I was diagnosed with stage IIA IDC in January, 2004. I had a normal mammogram 19 months before and in this short amount of time, my tumor had grown to 3.5 cm.! Luckily a sentinel node dissection showed no metastasis but since my tumor was large and grade 3 histology, I needed both radiation and chemotherapy to give me the best chance.
I got lucky and was referred to a local oncologist who had participated in the dose-dense trial which meant I got chemo every 2 weeks rather than every 3. Although it was rough at times, I think some of the side-affects weren't as bad with this method and at least I was finished with chemo faster!
Since my tumor was on my left side, I investigated radiation and found out about a newer technique called IMRT that was much more precise than traditional radiation and could actually avoid damage to my heart. Once again, I was lucky to find a local radiation oncologist who could do this treatment for me. Imagine my surprise when he told me that even though I would be a perfect candidate for this type of treatment, Blue Cross wouldn't cover it! I was appalled. Why would they cover the cost for prostate and not breast? I did more research and found that although there were some studies out there, there wasn't a randomized clinical trial that accurately demonstrated the advantages of breast IMRT. This was the excuse they gave for calling it experimental/investigative. Medicare covers breast IMRT, Medi-Cal covers breast IMRT. Many small insurance covers breast IMRT and some Blue Cross companies cover breast IMRT. My company, which is owned by Wellpoint and is a for-profit company refuses to cover this procedure which usually costs around $50,000.00!
We took out a home equity loan to cover the cost and I finally had to hire an attorney to help me fight this huge company.
I feel that if I am successful, perhaps insurance companies will be more likely to approve this therapy for future patients.
Unfortunately, I am not getting much support from the breast cancer community. Susan Komen barely even acknowledges the advantages of this therapy and when I asked for their help with legal fees, they didn't even write me back. I would think that breast cancer advocacy groups would show an interest in this topic but I haven't had any success there either.
I am now on Tamoxifen and feeling really well. I am very lucky I found my cancer before it had time to spread and have had wondeful care throughout this year.
I hope I am successful in my fight with Blue Cross of California.