Word: geisbush
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...Geisbush, 32, a veterinarian from Phoenix, Ariz., was recently found to be suffering from metastatic breast cancer, an especially aggressive malignancy that had already ranged well beyond the site of the original disease. Eventually she and her doctors agreed they should attack the advancing cancer with what many people believe is the most potent weapon available: high-dose chemotherapy accompanied by a transplant of stem cells, precursors of disease-fighting immune-system cells...
...treatment was still considered experimental, it was ineligible for coverage under the terms of Trustmark's policy. "Whether it's a $100,000 charge or a $10 charge, we make our decisions based on that contract language," says Lloyd Sarrel, Trustmark's assistant vice president for benefits. Geisbush, understandably, has bigger things than contracts on her mind. "I'm in a fight for my life," she says. "I shouldn't be having this fight with the insurance company...
...Geisbush is not alone. In the past decade, more than 12,000 American women have taken their chances with transplant therapy, in many cases only after battling their insurers to make sure the bills got paid. Lately, public opinion--plus a few multimillion-dollar lawsuits--had begun to change that. Ten states require insurers to cover transplants; most health plans elsewhere in the U.S.--seeing which way the legislative wind was blowing--have decided to go along too. Patients know, however, that a company that makes up its mind to offer coverage can later change it, and that laws requiring...
...than traditional therapy. The findings, however, are preliminary, and further study may overturn them altogether. By week's end, all that was certain was that an already heated debate would get hotter still and that patients who want the therapy are not giving up hope. "With this treatment," says Geisbush, "at least some people have survived...
...HMOs that have been disinclined to offer coverage, however, last week's news offers little incentive to do things differently. Legislative pressure--plus the ongoing threat of more jackpot lawsuits--may yet force the hands of those holdouts. But whether that will be enough for women like Tawnya Geisbush, still awaiting an O.K. from her insurer, is unclear. "I have a fairly small window of time to work with," she says. By the time the company is persuaded, one way or the other, her window may have already closed...