Trina Sanford is a new mom with a mountain to climb.
“I thought no way. All of my dreams have just come true. It can’t be it can’t be real,” said Sanford.
Trina’s crushing reality is that she has Stage 4, non-Hodgkins, marginal b-cell lymphoma. It has spread throughout her body and the entire family feels its effects, including her husband Ryan and their six-month-old son Walker.
“We’re guys. We’re supposed to fix stuff, but I can’t fix this. It bugs me. But you do it because you have no other choice because you love her. You have to be positive,” said Ryan.
Trina said after her diagnosis her insurer, Group Health, sent her to an oncologist at Providence in Everett.
“As we got the initial diagnosis, after they saw the spot on her lung. They said you know, I think getting a second opinion at SCCA is a good idea,” explained Ryan.
SCCA is Seattle Cancer Care Alliance. They have some of the best doctors in the nation who specialize in non-Hodgkins Lymphoma. It’s there where Trina and Ryan found hope.
“The doctor was amazing. He spent two hours with us. He gave me his full background story. He got to know my story. He explained everything about the diagnosis in detail. He never spoke in terms of years that I have left to live,” said Trina.
The couple was set and ready to go at SCCA. They thought it would be covered since the doctor referred them there. Group Health’s website says the company has a special affiliation with the facility, but all of that meant nothing.
“We got a call from the insurance company saying you were denied. I was caught completely off guard,” said Trina.
The Group Health denial letter said, “After a review of your records, we find no medical reason that care for your condition must be provided by this provider.”
The couple admits they assumed SCCA was in their network because of the referral and the information on the website.
Ryan couldn’t understand the reasoning.
“Strongly affiliated, go take a look, get a second opinion, but don’t actually get treated here,” said Ryan.
The Sanfords called me and I contacted Group Health. Trina filled out a waiver so the hospital could speak freely about her case. I asked Group Health about the details of Trina’s plan, why was she sent to SCCA for a second opinion but couldn’t be treated there and why SCCA was on its website. I also inquired about the cost difference between the treatment at Providence and SCCA because friends and family are raising funds to help with the costs of care.
I also asked if she had any more appeals available.
In response, Group Health said:
“Group Health is proud to provide access to some of the best oncologists in the state, with proven success rates of treating multiple cancer types. Group Health encourages members to familiarize themselves with their coverage at the time they select their plan and prior to seeking care, to ask questions about coverage, and to take advantage of our multiple customer-service and clinical staff resources.”
In the letter, Group Health did not provide any specifics of Trina’s case. In fact it didn’t even mention her by name.
Trina was perplexed and disappointed.
“I’m 32 years old. It’s spread to my kidneys, my lungs, my neck, my abdomen. They don’t care. They don’t care that I have a brand new baby, because I’m money to them,” she said.
It’s imperative that everyone understand their plan. Don’t look at your providers website thinking what is offered for some will be provided for all. As for Trina, she couldn’t wait longer for a decision about SCCA, so she has started a similar treatment at Providence. The battle has begun and Trina knows she will win, because she has to.
“I’m thankful to God that there is a treatment. Some people don’t have any form of treatment. I’m thankful there is a way to treat it, hoping for a miracle,” said Trina.
And then all of Trina’s dreams will come true.