TERMINALLY ILL: New Law Expands Access To Experimental Treatments
A new law set to take effect July 1 will allow terminally ill patients to appeal a health plan's refusal to cover the costs of experimental treatments. The Orange County Register reports that the law establishes independent panels that will review patients' medical histories and decide whether experimental therapies are the best treatment route. The law "is California's latest attempt to calm the outcry from consumers" by cutting insurers out of the loop. "A lot of patients are very skeptical about the decisions made by their insurance companies; was it a financial decision?" said Carol Lee of the California Medical Association. "This will give them a chance to go outside the entire system and get a medical opinion from the best known experts around the country," she added. Patients with two years or less to live who have been denied experimental therapies by their insurers "can take their case to" one of the independent panels, which will issue a binding decision. The panels, made up of three doctors, will be accredited by the nonprofit Institute for Medical Quality of San Francisco.
The Register reports that "no one knows how many patients will demand outside reviews [or] what the financial effect will be on insurance companies and doctors." In the battle over experimental treatments for dying patients, "emotions clash with science in unprecedented ways." Patients are searching for any possible cure and insurers "have limited dollars to spend on patient care and don't want to waste them on questionable therapies just to please patients." Lee Greer of Huntington Beach fought the state's Blue Cross plan over experimental therapies for his wife and daughter, who were dying of breast cancer. "They deny this stuff on purpose because it saves them money. I didn't trust their objectivity. I was losing my family," he said (Kowalczyk, 6/14).
One Man's Struggle
A separate article in the Orange County Register profiles Greer, who wrote 46 letters, sent 15 faxes and made a dozen phone calls in his battle to secure Blue Cross coverage for "unproven" treatments for his wife and daughter. A few years ago, doctors told the Greers that a tandem bone-marrow transplant could increase Wendy Greer's chances of survival, and the doctors said "it was the only hope" for the Greers' daughter Julie. But "Blue Cross said no way," unconvinced that the Greers' doctors could provide proof that the treatment would work. Finally, the insurer "relented and granted" exceptions for the two women. Julie died this spring, but Wendy is in "deep remission." The Greers laud the new law requiring review panels, which they say will "prevent other families from having to hound insurers for experimental procedures" (Kowalczyk, 6/14).