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Sloan Hunter, 18, needs a bone-marrow transplant because of a rare form of cancer. Her insurer |
By CATHY DYSON
Four years after she retired from the Marine Corps, Bessie Miller had to fight the same military she was a part of for three decades.
TRICARE Prime, her military insurance, had refused to pay for a procedure for her daughter, Sloan Hunter. Hunter is 18 and suffers from a rare and aggressive form of cancer.
Miller, 57, felt as if she and her daughter were getting "slapped in the face every time we turn around." After she gave the Marines 30 years of her life, she said, she expected its insurance to provide the care her daughter needed.
When it didn't, Miller went to battle.
She fought to get Hunter admitted to VCU Medical Center in Richmond, even though the hospital is not in TRICARE's network.
Then she fought TRICARE when it refused to pay for a bone-marrow transplant for her daughter.
By the time her claim reached the third and final level, Miller had contacted The Free Lance-Star and 1st District Rep. Rob Wittman, whose office lobbied for her.
In addition, Miller called the hospital and insurance company regularly to confirm that each had the needed paperwork.
TRICARE announced on Thursday that it would pay for Hunter's $110,000 operation. Officials said she qualified for care under a rare-disease regulation.
"I guess just bugging all these people, not giving up, refusing to accept 'no' for an answer, made the difference," Miller said. "That's the only thing I can think of, and I am totally thrilled and happy."
Miller hasn't said that often in recent months. She and her daughter, who live in a Stafford County townhouse, have had bad news since August 2007.
That's when the two went to Mary Washington Hospital because Hunter, then 17, had pain, no appetite and lumps on her abdomen.
In one afternoon, they learned Hunter had Stage 4 cancer, the most advanced level, and that it had spread to several organs.
Hunter had chemotherapy in the fall and early spring, then surgery in April to remove her ovaries, her gall bladder and a third of her liver.
She was slated to receive eight cycles of high-dose chemotherapy, then have a bone-marrow transplant. The high levels of chemotherapy would wipe out her immune system, so Hunter's own marrow, which had been harvested in September, would be transplanted back into her body.
The type of cancer Hunter has is called desmoplastic small round cell tumors. First identified in 1981, the disease usually strikes teenage or young adult males, according to DSRCT.com, a Web site maintained by family members of patients.
Only 20 percent of its victims live five years. The DSRCT.com site lists 168 known cases worldwide, with only 42 patients confirmed to be alive.
TRICARE cited those grim statistics in its second denial in late May. It quoted a 12-year-old Journal of Clinical Oncology study that said various treatments had been tried, but none succeeded.
"It's basically saying it's a lost cause no matter what you do," said Tom Bridenstine, an ombudsman with Virginia's Bureau of Insurance in Richmond.
The ombudsman's office answers questions residents have about insurance policies and helps them file formal appeals. The department has no jurisdiction over TRICARE because it's a federal program, like Medicare or Medicaid.
As a retired Army officer, Bridenstine dealt with TRICARE a few years ago when he submitted what he considered a simple claim.
"I was astounded at all the problems that were involved, so I can imagine what this poor woman is going through," he said recently. "When you have somebody who is seriously ill, the last thing you want to worry about is making sure your claims are covered."
TRICARE's decision came in the nick of time, Miller said. She got the call on Thursday morning, as she and Hunter were headed to VCU Medical Center.
A few days before Hunter graduated from Stafford High School on June 14, she started complaining that she had the same pain and "full" feeling in her stomach and couldn't eat.
She and her mother worried that the tumors--some of which still remain on her liver--had started growing again.
If TRICARE hadn't approved the transplant, Hunter would have been hospitalized Thursday and given continuous chemotherapy for three days. She wouldn't have been eligible for the operation for several weeks.
The phone call changed everything. Miller and her daughter had tried to stay optimistic in recent weeks, but both seemed on the verge of giving up. Several times recently, Hunter said she didn't want any more treatment because she was going to die anyway.
Now, she's scheduled to go back to the hospital tomorrow. She's supposed to get various levels of high-dose chemotherapy for six days, then rest for two. Her bone-marrow transplant is scheduled for July 1.
"It's not over yet, it'll take a year for her to totally recover," her mother said. "But at this point, all I can say is, 'Thank you, Jesus.'"
Cathy Dyson: 540/374-5425
Email: cdyson@freelancestar.com
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INSURANCE ASSISTANCE
Residents who have general questions about insurance policies or need help filing appeals can get assistance from Virginia's Bureau of Insurance in Richmond.
The office is a division of the State Corporation Commission. It answers about 75 to 80 general questions a month about policies and helps another 15 to 20 consumers file formal appeals, said Tom Bridenstine, an ombudsman in the office. The advice he gives most often is to not waste time on phone calls. If the first call to an insurance company doesn't resolve the issue, submit a written appeal. "That's a lot better use of somebody's time than making phone call after phone call to different people and being put on hold forever," he said. The Bureau of Insurance can be reached by phone at 877/310-6560 or by e-mail to ombudsman@scc.virginia.gov. |
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how to help
Collection jars and a fund have been Jars are at the Wawa stores on Butler Road and U.S. 17 in Stafford County, where Hunter and her mother work. The Wawa on U.S. 17 also will have a yard sale, starting at 8 a.m. on July 12 and 13. For more information, contact Robin Stafford at 373-0571. Hunter's classmates at Stafford High School raised $1,000 during the last two days of school. Her former history teacher, Sarah Jackson, wrote letters to get support from businesses. "Sloan has an abundant amount of potential," she said. "She is not one Donations can be sent to the Sloan |
