/Gray News) – An Arizona man battling throat cancer says his health insurance provider is denying a key part of the treatment he needs to fight the disease.
Gary Schmit says he’s running out of time to get radiation therapy as he faces throat cancer.
“Our insurance is throwing a curve ball at us like this, and I’ve got days to solve it. It’s unacceptable,” Schmit told KTVK/KPHO.
His wife, Serena Greene, says Anthem Blue Cross Blue Shield is denying their claim.
“They deny it as if they know more than our doctors at the Mayo Clinic know about what is best to treat his cancer,” Greene said.
Schmit says his treatment plan started with surgery to remove his tumors. Anthem signed off on the procedure but not the radiation that follows.
“It doesn’t make sense that they’re almost à la carte my treatment. It’s cancer treatment,” Schmit said.
He explains the radiation is only effective if it happens within six weeks of surgery, and that was a month ago.
Because of a rare complication, Schmit says everything was pushed back even before the denial.
“I didn’t know if he was going to make it. It was scary. So, it’s just been a lot to go through,” said Greene through tears.
Schmit says he’s doing better, and the tumors are gone. His medical team tells him it’s time for the next step.
“It’s not like somebody wants to get radiation,” Greene said.
“If I don’t have the radiation treatment, there’s a 20% more chance that the cancer returns, so they’re messing with 20% more of my life at that point,” Schmit said.
Anthem Blue Cross Blue Shield released the following statement via Emily Snooks, the company’s director of public relations:
Anthem Blue Cross and Blue Shield is committed to providing access to medical services and treatments that are safe and effective. This matter was reviewed in accordance with scientific evidence published in peer-reviewed medical literature. In this particular case, the requested service was denied due to the particular type of radiation requested not being medically necessary to treat this form of cancer. Anthem continues to work with this member to ensure he receives clinically appropriate and medically necessary care.
Schmit says his doctors disagree with the insurance company and that out-of-pocket treatment could cost nearly $250,000.
“Something’s seriously wrong with our healthcare system if the health insurance companies are dictating what kind of treatment we’re receiving over the specialists, the experts,” Schmit said.
It’s an additional setback amid a difficult diagnosis.
“All that turmoil, you have to deal with the cancer but then also the rage that you feel at just being a number on the back end, and it’s like this is somebody’s life,” Greene said.
Mayo Clinic released the following statement:
“Mayo Clinic works with insurance companies and other payers to advocate for patients who may benefit from a recommended treatment plan.”
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