Word: bone-marrow
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Health Net collects premium dollars from employers and reserves money for its own profit, salaries, bonuses, marketing and administrative costs, as well as for two special reserve pools to pay for AIDS care and all transplants, including bone-marrow transplants. Last year alone it collected over $2 billion in monthly payments from 1.2 million subscribers...
...medical care than most of the other plans surveyed and more on marketing, salaries and other administrative expenses. The company is known among California doctors as one of the most aggressively cost conscious in the state, a reputation that stems in part from an earlier attempt to deny a bone-marrow transplant to a subscriber named Nelene Fox, who by coincidence lived just minutes from the deMeurerses. The jury in that case awarded the Fox family $89.1 million, later negotiated down to an undisclosed...
...Christy underwent a bone scan, which showed her cancer had spread; her disease was now classified as Stage IV metastatic breast cancer. Given the standard therapies available, it was a death sentence, but her oncologist, Dr. Mahesh Gupta, warmly assured her there was hope. He recommended she consider a bone-marrow transplant and, in a breach of Health Net procedure, skipped the usual channels for making referrals and arranged a consultation with a physician he knew, Dr. Robert McMillan, an oncologist at the Scripps Clinic in La Jolla. Christy's sister, living in Colorado, had urged...
...Gupta, reviewing his notes on the case, says Dr. McMillan agreed Christy was a candidate for a transplant but said she would first have to undergo several cycles of chemotherapy to demonstrate that her tumor would respond to the potent drugs used in bone-marrow therapy. In the deMeurerses' eyes, however, it was a deeply troubling encounter. Dr. McMillan declined even to describe what was involved in a bone-marrow transplant or give the family a tour of the Scripps facilities, according to Alan deMeurers and Christy's mother, Joyce Nesmith. "I believe he was told to send us away...
When Dr. Jones examined Christy deMeurers, he believed a transplant could help her. "The available proof for its efficacy in breast cancer was at least equivalent to many other procedures that we do every day," he says. As early as 1990, even Health Net had found evidence that bone-marrow transplants might become a standard weapon against breast cancer. That year the company's then chief medical officer, Dr. Leonard Knapp, ordered a study by Technology Assessment Group of San Francisco to evaluate the treatment. The report, however, didn't reach the conclusion he had hoped for. It found that...