The life-saving medication was not affordable after her insurance company denied coverage, twice.
With nowhere to turn, the survivor reached out to 7 On Your Side.
The Triple Negative breast cancer put her in double jeopardy, first the chemo and radiation for 4 years and then the side effect, a weakened heart.
So weak she had trouble walking and breathing.
After being denied coverage for her heart medication twice, she sent a letter to 7 On Your Side.
"I am only trying to live, and it would be a shame if I beat cancer only to be killed by an insurance company's refusal to pay for life-saving medication," Jessica Morgan wrote.
"Basically throughout my entire chest wall, on both sides, and in my lymph node, and I was told that it was terminal," Morgan said.
Diagnosed at just 40 years old, Jessica Morgan was told her Triple Negative breast cancer was stage 4 after her very first mammogram.
"My mind just jumped to the worst-case scenario that I was going to pass away and there was going to be no one to help my kids navigate through high school and college," Morgan said.
She took an aggressive approach to fight for her family, 4 years of chemo and radiation put her in heart failure.
"The average life expectancy of that particular heart issue is one year without proper treatment, and because it was caused by chemotherapy, my cardiologist told me that there is a chance that it could be reversed to the point where it wouldn't shorten my life, but I needed specific medicines," Morgan said.
Morgan's doctor prescribed a drug sold as Farxiga and she says her cardiologist had submitted this this letter to her insurance company.
The letter said, "Without this medication, Ms. Morgan is at risk of worsening ventricular function, increased risk of death and hospitalization. It is medically necessary that Jessica use Farxiga or Jardiance as part of her heart failure."
But Horizon Blue Cross Blue Shield of New Jersey denied coverage for the medicine which cost almost $800 a month without insurance.
"But your cardiologist is saying you need this in order to survive. Is there a bigger medical need?" Pineda asked.
"It's very true. I was shocked that they even could say no," Morgan replied.
So she appealed the decision.
But it was denied a second time.
"It was just tiring. After having gone through so much with my cancer diagnosis, I just figured me being in remission, they would just give me the medicine, because it's a life-saving treatment, and they denied me," Morgan continued.
After getting some advice from her mother, her third try was a charm.
"We always whenever there's a problem, we're like we should call 7 On Your Side, but we never do it and I was like you know what I mean I have nothing to lose," Morgan said.
7 On Your Side appealed to the insurance company and within hours of our phone calls and emails Horizon Blue Cross Blue Shield New Jersey let their member know.
"They are going to cover the medicine for the next 12 months at least, and they're going to reimburse me what I paid out of pocket," Morgan said.
Horizon told 7 On Your Side the delay in approval was two-fold. First saying it has 'no record of Ms. Morgan's cardiologist detailed letter of medical necessity' and second 'an incorrect code didn't meet FDA approval for the medicine.'
Adding after it was brought to their attention by 7 On Your Side 'additional information and a related diagnosis was provided, meeting the FDA's criteria' and Horizon quickly approved coverage.
"I was ecstatic because it was really unaffordable," Morgan said.
"It's heartbreaking to know that so many people are going through this, and a lot of them can't afford it, you know. But thanks to you, it was possible," Morgan's mother said.
"I just want to thank you guys so much for everything that you did and everything that you continue to do for people out there who need help," Morgan said.
Morgan says the medication has been a life changer.
Now the 44-year-old can keep up with her 4 grandkids and is in remission.
If you or someone you know is denied similar coverage here's what to do.
Get a clearly worded letter of medical necessity from the doctor explaining why the treatment, procedure, or prescription is "medically necessary."
You will need those two words in there.
Ask the doctor to send it to the insurance company. And get a copy for yourself.
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