9 Investigates insurance companies denying breast cancer treatment

ORLANDO, Fla. — An Orlando woman who's seeking breast cancer treatment is battling an insurance nightmare.

Orlando Regional Medical Center is one of 23 hospitals nationwide that use proton therapy, a more effective treatment with fewer side effects. But some insurance companies won't cover it for certain patients, despite a doctor's recommendation.

Courtney Lane has kept records documenting her battle against insurance company Cigna since a breast cancer diagnosis in 2016, when doctors found abnormal cells in a milk duct.

“Hearing that at 35, you feel overwhelmed, you feel terrified,” Lane said. “You don't really hear the rest of the conversation.”

Lane sought opinions from four doctors before receiving a double mastectomy at Orlando Health UF Health Cancer Center. Doctors found leftover cells 10 months later.

“It grew to be a lump that you could feel,” Lane said.

Doctors said proton therapy was Lane's best treatment option, because the cancer had penetrated deep into her chest wall, near her heart, and because traditional radiation treatment could cause long-term heart problems.

"It allows us to deposit (a) dose into a tumor in a much more focused way," Dr. Naren Ramakrisha told 9 Investigates' Daralene Jones.

Cigna denied that coverage.

"Radiation therapy may be medically necessary for your cancer, but the service requested, proton beam therapy, cannot be approved based on policy guidelines," the company told Lane in a letter that she provided to 9 Investigates.

Cigna wouldn't specifically discuss Lane's case because of federal health care laws, but it said in an emailed statement that it covers proton beam therapy when it is medically appropriate based on the stage of a customer's cancer.

The company said that approach is consistent with the National Comprehensive Cancer Network's current treatment guidelines and that the therapy is only covered for patients with advanced breast cancer.

Dr. Ramakrisha and his team told Channel 9 that treatment approval is a constant battle that forces patients, such as Courtney, to receive traditional radiation treatment.

"There is a general acceptance that proton therapy does reduce short- and long-term side effects on a theoretical basis," Ramakrishna said. "But until clinical studies actually show that benefit and we're able to quantify it, it's difficult to convince insurance companies to accept that rationale."

Orlando Health, which owns ORMC, has treated about 300 patients with proton therapy since the treatment option was added two years ago. The cost ranges from $50,000 to $150,000, which is double to triple the price of traditional radiation.

Insurance companies approve 90 percent of pediatric and brain cancer cases, but that figure dips to about 30 to 50 percent for more common cancers, such as breast cancer and lung cancer.

"It's extremely frustrating," Ramakrishna said.

And it's frightening for Lane, who might not know for years whether traditional radiation treatment will cause her other health problems.

"I wish that the insurance companies could look at individual cases and look at each case individually," Lane said. "I don't feel that's what happened for me, and I don't feel that happens for most people."

Clinical trials for proton therapy are underway and will continue for the next two years, but determining the treatment’s effectiveness could take an additional 10 to 20 years.

Cox Media Group