“I started crying,” explained Dr. Alicia Billington, after learning a major insurer recently changed its policies to cover a popular breast cancer reconstruction treatment that had long been denied.
“I literally had on my desk a pile of patients that had denials for that, and I was actively working on writing letters to argue, please let them get the surgery that they need,” she explained recently.
WATCH: Cigna approves long-denied breast cancer treatment
The procedure she’s referring to involves a surgical mesh, called GalaFLEX. It’s often used on breast reconstruction patients and has become increasingly popular among surgeons, including Dr. Billington, a plastic and breast reconstruction surgeon in St. Pete.
“It has been an absolute game changer as far as my ability to do a surgery in a patient and get a good result versus having to come back and then operate again,” she explained.
Though the U.S. Food and Drug Administration has approved mesh for use in the body, when it comes to breast reconstruction, it’s considered an "off label" treatment and experimental, which is a reason some insurance companies, including Cigna, have historically denied coverage for it.
Since December, Dr. Billington has been among a growing number of doctors taking their frustrations about health insurance denials to social media. As part of our special series, “Patient No More,” we’ve shared their stories.
We’ve also shared the stories of patients.
“All of us have been denied life-saving measures, just make it make sense,” said Rachel Roth McKnight, who is currently battling breast cancer.
McKnight is one of five women who spoke with Investigative Reporter Katie LaGrone back in March about being a breast cancer patient but getting denied coverage for treatments and procedures that came recommended by their doctors.
Among their denials — mesh.
PREVIOUS: Breast cancer patients share stories of insurance denials
But in an April policy update from Cigna, one of the nation’s largest health insurance carriers, some GalaFLEX mesh products for breast cancer reconstruction that had been listed as experimental, investigational and unproven (EIU) are now approved and described as “medically necessary.” According to the policy update, the approvals became effective on April 15.
A Cigna spokesperson confirmed the change in the following statement:
"We are committed to ensuring that our customers have coverage for the full range of breast reconstruction procedures, including many engineered tissue products. We regularly update our guidelines based on the latest medical literature, clinical evidence, and published guidelines.”
While more research is showing the product’s success in patients, Dr. Billington has her own thoughts on what inspired the insurer to change its tune.
“I think that your work has been so instrumental in getting the attention of these insurance companies and I think people are so frustrated that they're speaking out about it for the first time. I think that's why it changed. Yes, we have more research, but I think that you were a huge part in getting this change, so thank you,” she said.
Dr. Billington is currently working with other physicians and advocates to pass legislation that will update state and federal laws that are supposed to ensure coverage for all breast cancer patients through current laws, including The Women’s Health Protection Act. Those efforts remain ongoing.
