|
Getting your Trinity Audio player ready...
|
A Dublin mother diagnosed with breast cancer earlier this year has turned to the public for help since being denied insurance coverage for her selected treatment.
Shanty Gupta aims to receive cryoablation, a minimally invasive procedure. But without coverage, Gupta’s treatment has been put on hold as she and her family stare down an out-of-pocket cost totaling approximately $100,000.
“A lot definitely goes through my head, especially having two little ones,” Gupta, 36, said of her diagnosis. “Now when you start dealing with insurance and having to wait – I feel like that added a whole load of stress, right on top.”
On March 31, Gupta’s life changed forever. That was the day she was diagnosed with invasive ductal carcinoma.
More specifically, the cancer was found to be hormone receptor-positive, meaning cancer growth is stimulated when hormones attach to specific receptors on the cancer cells, according to the American Cancer Society website.
The diagnosis was scary, particularly when thinking about her two children, 3-year-old Mila and 1-year-old Leonzo, Gupta told Pleasanton Weekly.
It was also an unexpected discovery at 35 years old, as she typically associated the diagnosis with older women.
According to the American Cancer Society website, only a “very small number of women” diagnosed with breast cancer are younger than 45 years old. Meanwhile, the median age at the time of diagnosis is 62 years old, the website states.
Upon researching treatment options and finding a support group online, Gupta discovered cryoablation.
The treatment does not require large cuts through the skin. Instead, the procedure kills cancer cells by freezing them with thin metal probes, according to the Mayo Clinic website.
Cryoablation can be a helpful treatment for cancers of the bone, breast, kidney, liver, lung and prostate, according to the Mayo Clinic website. The procedure is typically used when people can’t have surgery to treat the cancer, and it may be useful for people who have other health conditions that make surgery unsafe, the website states.
The treatment option appeals to Gupta as a chance to preserve her breast while avoiding the effects of major surgery, chemotherapy and radiation.
According to a study published in 2024 by Springer Nature, breast cryoablation presents a promising alternative to surgery in select patients by offering the benefits of a minimally invasive procedure with minimal risks, although further studies are encouraged.
Upon discovering that her regular doctor did not perform cryoablation on breast cancer, Gupta requested insurance coverage for a consultation with an outside provider who could perform the procedure.
In April, her coverage request for the consultation was denied.
Nevertheless, Gupta went on to meet with a surgeon who performs cryoablation. The doctor approved her treatment and submitted a request for coverage of the procedure to Gupta’s insurance provider, she said.
The surgeon’s request was later denied, Gupta added.
According to the Dublin mom, she submitted appeals to her insurance provider a total of four times.
But the procedure and any follow-up are not considered standard of care, Gupta said of the insurance provider’s response.
Instead of cryoablation, she was recommended a mastectomy, chemotherapy and hormone blockers.
In their denials, representatives of the insurance provider pointed to the treatment’s lack of FDA approval at the time, according to Gupta.
Representatives also claimed that she required a breast reduction based on an incorrect diagnosis of breast hypertrophy, meaning excessive growth of breast tissue, Gupta added.
“In a way, health care kind of chooses decisions based on insurance and not for the health of the person,” Gupta said.
Through discussions with other women online, Gupta found many who shared a similar experience of being denied coverage for breast cancer treatment.
“On top of the stress of having to deal with cancer, now they’re financially also having to deal with that stress,” she said.
Gupta did not state the name of her insurance provider out of concern for future retribution.
Out of pocket, cryoablation itself costs about $50,000, Gupta said. Taking into account follow-up imagery, labs, supplements and IV therapies, she expects the total cost of care to be approximately $100,000.
“I’m just ready to get my treatment and get things going,” Gupta said. “I just want this to move past me.”
But for now, Gupta and her family are waiting on financial assistance to pay for her treatment, she said.
“Shanty isn’t just fighting cancer — she’s fighting to watch Mila and Leonzo grow up, to celebrate birthdays, graduations, first loves and all the milestones in life,” Gupta’s husband Steven Pacheco wrote on a GoFundMe page for her procedure and medical aftercare. “I want to spend my life with her, and we dream of her being healthy and strong by my side.”
As of Oct. 14, the family has collected nearly $12,000 toward their fundraiser goal of $50,000.
“Shanty is strong, loving, and the heart of our family,” Pacheco said. “She gives so much of herself every day, and now it’s time we surround her with the same love and care.”
