Insurance company refuses to pay for FDA recommended cancer treatment

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by Mike Colombo / News 4

KMOV.com

Posted on October 14, 2013 at 5:32 PM

 (KMOV) – A Metro East woman fighting breast cancer is now battling her insurance company who was supposed to be there to help.

Norma Sams called News 4’s Mike Colombo when her insurance refused to pay for a procedure that her doctor and the government said was necessary.

She is a breast cancer survivor and in 2006, Dr. CB Boswell performed an implant procedure on her.

Five years later, he told her it was time for a check-up but this would not be any kind of check-up.

“The FDA recommendation at this point is getting an MRI every other year starting at the 3-year mark, so I recommended that she have the MRI,” said Boswell.

The FDA recommends MRIs for detecting ruptures so Sams had the MRI in December 2011.

The good news, there were no leaks; the bad news came about 15 months later when  Sams’  insurance, Blue Cross Blue Shield, said they would not pay for it.

"At that point it was $1,859, I didn't feel I should pay for that,” said Sams. "I sat on the phone lots of days to talk to these people and you think you've gotten somewhere."

Things then got worse for Sams; “I had been turned over to a collection agency and I never had a problem with my credit and I thought, well, that shouldn't happen either, you should get this straightened out, you know."

News 4’s Colombo contacted Blue Cross Blue Shield who then said Sams should file an appeal but when then FDA guideline on required MRIs was pointed out; the insurance company contacted the doctor’s office.

After two years, Blue Cross Blue Shield reversed course and is paying the bill.

The FDA recommendations were issued in June of 2011 when Sams scheduled her MRI four months later.

Blue Cross Blue Shield assured News 4 they do cover MRIs for breast cancer survivors. 

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