Apr 25, 2007 9:40 pm US/Eastern
Cancer Patient Battles Disease, Insurance Company
by Mary Robb Jackson
NORTH HILLS (KDKA) ―
A local cancer patient is also battling her health insurance provider at the same time as she takes on the disease.
Karen Storm's insurance company will not approve payment for a drug that her own doctor believes may help her survive.
Storm is a breast cancer survivor, a single mom, and has been teaching family and consumer science for 26 years in the North Allegheny School District.
In 1990, Karen was diagnosed with breast cancer.
After surgery and follow-up treatment everything seemed okay.
Then in 2003, the cancer returned.
It had metastasized to her lymph nodes, bones, lung, and liver.
"I just thought they must have test results mixed up," said Storm. "It must be somebody else they're talking about that can't possibly be me."
But it was hers.
"At least 61-chemotherapy treatment, over 30-radiation treatments, I had Kyphoplasty, a broken back, I had cyber-knife therapy delivered twice," recalled Storm.
That long litany added up to seemingly endless claims to her health insurer.
Conventional therapies are now exhausted and nothing has stemmed Storm's cancer.
A drug called Avastin may be her only hope.
It is currently approved by the FDA only for treating colon and lung cancers.
But The Journal of Clinical Oncology is reporting numerous studies showing great promise using "Avastin" in the treatment of metastatic breast cancer.
However, with no FDA approval for that use, it is viewed as an experimental by her insurer Health America-Health Assurance" and the company will not cover the cost of the drug which adds up to about $1,500 a week.
"I feel that I am being held hostage by an insurance company," said Storm. "I don't think they truly listen to the doctors."
"It does make me a little angry because for me it's the patient first," said Doctor Victor Vogel of Magee Women's Hospital.
Dr. Vogel, a highly regarded breast cancer specialist, believes that Avastin might help Storm.
He has personally appealed her case - asking the health insurer to pay for the drug but they have been turned down five times.
A petition to the State Insurance Department was also denied.
"Yes I understand that we do not have unlimited resources in health care and we do have to be careful where we spend our dollars because dollars spent one place are not available somewhere else," said Dr. Vogel. "But in this case, in an otherwise healthy woman who's exhausted all her options and who's done everything that her insurance company wants her to do I think it's reasonable to say we've some to a point where paying for a treatment that's approved for other cancers and has a good possibility of working in breast cancer is a thing that a reasonable person would elect to do."
The insurer, Health America-Health Assurance, responded with this statement: "When a treatment is not FDA approved for a condition and has not conclusively shown demonstrated value for people with this disease, as is the situation with this case, a requested course of treatment may not be approved for coverage."
It also states that "two independent expert physicians with no affiliations to Health America" and the State Department of Health agreed with the insurance company.
Storm is not eligible to be part of any clinical trials currently underway because of her previous chemotherapy.
There is a possibility that Avastin will be approved by the FDA for breast cancer patients by the end of the year.
Whether it will come in time for Storm is still unknown.
(© MMVII, CBS Broadcasting Inc. All Rights Reserved.)
