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Desperate cancer patient turns to Nakamoto; Insurance company springs into action

4 months 1 week 4 days ago Thursday, June 08 2017 Jun 8, 2017 June 08, 2017 4:41 PM June 08, 2017 in News
Source: WBRZ

PRAIRIEVILLE- A mother of four children battling an aggressive form of breast cancer is in one of the biggest fights of her life. For nearly a month, she not only battled cancer, but also her insurance company after it denied her participation in a clinical trial that could possibly cure her.

Daphne Spears, 47, is a wife, mother of four children and a nurse at Our Lady of the Lake Hospital. In 2013, she was diagnosed with a very aggressive form of breast cancer, Triple Negative. After a mastectomy, chemotherapy and radiation, Spears went into remission for about two years.

In 2016, the cancer returned with a vengeance; metastasizing to her lungs and bones. After undergoing chemo for several more months, her oncologist suggested that she go to Houston's MD Anderson Cancer Center to participate in a clinical trial for people with her form of cancer. She went in May and was approved as a good candidate for a clinical trial, but UMR, her insurance company that she has through Our Lady of the Lake, denied her participation.

"You have to be cleared through insurance, because insurance pays for incidentals, lab work or anything the trial doesn't pick up," Spears said.

So for almost two months she went without getting any sort of treatment for her cancer that continues to grow inside her body. An emotional Spears hoped telling her story would cause the insurance company to change their mind.

"I'm not asking for handouts," Spears said. "I'm just asking for what's fair. Why can't they approve this and get it going?"

Paperwork Spears provided to the Investigative Unit indicated she was denied because the clinical trial was not being administered through one of UMR's sponsors. UMR is a division of United Healthcare.

"I'm a person, I'm a human being," Spears said. "I'm not just a number. I'm 47-years-old. I still have a lot of life. Everyday they are making me wait is a day they are taking off my life to spend with my children and my family."

The Investigative Unit sent emails to UMR and United Healthcare and called them. Moments after the healthcare company received a HIPPA waiver for them to discuss Spears' case with WBRZ, she received a phone call from someone at United Healthcare this afternoon.

"The criteria are met and requested services are covered," A United Healthcare employee told Spears.

Spears is grateful to begin getting treatment again, and is thankful to all of those people in Ascension Parish and beyond who have supported her in this fight for her life.

"If it wasn't for their support, I couldn't be here today," Spears said. "For my family and this neighborhood I live in, it has been overwhelming."

WBRZ requested a statement from United Healthcare and UMR about why Spears was denied to participate in a trial that was free. The company released the following statement:  "As soon as we discovered, on our own, that this was a registered clinical trial, we approved coverage for Ms. Spears in it," United Healthcare said.

Spears is now making arrangements to head back to Houston to begin the clinical trial for her cancer.

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