Judy Marsh, the Pasadena woman fighting Blue Cross/Blue Shield to pay for a bone marrow transplant that could rid her body of cancer, could receive a decision today.
Marsh's medical records were faxed from North Carolina -- where she is scheduled to undergo the procedure -- to Washington last night.
They will be reviewed by officials in the Office of Personnel Management, which sets coverage guidelines for people covered under BC/BS's federal benefit package.
Meanwhile, Marsh, who lives in the 7900 block of East Shore Road, has talked to a lawyer and said she will file a lawsuit if she is turned down again.
She must be admitted to Duke University Cancer Center this weekend, or it may be too late for her to have the procedure -- where her bone marrow is removed and filtered back in after high doses of chemotherapy are administered.
Marsh, who found out she had breast cancer in June 1988, was told last month that Blue Cross deemed the procedure experimental and would not pay for it. The 49-year-old woman needed to come up with $94,000 to get into the hospital.
Marsh said doctors told her the procedure may be the only way to save her life. She said regular chemotherapy sessions have not helped, and the cancer has now spread to her lungs. The insurance will pay $100,000. The procedure could cost as much as $170,000.
Her battle with the insurance company has left her frustrated. Liz Wagner, an aide to U.S. Representative Tom McMillen, D-4th, helped Marsh get Blue Cross to review its earlier decision denying payment.
Marsh said she was told she was being denied because her husband, a retired federal employee, was not covered for such "experimental" procedures. She said she was told by officials at Duke that a memo had been sent down by the OPM saying federal employees were not covered for bone marrow transplants aimed at treating breast cancer.
"In essence, what they are saying is because you are a federal employee, what we would normally cover, we will not cover," said Richard Carter, a Virginia attorney who has represented many clients in Marsh's position.
Carter said he has not seen the memo or confirmed its existence.
Both Carter and Wagner said the procedure is not experimental. Wagner cites a letter she received from the American Medical Association, which says it is "an appropriate method" for treating the disease.
Also, there have been four other recent cases involving the bone marrow transplant procedure in the county, all for people covered under federal or state health insurance plans. At least three have sued and won -- although the victory came too late for one woman. Wagner said the woman, whose disease had progressed to the point where the bone-marrow treatment was no longer feasible, is in a holistic treatment center in Pennsylvania. The other two woman had the procedure and are doing fine, she said.
Carter said he has helped at least 16 people this year get Blue Cross to pay for the procedure. "For every woman who fights it after being turned down, there are five or six or seven who for some reason accept it."