NBC 5 Responds is taking a deep dive into health insurance denials and the creative solutions many are using to get their medical treatments approved.
When a Wheaton woman’s cancer treatment was denied days before it was supposed to start, her desperate posts for help gained her an unexpected ally.
At the start of 2024, 35-year-old Jessica Wozniak lived a very family-focused life with her husband and young daughter in Wheaton.
“Just chasing after a toddler really, most of the time. One of my hobbies, my passions is riding horses, so I would try to do that as often as I could,” Wozniak said.
But in early 2024, what she thought was a simple stomach flu turned out to be a medical emergency.
“It just really turns your life upside down,” Wozniak said.
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It began with a surprise diagnosis of stage 4 colon cancer in June of last year. Wozniak was told the cancer had also spread to her liver.
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Because part of her condition was genetic, she was given immunotherapy treatments, which didn't work on its own for Wozniak.
“Essentially, I was told that the immunotherapy was working to shrink the spots in my liver. But the doctors were concerned that [the] primary mass in my colon, one of them was actually growing despite the immunotherapy,” Wozniak said
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Late last year, Wozniak said her doctors recommended she combined her immunotherapy with chemotherapy.
“They thought adding chemo would give me the best chance to shrink the size of the primary tumor in my pelvic area,” Wozniak said.
But just two days before her combined treatment was scheduled to begin, Cigna denied her coverage.
“My doctor was denied both in a pre-authorization and in a peer-to-peer and told ‘the immunotherapy isn't working, and so therefore you shouldn't continue that. We'll approve and pay for chemo, but not immunotherapy’,” Wozniak said.
Wozniak said it felt as if Cigna had put a price tag on her recovery, and it was more than it was willing to cover.
"I thought, absolutely not. Who is this person at an insurance company deciding who’s going to live or die?” Wozniak said.
That’s when Wozniak, a public relations professional, posted a plea for help on Linkedin and TikTok, receiving one tip that would change everything.
“I was told from some people was that if you are on a healthcare plan, an insurance plan paid for by your employer, that your employer's benefits human resources team has some say on the decision-making that goes into these authorizations,” Wozniak said.
Rather than going through Cigna's formal appeal process, Wozniak said her company’s HR team immediately began making calls on her behalf. To her surprise, the day after her treatment was denied, there was news.
“My husband came in, handed me the phone and [my HR rep] said, ‘OK, you're authorized for treatment on Wednesday’,” Wozniak said. “I had no idea that HR was so powerful in this process.”
Wozniak has now completed her fifth round of combined therapies and is slated for another round as doctors prepare for surgery to remove the masses on her liver and colon.
“If there's one thing I learned through all of this, it's that you are your own biggest advocate. No one will do it for you, so keep pushing if you feel like something's not right. Something can be different. Something should be more. Tell your doctors,” Wozniak said.
A spokesperson for Cigna told NBC Chicago it re-reviewed Wozniak's claim after they were contacted by her employer's HR department and approved it within 24 hours.
They added that there are multiple levels of appeals patients can request, including a review by an independent third party. If your physician requests an expedited review, Cigna will complete it within 72 hours, the spokesperson said.
Have a consumer complaint? Call 1-844-NBC-RESP or let us know, so we can help.
