When Insurers Won't Pay for Experimental Treatments

ByABC News
February 22, 2001, 12:21 PM

ST.   L O U I S, Feb. 22 -- Just last year, Debbie Robison of Decatur, Ill., was a vibrant 45-year-old.

She had her own business teaching the elderly how to use computers, and she enjoyed taking cruises with her husband, Joe.

But last spring, she noticed something was terribly wrong with her body.

"I felt like I had a big bowling ball in my belly," she says.

She found out that she had an advanced stage of ovarian cancer, a disease that kills half its victims.

Robison's doctors believed there was only one way to save her life: a stem cell transplant combined with almost lethal doses of chemotherapy. It's a treatment that is both controversial and expensive. Despite the risks, Robison was willing to go ahead with it.

"I thought, I'm too young to die, and if that's what it's going to take to save my life then, I was going to do it," she says.

Treatment Too 'Investigative'

But her husband's employer, the construction and mining equipment manufacturer Caterpillar, runs its own insurance plan. Company officials said the procedure was unproven and "investigative," so they refused to pay for it.

It's not unusual insurers often require that a medical procedure be thoroughly tested and proven effective before they decide to cover it. Unfortunately, it's a lengthy process, and people with life-threatening illnesses don't have time to wait.

In Robison's case, her condition was deteriorating so fast that her doctors believed she had to have the treatment within six months. They convinced Barnes-Jewish Hospital in St. Louis to pay half the cost, but the Robisons would still owe more than $60,000.

Debbie Robison went ahead with the treatment last month, but fears it will bankrupt her family.

"I just did not feel that I had the right to spend everything that we had worked so hard all our life for," she says.

Nevertheless her husband, a supervisor at Caterpillar, was very supportive of her decision. He insisted that she have the treatment, despite the high medical bill.