Kathleen H.

Breast Cancer

My pre-biopsy diagnosis differed from the actual diagnosis of Stage II Invasive Lobular Carcinoma (ILC). The lymph nodes tested positive, so I had a double mastectomy and sought approval for a clinical trial. The trial at Hematology Oncology Associates of Central NY (HOACNY) was denied, requiring that I travel to Sloan-Kettering for the same trial. Empire Plan of NY (NYSHIP) refused payment for a mastectomy, denied chemotherapy, and that I should have had a lumpectomy. Upon exhausting the appeals process, I then enlisted the help of an attorney, provided through our local Cancer Society. She filed an appeal to the NYS Insurance Board. A Board hearing before 3 oncologists, unanimously ruled that the insurance pay in full for all surgery, and chemotherapy, including participation in the clinical trial and other costs deemed necessary. Had this support not been available, my prognosis would have been dire, plus unpayable debts. How ridiculous to refuse a mastectomy or travel 247 miles when I had identical treatment close to home at Hematology Oncology Associates of Central NY, avoiding the stress of travel to a strange place.

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