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For mom with breast cancer, son's frustration with health insurance is painful

Insurance company gets in way of better care for mom fighting cancer, son says

Olga Bandiera during a recent chemotherapy in Miami.
Olga Bandiera during a recent chemotherapy in Miami.


MIAMI – Chemotherapy was flowing through Olga Bandiera's veins when she said she was more worried about her sons than about breast cancer. 

She was in a tight space in a building on Eighth Street and Ponce de Leon. There were about a dozen reclining chairs that were lined up closely. The place is called Miami Oncology Institute, but it is not a research institution, or part of a university -- it is Dr. Eduardo Acle's private practice.

"I know that not everyone dies of cancer," she said in Spanish. "I'm going to be a grandmother, and I'm not going to die before that."

Her two sons were deeply concerned about the way the disease has advanced, while she has been under Acle's care. Bandiera, 71, said she has had many difficulties in her lifetime. And she believes that she will be able to overcome breast cancer with the support of her family, her doctors and her health insurance.

LIFE STRUGGLES

She remembers when she left Havana, Cuba for Madrid, Spain with her mom, some years after Fidel Castro took power. While they waited for legal entry into the United States, her mom got very sick with pneumonia and died. Bandiera was all alone.

"I didn't have any money for her burial. No one wanted to help me, and then a family gave me a hand and lend me the money," she said in Spanish. "I left her remains in a sepulchral vault in Madrid."

When she made it to Miami, she began to work in a factory. It was there where she met the love of her life, Carlos Bandiera, now 67. They spotted each other in the break room.  They talked and spent time during lunch. He eventually said he was in love. But she was cautious.

"He was young. He had moved here from [Mar del Plata] Argentina," she said. "I was afraid. I wanted to make sure that he was serious and didn't just want to take advantage of me. We eventually got married and I met his family in Argentina."

She got a job with American Airlines, and he worked selling insurance. They live in Sweetwater, near Florida International University.

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The couple had two sons. Frank Bandiera, 32, is an epidemiologist from the University of Miami, who is working at the University of Texas. Ernest Bandiera, 36, is a U.S. Marine, who is now a Hialeah Police Department's SWAT officer.

THE BAD NEWS

In October 2013, she began to notice that her left breast was changing shape. She assumed it was "another thing of old age." But her primary care physician said it wasn't.

Bandiera was also dealing with Parkinson's disease, a progressive disorder of the nervous system, and psoriasis,a skin condition. She was diagnosed with breast cancer in November, 2013.

"I had a mammogram and got the phone call when I was home with my husband," Bandiera said in Spanish. "It was really tough. I was very sad. My husband calmed me down. He said there were good treatments now."

Frank Bandiera said he didn't find out until December when he was back in Miami to celebrate Christmas with his family. 

"They told me when I got off the plane from San Francisco," he said. "I fainted in the airport."

Ernest Bandiera is having a baby boy in February, so he has been juggling helping his mom and getting ready for his first son.

"I'm worried about my sons. I know they worry. The chemotherapy makes me tired. I still drive myself to appointments, pick up my prescriptions and I get things done," Bandiera said. "My husband is convinced that it is all going to be fine."

Bandiera was first diagnosed with breast cancer stage 3, which means it had spread to nearby lymph nodes. About 72 percent of stage 3 patients survive at least five years after being diagnosed, according to the American Cancer Society.

After a bilateral mastectomy and chemotherapy, she was diagnosed with stage 4 -- the highest stage, because she learned that the cells had moved to her hip bone and spinal cord. About 22 percent of stage 4 patients survive at least five years after diagnosis, according to the American Cancer Society.

'UNHELPFUL' INSURANCE

"The youngest one of my sons has been getting really, really nervous, and he is in a different city and calls me all day long," Bandiera said in Spanish. "He wants me to get another doctor at UM. Just look at my phone, he calls and calls and calls."

She has a Preferred Care Partners plan, a health insurance plan that doesn't cover treatment at UM's Sylvester Comprehensive Cancer Center, where her youngest son said he wants her to get treatment.

"UM wanted an authorization form and letter of agreement," a document outlining the rate that the insurance has agreed to pay, Frank Bandiera said. "The insurance only gave me the authorization form," permission to see a UM doctor.

From Dallas, Texas, he said he tried to advocate for his mom.

He called the insurance company dozens of times and sent about 10 e-mails to both UM and the insurance company. UM Health System will not admit her unless she has this letter. And the insurance representatives refused to give him the letter that UM was requesting.

"Insurance agents gave me attitude," he said.

They also put him on hold for 15 to 30 minutes only to tell him that they couldn't help him. And the e-mails to the insurance company went unanswered. He said a Preferred Care Partners representative said "they never do letters of agreement."

When he tried to appeal their decision, a representative told him that they haven't denied services, so he is unable to appeal. He has lost his patience at times.

"I'm tired of them all giving me attitude," he said. "They talk down to you like a kid."

He said he is not going to give up. And neither is his mom. 

"I'm doing everything the doctor tells me to do," she said. "In January, I'm going to get Humana Gold Plan, and that is going to let me see the doctors that Frank wants me to see. Let's see if that makes him calm down."

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