Blue Cross told by judge to fund cancer therapy

February 28, 1991|By Susan Schoenberger

When Kelly Sue Whittington learned yesterday that a judge has required Blue Cross and Blue Shield of Maryland to pay for an expensive breast cancer treatment she underwent last year, she thought of all the other women who might be in her shoes in years to come.

"Hopefully, other women won't have to go through what I went through," the 29-year-old Hagerstown resident said yesterday. "I'm glad I helped to be a part of setting a precedent" in the state.

U.S. District Judge Marvin J. Garbis ruled yesterday in Baltimore that Blue Cross must pay for the treatment, which costs more than $100,000. The insurance company had refused last year to cover the treatment for Mrs. Whittington and Alexandra Adams, 34, of Millersville, contending the procedure was experimental.

Both women filed suit last summer, arguing that the therapy, called high-dose chemotherapy with autologous bone marrow transplant, was an accepted treatment for their advanced form of cancer. Doctors recommended the treatment for both women after they underwent chemotherapy and breast removal surgery.

Judge Garbis agreed.

"Blue Cross' decision was both incorrect and unreasonable," he wrote in his ruling. "The benefit plan does not allow Blue Cross to form its own independent evaluation of the treatment."

He criticized Blue Cross for failing to contact Maryland oncologists to find out if the treatment was an accepted medical practice in 1990, when Mrs. Whittington and Mrs. Adams learned of their cancer. Instead, Blue Cross relied heavily on a scientific report from 1988, the judge said.

Liz Ziemski, a spokeswoman for Blue Cross, said the company could not comment on the judge's decision until it had received a copy of the ruling.

Richard Carter of Alexandria, Va., one of the lawyers representing Mrs. Whittington and Mrs. Adams, said yesterday that both women received their treatments last year. Private donations paid for Mrs. Whittington's treatment, and Mrs. Adams' hospital agreed to defer payment pending the decision, he said.

Mr. Carter said his firm had represented about 20 women around the country who had been denied coverage for the treatment. Most insurance companies -- but not all -- now will pay for the therapy, he said.

"There are still cases out there," he said. "I got a call today."

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