Troubleshooter

Woman battles insurance company for life-saving surgery

Monday, November 04, 2013

Lisa Weaver is a military wife, a mother, and grandmother who wants to be around for her family for years to come. Now, she's got ABC11 Troubleshooter Diane Wilson fighting for her too.

Lisa Weaver is a military wife, a mother, and grandmother who wants to be around for her family for years to come. Now, she's got ABC11 Troubleshooter Diane Wilson fighting for her too.  

She reached out to me when she couldn't get her insurer to sign off on preventive surgery. It's surgery she says she needs to beat cancer. It's the same cancer she watched kill her own mother.

"It was sad and I didn't want to die like that," said Lisa.

Lisa watched her mom fight breast cancer for seven long years only to lose her fight.

"She never went into remission," said Lisa. "It metastasized literally head to toe."

Fearing the same fate, Lisa got tested last fall and discovered she had the same mutation in her BRCA2 gene.

"Your chances go up significantly for breast, ovarian and pancreatic cancer, and it's a hormone induced cancer," said Lisa. "So the first thing they want to do is take the ovaries."

And Lisa didn't hesitate.  With grown kids and a young grandchild, she went ahead and had preventive surgery to have her ovaries removed. Her next, best option to fend off cancer was a double mastectomy.

"It was left up to me, as to whether or not I wanted to do the mastectomy. Um and instantly, 'Yes, I want it done.  You know, my mom died from breast cancer,'" said Lisa. "I didn't want to die the way my mom did. My husband, my children, I do not want them to ever experience that. "

But this surgery wouldn't be so simple. Even though her doctors okayed it, and scheduled it for early this year.

"Jan. 16, they called me and said, 'No.' TRICARE pulled it, and there was no explanation," said Lisa.

TRICARE is the military's health care program.  They denied the double mastectomy as nonessential.  Lisa, and her doctors at UNC, appealed.

"Denied again," said Lisa. "I tried appealing it, denied again."

She even enlisted congressional support and was denied again.

"It was hard. It was," said Lisa. "The one thing that I had fought so hard for was being yanked, and I knew I needed this, to not let my husband, my kids, my grandkids, to not let any of them see that happen to me."

Lisa's had the full support of her husband, Sgt. 1st Class Teddie Weaver, who's been serving our country for 23 years. He never thought he'd have to fight this fight.

"It's always the hardest part to kind of swallow," said Teddie. "Because after 23 years, you don't expect anything like this, you know. Yes, I know There's rules and boundaries, but really? Cancer? And genetically proven cancer? How can you turn that down?"

"I think that watching mom die was the hardest thing I've probably ever been through in my life," said Lisa. "But fighting TRICARE is like right there with it."

Despite the denials, they refused to be defeated.

"My world consisted of, I woke up each morning, went to fight TRICARE," said Lisa. "I went to bed each night crying because I didn't get anywhere."

And then, they got their story to me.

"You were our last hope, and you did it," said Lisa, "You contacted them on Thursday. On Friday, I got the phone call."

It was the phone call they'd been waiting 10 months for.

"She said I should have never been denied, and I was like 'Really,' and she said that it had never even touched the medical boards," said Lisa.

With her double mastectomy approved, Lisa's fears are finally starting to subside.

"We'll never be able to thank you enough, never," said Lisa.  "I won't have to worry about breast cancer anymore."

Lisa's surgery is scheduled for later this month.  We'll certainly stay in touch with her and let everyone know how she's doing.  As for TRICARE, they tell me the initial denial was based on an interpretation of their policy, and that's why they have multiple levels of appeals.

So why did TRICARE deny Lisa in the first place?  

Lisa says they denied it because, technically, Lisa only had one relative who died of cancer -- her mother. They generally require two for the there to be a trend and an approval for the surgery. But Lisa argued that her aunt also had cancer, but says she committed suicide before the cancer could take her life.

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