Valley woman's insurance would not cover vital blood test

Posted: Updated:

An Anthem woman could not believe it when her insurance company refused to pay for a $77 blood test that would show if her breast cancer was still in remission.

The insurance company did not want to pay for the $77 blood test but was willing to pay for a much more expensive pet scan, which costs thousands of dollars.

The letter sent to her was what caught 3 On Your Side's attention. Heather Toplak wrote to 3OYS saying "I would love to have this appeal overturned. It is not an issue of personal cost.It is an issue on money insurance companies are willing to waste when it is not necessary."

Heather told 3OYS she did not want to waste money. She just wanted the blood test her doctor ordered. She admits, "Coming to grips with fact that as a 35-year-old you have breast cancervery difficult, still very difficult."

Everything seemed perfect. Heather and her husband were enjoying life with their daughter and then cancer reared its ugly head without warning. Heather was fighting for her life. She says, "You put your battle gear on and go into it head first."

That is exactly what she did.Over the past year, Heather has gone through a double mastectomy, six rounds of chemotherapy, reconstruction and two additional surgeries and she says her insurance carrier, Blue Cross Blue Shield, paid for everything along the way.

After going into remission, her oncologist ordered what is called a Cea Tumor Marker Panel, a blood test to show cancer levels in the bloodstream. After paying for all of her cancer treatment along the way, Heather says she was shocked when they refused to pay for the $77 test.

The insurance company's denial letter said the blood test was "not medically necessary." Heather's oncologist wrote a letter to the insurance company stating that the Cea Tumor Marker is " standard of care for breast cancer" and that this is "a routine test."

Instead of approving the $77 blood test to make sure her cancer was not back. Heather says the insurance company approved a pet scan, which can cost thousands of dollars.

She says she called 3 On Your Side to bring awareness. Heather explains, "It wasn't a factor of money. It was a factor of principal. Our insurance companies are paying for tests left and right that cost us thousands of dollars but denying $77 blood work.

If you're not going to allow doctors to use the latest therapy and the latest studies on patients you are tying hands behind back and the one who is gonna get hurt is the patient."

Dr Richard Dolinar does not treat Heather but says her story is not unusual. He believes insurance companies need to do a better job of listening to the doctors. He explains, "Doctors are in the business of trying to save lives."

In Heather's case, her oncologist ordered these blood tests to monitor if she is still in remission, tests that could save her life and could save the insurance company a lot of money.

Heather tells 3OYS, "I'm not going every three months six months to get pet scan cat scan. It's $77 but if the insurance company wants to fork out 10K every three months I can do that. They have approved that."

3 On Your Side contacted Anthem Blue Cross Blue Shield out of Ohio and its parent company Well Point are glad to report that Heather's denial is being reversed. The insurance company has agreed to pay for the tumor marker panel. Not only that, they are changing their policy on paying for these blood tests going forward.

If you would like to comment on this story or weigh in on the health care conversation, you can contact on twitter or Facebook.