Blue Shield of California is denying me life-saving and life-prolonging treatments.  I am 36 years old and have Blue Shield HMO health insurance coverage through my employer.  In January 2009, I was diagnosed with metastatic (stage 4) breast cancer.  When discovered, it had already spread to my bones, lungs, liver, and brain.  My doctors prescribed a medication that targets and removes the cancer throughout the body like a “smart bomb”; however Blue Shield of California denied coverage of my doctors’ recommended treatment.  Blue Shield also denied a radiation procedure that would target and remove the two lesions in my brain.  In both cases, Blue Shield denied the original requests and subsequent appeals I filed on the grounds that the treatments are not a medical necessity.  I have learned that insurance companies will use “medical necessity” as an excuse to not cover treatment when it appears that the patient is “too sick” (read: not worth it).  I am paying out-of-pocket for these life-saving and life-prolonging treatments, and intend to file an appeal to the State Dept. of Managed Care.

A Seattle journalist who runs the website www.assertivepatient.com posted this article on my situation:

My friends have started a group on Facebook called “Megan’s Circle” which will provide updates on my battle with Blue Shield, and collect donations to help defer the costs of the denied treatments.

Megan Jones

Altadena, CA