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Cancer Patient Fights For Coverage

2:09 PM, Oct 22, 2013   |    comments
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PHOENIX, AZ -- Kristina Anderson was the picture of youth, a former Big 10 cheerleader at the University of Illinois. These days, the 25-year-old is in the fight of her life against a rare, aggressive form of ovarian cancer.

Until Call 12 for Action stepped in, she was also locked in a battle with her insurance carrier, UnitedHealthcare.

From the moment Veronica Sanchez heard about Anderson's case, Call 12 for Action was on the phone and on the computer sending e-mails back and forth to UnitedHealthcare spokeswoman Cheryl Randolph.

Anderson signed up for insurance coverage with UnitedHealthcare on June 18. Her coverage became effective July 3.

A week later, doctors found an ovarian cyst and told her it might be cancerous. The doctor said Anderson needed surgery to remove it. Days before that surgery, Anderson called a UnitedHealthcare representative and asked if her surgery would be covered.

Anderson said she was flat-out denied over the phone because of a clause in her policy that allows UnitedHealthcare to deny coverage of a reproductive cancer within the first six months of insurance coverage. Scottsdale Healthcare also called the insurer on Anderson's behalf and was told the same thing, Anderson said.

When Call 12 for Action intervened, UnitedHealthcare said that the six-month reproductive clause did not apply to Anderson's case. The spokeswoman then said Anderson had not called the insurer and had ignored requests for more information.

But Anderson denies that. "That's not what happened," Anderson said.

Call 12 for Action went back to Randolph and asked her to review the transcript of Anderson's July 8 phone call.

UnitedHealthcare then admitted Anderson did in fact call, asking if the surgery would be covered, but Randolph said that she never mentioned the word "cancer." Had the mass on her ovaries been benign, it wouldn't be covered, but all cancers are covered by UnitedHealthcare, even for policyholders who have the six-month reproductive waiting period.

That last, very important point was not communicated to Anderson. During her phone call to UnitedHealthcare, Anderson likely didn't mention "cancer" because at the time, she didn't know she had it. Doctors discovered it after examining the mass they removed from her ovaries.

Either way, UnitedHeathcare insists it never officially denied Anderson coverage. The insurer paid Anderson's medical bills totaling nearly $20,000.

Randolph sent us this statement: "We understand what a difficult time this must be for Ms. Anderson and empathize with her and any of our customers who are facing serious illnesses. Once we received the medical information necessary to process claims from Ms. Anderson and her providers, the claims were processed in a timely manner.

"We talked with Ms. Anderson by phone last week to let her know that all submitted claims were being paid, that no claims were denied and that she would be receiving written Explanations of Benefits (EOBs) by mail."

According to Randolph, when the Affordable Care Act kicks in on Jan. 1, the six-month waiting period will no longer exist for anyone covered with any health insurance.

After our story ran on television, Anderson sent a note saying, "Thank you so much for taking the time to hear my story and fight for me. It's a relief not to have the stresses of overwhelming amounts of bills come in. I am truly grateful for all the work you put into helping my cause.

"I feel blessed to have met compassionate people who are making a great difference."

Kristina is still in cancer treatment but she's also preparing for the Miss Arizona pageant! She signed up for it to have something positive to look forward to. Last week, she picked out her evening gown, interview dress, and earrings and took these stunning pictures.

KPNX

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