Cancer Patient Sues Blue Cross As Tumors Return

June 23, 1991|By Peter Hermann | Peter Hermann,Staff writer

Judy Marsh, who has been battling Blue Cross/Blue Shield to pay for a controversial cancer treatment, filed suit Friday to force the insurance company to provide coverage.

But, there is a chance the Pasadena resident won't live to see the outcome of her court case. Last week, doctors found the breast cancer had spread to her liver and bones. The radical treatment she received has apparently failed.

"I didn't go through all this to give up at this point," Marsh said Friday from her room in University Hospital in Baltimore. "Maybe they will come up with something. If they come up with anything other than chemotherapy, maybe I'll try it.

"Unless doctors can promise me a miracle, I'm not not going to go through more chemotherapy."

She said she asked doctors how much time she had left, but they couldnot give her an answer. "Of course you ask, because you really want to know," she said.

Marsh, 50, was able to go to Duke Medical Center in North Carolina in November because the community did what her insurance company would not. Neighbors and strangers dug into their pockets and gave her $130,000 for a bone marrow transplant.

But the bills were more than double the original estimate, Marsh said, and she still owes Duke $130,000.

Even the though the transplant didn't work, Marsh said she is happy she got the chance to try it. "I'm so glad I was able to do it," she said. "I know now I've done everything I can. If I didn't do it, I would be sitting there and saying, 'If only I had that treatment, then maybe I would be all right.' "

The treatment -- an autologous bone marrow transplant -- was recommended last year by Marsh's doctors, who called it her best chance of surviving breast cancer. Doctors removed some of her bone marrow, froze it and filtered it back into her body after high doses of chemotherapy destroy the tumors and remaining marrow.

Blue Cross officials first told Marsh they would pay for the risky procedure, but then reversed themselves, calling the transplant "experimental."

It appeared in February that Marsh would get insurance coverage when a federal district court judge ruled against Blue Cross of Maryland in a similar case.

The company had argued that the transplant was experimental because it was not accepted by the medical community.

But Judge Marvin J. Garbis ruled that it was the clear the medical community -- eventhose doctors testifying for Blue Cross -- recommends a marrow transplant for certain patients.

Garbis called Blue Cross' decision to withhold payments to two cancer patients "arbitrary and capricious" and ordered the insurer to pay the bills.

Marsh's attorney, RichardCarter, said the ruling forced Blue Cross in Maryland and several other states to change their policy to include covering the bone marrowtransplant.

But, he said, Blue Cross insists the ruling doesn't apply to Marsh because her policy is for federal workers. Marsh's husband, Roland, used to work for the U.S. Postal Service.

In the lawsuit, Carter says Blue Cross has "ignored all of the information contradicting its position" and has "adopted a strategy of stalling" in dealing with Marsh.

"Federal workers by law are supposed to have comparable health insurance to private citizens," Carter said in an interview Friday. "They (Blue Cross) are excluding as much coverage as they can. I think it's really unfair that federal workers don't get thesame compensation.

"We're just asking Blue Cross to pay for what they agreed to in the contract," Carter said. "All we're asking is for them to live up to their word. It really is frustrating. I can't believe they are making these people go through this."

Liz Ziemski, a spokeswoman for Blue Cross/Blue Shield of Maryland, said Friday that the company could not comment because officials had not been servedwith the suit.

Marsh said she went to Duke about a week ago for one of her regular checkups. There, doctors found new tumors.

"I had good reports, that the tumors were shrinking," Marsh said. "The wayI looked, I wasn't going to have to come back for another 12 weeks. I came home the next day, but then they called and said they had really bad news."

Marsh said she is not in any pain and plans on returning to her business -- transcribing notes for doctors -- as soon as she returns home. "As long as I feel good, I'm going to keep going."

But the bills from Duke keep coming. "Every one is stamped 'Refused' from Blue Cross/Blue Shield," she said. "They have not paid one penny, and we don't have it to pay."

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